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What Health Plans Should Know: Value Based Care, PBM Contracts, and Rebate Aggregators

Event Date: 5/12/2021

Event Overview

Wednesday, 5/12/2021
11:00 AM CT – 12:00 PM CT (60 minutes)
Vendor Spotlight Host: Frier Levitt, LLC.

This vendor spotlight is hosted on our BigMarker platform you must use Google Chrome or Firefox when participating in the webinar.

 

During this interactive webinar, Frier Levitt’s Co-Founding Partners will discuss the importance of value-based care in the medical and pharmacy benefit space, as well as loopholes in the contracts between PBMs and Plan Sponsors that impact cost-containment strategies. Health Plans will learn about value-based care in the medical and pharmacy benefit space, where providers are rewarded financially for helping their patients stay healthy – instead of being financially rewarded by increasing fee-for-service payments they prescribe when their patients get sick.

Information asymmetry leads to a growing national trend in which Plan Sponsors in the Medicare, Medicaid and Commercial space get fleeced by PBMs, particularly as it relates to drug rebates.  Panelists will discuss key contract provisions that Health Plans should negotiate into Pharmacy Benefit Arrangement contracts.  Cautionary tales will be told about the dangers of “rebate aggregators”.

Learning Objectives:

  • Learn the difference in payment models (balancing financial risk) versus traditional fee-for-service payments (paid separately for each service) to Bundle/Episode-of-care which cover all the care a patient receives during treatment.
  • Learn the legal considerations of the Anti-Kickback Statute and the Health Insurance Portability and Accountability Act (HIPAA).
  • Learn about the types of Provider Organizations and management of data
  • Learn the critical contract terms between a PBM and Health Plan, including manufacturer rebates, audit rights, and market check. 
  • Learn what every Health Plan needs to know about Rebate Aggregators.
  • Learn what Health Plans need to know about negotiating with PBMs. 

 

About Frier Levitt
Frier Levitt, established in 2000, is a national boutique law firm focused exclusively on Healthcare and Life Sciences. The Firm draws on its experience representing stakeholders across the entire healthcare spectrum. In the Life Sciences space, we have represented pharmacies of all kinds and assisted with regulatory, transactional and litigation matters. On the Healthcare side, our clients have included large physician group practices, hospitals, hospital medical staffs, ambulatory surgery centers, laboratory companies, as well as the complete panoply of ancillary service providers. We frequently make use of the wisdom from our many clinician attorneys, including multiple pharmacists, a podiatrist, registered nurse and paramedic. Frier Levitt attorneys are licensed in a number of states. In addition to New Jersey, the firm has attorneys licensed in New York, Connecticut, Pennsylvania, Washington, D.C., Maryland, Florida, Texas, Arizona, California, Massachusetts and Missouri. Our attorneys are also admitted in multiple federal courts throughout the country. We have offices in Pine Brook, NJ, New York, NY and Uniondale, NY.


Notice to Participants:
Please note that this webinar is a Vendor Spotlight and will be a capabilities-focused presentation. While this vendor is not under contract with the Health Plan Alliance, we believe this webinar will provide you the opportunity to learn more about this vendor and the programs and services it provides. Offering this webinar does not imply that the Health Plan Alliance endorses this vendor. The webinar is merely for informational purposes only. Should you wish to share feedback and/or have questions about this vendor, please contact Jaime González, the Alliance’s Chief Business Development Officer, at jaime.gonzalez@healthplanalliance.org or 972-830-6355.



 

Thank you to our event sponsors


Vendor

 

Documents
5/12/2021

Presentation: What Health Plans Should Know: Value Based Care, PBM Contracts, and Rebate Aggregators
Frier Levitt's Co-Founding Partners provide an introduction to Value-Based Care with examples of Value-Based Arrangements and important legal considerations from both the medical benefit and pharmacy benefit perspective.

5/12/2021

Recording: What Health Plans Should Know: Value Based Care, PBM Contracts, and Rebate Aggregators
During this presentation, Frier Levitt’s Co-Founding Partners provide an introduction to Value-Based Care with examples of Value-Based Arrangements and important legal considerations from both the medical benefit and pharmacy benefit perspective.

Attendees

Below is a list of all delegates registered to date for this event

  • Robyn Anderson
  • ALLIANCE MEMBER
  • Delegation Oversight Auditor at Health Alliance Plan (HAP)
  • Ashley Baran
  • ALLIANCE MEMBER
  • Stars Accreditation Coordinator at Health First Health Plans
  • Kiran Biring
  • ALLIANCE MEMBER
  • Pharmacy Director at Western Health Advantage
  • Tiaura Bliss
  • ALLIANCE MEMBER
  • Compliance Analyst at Care N' Care Insurance Company, Inc.
  • Eric Cannon
  • ALLIANCE MEMBER
  • Chief Pharmacy Benefits Officer at SelectHealth
  • Mary Eldridge
  • ALLIANCE MEMBER
  • General Counsel at Neighborhood Health Plan of Rhode Island
  • Jeremy Fejfar
  • ALLIANCE MEMBER
  • Pharmacy Director Government Programs at Quartz Health Solutions
  • Elizabeth Heying
  • ALLIANCE MEMBER
  • Counsel & Compliance Manager at Medical Associates Health Plans
  • Brendan Hodges
  • ALLIANCE MEMBER
  • President/CEO at HealthTeam Advantage
  • Deanna Homer
  • ALLIANCE MEMBER
  • Chief Operations Officer at HealthTeam Advantage
  • Don Hufford
  • ALLIANCE MEMBER
  • Innovation Strategist at Western Health Advantage
  • Henry Johnson
  • ALLIANCE MEMBER
  • Executive Director - Pharmacy at IU Health Plans
  • Jeff King
  • ALLIANCE MEMBER
  • Director, Pricing and Audit at PreferredOne
  • Jennifer Lu
  • ALLIANCE MEMBER
  • Clinical Pharmacist at Health New England
  • Kristen Mathis
  • ALLIANCE MEMBER
  • Pharmacy Business Analyst at Providence Health Plan
  • Bess Ann Mckillop
  • ALLIANCE MEMBER
  • Product Development Supervisor at Physicians Health Plan
  • Stuart Meltzer
  • ALLIANCE MEMBER
  • Provider Business Data Analysis Manager at AvMed
  • Stephen Muldoon
  • ALLIANCE MEMBER
  • Manager, Actuary at Sentara Health Plans (Optima)
  • Liza Paul
  • ALLIANCE MEMBER
  • Vice President of Health Services at MediGold
  • Darcie Paz
  • ALLIANCE MEMBER
  • Contracts Manager at Sharp Health Plan
  • Wade Penner
  • ALLIANCE MEMBER
  • Manager Revenue-Risk at Samaritan Health Plans
  • Tim Riley
  • ALLIANCE MEMBER
  • Chief Information Officer at Network Health
  • Athena Santos
  • ALLIANCE MEMBER
  • Population Outreach Manager at AdventHealth (FHHS)
  • Kathleen Schofield
  • ALLIANCE MEMBER
  • Manager, Strategy at Community Health Plan of Washington
  • Gina Shure
  • ALLIANCE MEMBER
  • Manager, Provider Network Management Operations at SummaCare
  • Mike Takach
  • ALLIANCE MEMBER
  • Pharmacy Director at Community Health Options
  • Angela Thomas
  • ALLIANCE MEMBER
  • Director, Quality & HEDIS at MediGold
  • Jill Thomas
  • ALLIANCE MEMBER
  • Clincal Auditor at Geisinger Health Plan
  • Anol Thrift
  • ALLIANCE MEMBER
  • Sr. Business Analyst at Providence Health Plan
  • Valerie Van Buren
  • ALLIANCE MEMBER
  • Director, Quality Improvement and Performance at Jefferson Health Plans
  • Andy Wheaton
  • ALLIANCE MEMBER
  • Manager-Pharmacy Benefits at Network Health
  • Cindy Xiong
  • ALLIANCE MEMBER
  • Pharmacy Business Analyst at Providence Health Plan
  • Holly Zorz
  • ALLIANCE MEMBER
  • Quality Improvement Team Lead, Medicare at Paramount Health Care