MedicareProduct10/16/08

ElectionAnalysis11/21/08

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Track A: Industry Trends and Strategies

Dr. Kongstvedt will identify key issues and responses that are likely to shape the health care landscape throughout the upcoming 2007 year. This presentation is also available as a live webcast/ audioconference.

Mr. Coburn provides the 65 page Shattuck Hammond report on the State of the Managed Care Industry. The presentation includes: Selected Highlights in the Managed Care Industry; Selected Capital Markets Activity; Selected Merger and Acquisition Activity; Stock Price Performance Analysis; Wall Street Analyst Managed Care Report Card; Financial Performance Analysis; Valuation Analysis; and Closing Thoughts. 

The Deficit Reduction Act of 2005
Thomas Kaye, RPh, MBA, Senior Pharmacy Director 

Passport Health Plan, Louisville, Kentucky

2007 Health Plan Premium Rate Increases & Trends
Mark Olson, Principal and Consulting Actuary

Paul Crowley, Consultant
Towers Perrin Health & Welfare Practice

This presentation discusses employer health plan premium rate increases and trends for 2007, based upon Towers Perrin research. The presentation is also available as a live webcast/ audioconference.

Track B: Consumerism

A 360 Degree View of Healthcare Consumerism

Michael J. Thompson, Partner 
PricewaterhouseCoopers LLP, New York, New York

Due to the breadth of its Health Industries practice, PwC is uniquely positioned within the industry to understand the impact of healthcare consumerism across the healthcare value chain. In this presentation, we will offer insights into how consumerism is likely to evolve related to "quality based design", how employers are adapting consumerism strategies based on their unique business needs, what are the key issues facing health plans as they seek to support these next generation health strategies, and what are the key concerns and reactions of providers and others in the value chain including new players such as financial institutions. We expect to offer a rich discussion of the issues and offer insights on the thoughtful evolution of the consumerism model. A Podcast of an interview with the Presenter is available. 
  

Empowering Consumers to Make Better Healthcare Decisions
Jerry Reeves MD, Chief Medical Officer
H.E.R.E.I.U. Trust Funds, Las Vegas, Nevada

Based on Dr. Reeves experiences as Chief Medical Officer with the Hotel Employees and Restaurant Employees International Union (HEREIU) Welfare Funds in 22 States, this presentation addresses various consumer engagement strategies in medical management including health decision support, health risk assessments, and patient behavior change programs.
  

A New Era in Health Care Consumerism

Phillip L. Polakoff, M.D., Senior Vice President, Medical Affairs
ACS Healthcare Solutions, San Francisco, California  

Dr. Polakoff's presentation starts by critiquing the Healthcare Dilemma – and asks and answers what’s needed to empower healthcare consumerism? The concept brought forward involves architecting an innovative solution and integrated approach – Lifetime Health. Optimizing buy-in is addressed via the power of effective communications. Executing for Success is discussed utilizing technology as an integrator. Closing Thoughts to ensuring success are also provided.  A Podcast of an interview with the Presenter is available. 

Provider Strategies to Deal with the Impact of Consumerism

Clive Riddle, President
MCOL, Modesto, California  

This presentation addresses issues and strategies involving the impact of consumerism on providers including: increased patient cost sharing; the under and uninsured' price transparency; discount cards; report cards and decision tools; and consumer driven plans. This presentation is also listed in the Provider and Patient Care Issues Track. A Podcast of an interview with the Presenter is available.   

Ms. Tellez draws upon Sterling HSA case studies as well as national marketplace activity to share various employer best practices utilized in the design and roll-out of HSA programs. 

Offering an investment option as a feature to an HSA platform adds a differentiator that has been proven to win additional customers and separate and HSA account offering from the competition. We will explore the HSA Investment offerings that exist today, where we see the marketplace moving to and what to consider when looking to add investments to an HSA program.

The healthcare industry continues to look to consumer-directed, high deductible health plans as an answer to rising healthcare costs. However, healthcare providers struggle with the collection of patient responsibility amounts. How does a healthcare card simplify the process for the patient, provider, and healthcare payer? How has a card contributed to the success of the Flexible Spending Account and can it offer the same or even more hope for the Consumer Directed/High Deductible Health Plans?

Track C Provider and Patient Care Issues

Can Medicare Control Costs for Patients With Chronic Conditions? Medicare Health Support (MHS) and Other Pilot Projects
Vince Kuraitis, Principal

Better Health Technologies, Boise, Idaho

This presentation provides a brief history of Medicare Health Support and other demonstration/pilot projects involving chronic care; outlines a summary of current projects; reviews early lessons learned; and discusses the future of MHS and Medicare efforts to control costs for patients with chronic conditions. A Podcast of an interview with the Presenter is available. This presentation is also available as a live webcast/ audioconference. 
  

The Medicare Health Support Project
Harry Leider, MD, MBA, Chief Medical Officer 
XLHealth, Bala Cynwyd, Pennsylvania

Dr. Leider discusses XLHealth's approach to the Medicare Health Support (MHS) project; provides a comparison and contrast of XLHealth's approach to the other MHS projects; addresses the cost-cutting potential for MHS, and reviews the early challenges and early successes experienced with the project. This presentation is also available as a live webcast/ audioconference. 

The Integration of Wellness and Prevention into the Care Management Model: Strategies for Action
Dr. Marybeth Regan
Libertyville, Illinois

The future of health is the Integration of Wellness into the current “sickness” model. Many have long been frustrated with a health care system that is focused only on “sickness.” Healthplans are pre-occupied with acute care interventions. Disease management programs have shown that optimal management of chronic diseases can prevent complications. The focus has been on providing interventions to a select group of high-cost individuals who have been diagnosed with one of the more common chronic conditions. However, there has been relatively little investment in preventing chronic disease in the first place. 

This approach is short-sighted and the time has come to broaden the accessibility of preventive care to an entire population. An approach that merges risk management and lifestyle management strategies with traditional disease management interventions is the solution. The focus on lifestyle -related risk factors is still in its infancy. Significant savings are possible by targeting individuals who are not yet sick but who have risk factors. These risk factors suggest they will develop one or more chronic diseases in the near future if not modified. A winning formula can be implemented when this approach is coupled with on member who are willing to change. The value can be beyond just direct cost savings. In fact, in many cases, problems as high absenteeism, low worker productivity (presenteeism), or employee satisfaction can be the benefits of this integration. This session will share a model that can be utilized with healthplans and employers.
  

Provider Strategies to Deal with the Impact of Consumerism

Clive Riddle, President
MCOL, Modesto, California  

This presentation addresses issues and strategies involving the impact of consumerism on providers including: increased patient cost sharing; the under and uninsured' price transparency; discount cards; report cards and decision tools; and consumer driven plans.  This presentation is also listed in the Consumerism Track. A Podcast of an interview with the Presenter is available. 

While many are waiting for someone else to do something, they are. Medicare will move to risk adjusters for MA plans in January 2007 and this will require Medicare Advantage plans to seek performance based compensation and quality measurement for hospitals and physicians. Many of these Medicare contractors are also Commercial contractors like United and Humana. As they are able to model utilization and reimbursement in advance of service many negotiations will become more sophisticated this fall and providers using the old method of managed care fee manipulation and discounts may be very surprised to learn that in addition to price and volume there are now 5 additional ways insurance companies can deny or delay a claim. Providers need to take an aggressive , and sometimes humbling, first look at their own data to see what gaps need to be fixed and also what leverage they have in being able to proclaim themselves as a quality leader in these new contract negotiations. This session will review the why and what of PBC and show how all the P4P, quality and charge transparency and employer managed care systems demands fit together. Mr. DeMarco will then offer some examples of how to turn these changes into new revenue streams and business opportunities for the future. A Podcast of an interview with the Presenter is available. 

California healthcare stakeholders have embarked on an exploration of adding efficiency measurement into its statewide collaborative P4P program. In this session, you will learn about the progress to-date, the process used to get there, and the issues encountered along the way.

Track D  Prescription Drug Issues

Numerous companies are spending immense sums of money on RFPs to locate new Pharmacy Benefit Management companies ("PBMs"), typically with little (if any) benefit: At the RFPs' conclusion, the companies virtually always execute contracts with their new PBMs that contain the same boilerplate terms as the companies had in their previous PBM contracts. This presentation will teach your company how to entirely restructure your PBM RFP to guarantee it results in truly beneficial contract terms that will dramatically decrease your rx coverage costs.

The Deficit Reduction Act of 2005
Thomas Kaye, RPh, MBA, Senior Pharmacy Director 

Passport Health Plan, Louisville, Kentucky

As we all know, current practice is to discourage use of higher cost drugs by setting multi-tiered formularies and co-pays to penalize the patient for not getting lower cost drugs. In spite of whatever the HR people and their consultants and PBM’s say, this strategy simply has not worked since drug spend is still rising at 10% to 15% per year. This presentation outlines the MedisaveRx^(tm) approach, which involves sharing the gross savings of suggested lower costs drugs directly with the patient. 

Partnering with Retail Pharmacy to Drive Net Cost Results
Bill Barre, VP, Strategic Network Development, 
Medimpact, San Diego, California