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Predictive Analytics, MSSP & Star: Relating & analyzing these Medicare programs for hidden compliance & enrollment patterns 
 
Overview
There is a strong focus on improving quality for Medicare beneficiaries as a result of national healthcare reform. Medicare Shared Savings Program (MSSP) and Pioneer ACOs require the reporting of quality measures this year and will start paying for performance in subsequent years. Medicare rates Part C and Part D plans on quality performance and provides financial incentives to reward better quality. This session addresses and compares these different quality measures, and shares how predictive analytics can help uncover the hidden patterns of compliance and enrollment decisions.

The Medicare Shared Savings Program and the Medicare Advantage Part C "Star" rating program both provide significant potential financial rewards if participating organizations meet applicable criteria. Join Milliman's Rong Yi and Bruce Pyenson as they explore how the two sets of quality measures relate to each other, and what types of these Medicare members are less likely to be compliant therefore require more targeted communication or intervention.
Learning Objectives
Participants will be able to:
  1. Understand, compare and relate quality measures under the Medicare Shared Savings Program, Pioneer ACO and Star Ratings programs.
  2. Explore issues involving application of Predictive Analytics within these program populations.
  3. Consider how to identify applicable Medicare program members that are less likely to be compliant.
  4. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through a dedicated LinkedIn group.
Who Should Attend
Interested attendees would include:
  • C-Suite Executives
  • Medical Directors
  • Care Management Executives and Staff
  • Analytics and Informatics Executives and Staff
  • Actuarial Executives and Staff
  • Medicare Operations Executives and Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Health Plans
  • Accountable Care Organizations
  • PBMs
  • Provider Networks
  •  Solutions Providers
  • Government
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
 
Registration
Predictive Analytics, MSSP & Star: Relating & analyzing these Medicare programs for hidden compliance & enrollment patterns 
 
  Individual Registration Fee: $195. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!

 
 
Faculty
 
Rong Yi
Rong Yi, PhD
Director, Risk Adjustment and Predictive Modeling Practice; Senior Consultant
Milliman
  Rong is a senior consultant with the New York office of Milliman. She joined the firm in 2009. Rong has extensive experience in risk adjustment and predictive modeling for healthcare, workersí compensation, and other fields. She has worked with private insurers, providers, employers, government agencies, and researchers in the United States and other parts of the world. She is a frequent speaker at professional and academic conferences.
 
Rongís expertise includes risk adjustment for public programs and health reforms and predictive modeling for risk management. She has done pioneering work in the areas of workersí compensation predictive modeling, risk adjustment for the uninsured population, risk-based provider profiling, risk adjustment for small group underwriting, and models supporting the patient-centered medical home. She also led the adoption of diagnosis-based risk adjustment in the recent German health reforms, and is assisting foreign government organizations in their research and strategy for their future health reforms.

Before joining Milliman, Rong was a major contributor to commercial and governmental risk adjustment systems in wide use today.

Ron is a member of the International Health Economics Association and the American Society of Health Economists, She is also a Visiting Research Fellow, National Health Economics Institute, Ministry of Health, China. Ron received her PhD in Economics from Boston University, and BS from Peking University, Beijing, China
 

 
Bruce S. Pyenson
Bruce S. Pyenson
FSA, MAAA
Principal, Consulting Actuary
Milliman
  Bruce is a principal and consulting actuary with the New York office of Milliman. He joined the firm in 1987. Bruceís practice focuses on helping clients succeed in healthcare. He consults to healthcare businesses, integrated delivery systems, employers, providers, advocacy groups, HMOs, and reinsurers on issues ranging from market strategies and capitation to healthcare reform. Most of his projects involve integrating analytics from financial, clinical, and operational models.

In recent years, client projects have included assessment of cancer screening, lung cancer mortality, pandemic influenza, healthcare reform evaluations for advocacy groups, feasibility analyses for Accountable Care Organizations, restructuring of disease management processes, and actuarial cost/benefit evaluations for pharmaceutical manufacturers. Bruce is active in the cancer collaborative C-Change. He served on the board of the Health Project (Koop Awards) from 2002-2004 and 2010-2011, and on the National Advisory Committee of RW Johnson Foundationís Rewarding Results Program.

Bruce is the editor and co-author of Managing Risk: A Leaderís Guide to Creating a Successful Managed Care Provider Organization (AHA Publishing, 1998) and Calculated Risk: A Providerís Guide to Assessing and Controlling the Financial Risk of Managed Care (American Hospital Publishing, 1995). Bruce has also authored several Milliman research reports on topics such as obesity, hepatitis C, hospital outpatient trends, healthcare reform, and programs for the disabled elderly.

He is co-author of scientific articles on hospice, hepatitis C, and hospital-acquired infections, and is co-author of Employee Benefits for Small Business (JK Lasser, Simon & Schuster, 1991, 1992). The current Society of Actuaries exam syllabus includes his work on provider risk. Bruce is a Fellow, Society of Actuaries, and a Member, American Academy of Actuaries.
 
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