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Value of ACA Coding Improvement: Market Share and Market Effects 
 
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Overview
The risk adjustment program, a permanent feature of the Affordable Care Act, aims to mitigate issues in the commercially-insured guaranteed issue individual and small group markets. Under the ACA risk adjustment program, a member’s risk is measured using the Department of Health and Human Services hierarchical condition categories (HHS-HCC) risk adjuster model. In this particular model, carriers are incentivized to capture all existing member diagnoses that trigger any of the predefined 146 HCCs and condition groupings. By doing so, the carrier will maximize its average plan liability risk score and thus optimize its revenue transfer position relative to the market.

In this webinar, Milliman’s Doug Norris and Ksenia Whittal explore the crucial role of diagnosis coding by focusing on the role of certain variables—including carrier size, market share, and market size—on the ACA risk adjustment formula. They will provide an executive-level examination of the issues, followed by a more in-depth analysis, and will leave time for Questions and Answers.

Please join us Wednesday, April 6th, 2016 at 2 PM Eastern as Milliman’s Doug Norris and Ksenia Whittal address this crucial topic, in the HealthcareWebSummit event: Value of ACA Coding Improvement: Market Share and Market Effects.
 
Learning Objectives

After attending this webinar, attendees will be able to:

  1. Ascertain key executive decision-making considerations in developing a near-term coding strategy in the ACA marketplace.
  2. Understand ROI considerations for ACA coding improvement initiatives including estimating market conditions for applicable benefit years.
  3. Examine Milliman key findings from analysis of the parameters of the ACA risk adjustment transfer mechanism and actual 2014 benefit year transfer results.
  4. Grasp the applicable methodology involved with the ACA risk adjustment transfer formula.
  5. Explore the implications of market-wide coding completeness efforts on the market's plan liability risk score.
  6. Consider the impact of carrier size, market share, market size and other variables in the risk adjustment transfer formula.
  7. Comprehend how to evaluate the change in transfer amount resulting from identifying additional HCCs within a population based on these considerations.
  8. Understand different approaches to more accurately reflect the true risk of an insured ACA population.
  9. 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 dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Health Reform Executives and Staff
  • Actuarial Executives and Staff
  • Analytics Staff
  • Finance Executives and Staff
  • Managed Care Executives and Staff
  • Planning and Strategic Executives and Staff
  • Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Health Plans
  • Provider Networks
  • Benefit Consultants and Agents
  • Government
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
Registration
Value of ACA Coding Improvement: Market Share and Market Effects
 
  Individual Registration Fee: $195. Post-event materials, with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
 
 
 
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Faculty
 
Ksenia Whittal

Ksenia Whittal,
 FSA, MAAA
Consulting Actuary
Milliman

  Ksenia is a consulting actuary with the Denver Health practice of Milliman. She joined the firm in 2005.Ksenia's primary focus is on predictive modeling and lifestyle-based analytics application to underwriting and disease management. This work includes consulting to healthcare plans on the use of lifestyle-based data to augment underwriting decisions and identify individuals for disease management and wellness initiatives. Lifestyle-based analytics plays an especially strong role in risk selection in the small/medium group market, and will integrate well with other risk selection approaches such as risk adjusters, IntelliScript, and medical underwriting.

Most recently, Ksenia has been managing the technical development of Milliman Advanced Risk Adjusters (MARA), which was released in 2010. MARA utilizes Milliman's existing actuarial and clinical expertise and is well suited for advanced applications of risk adjustment in healthcare budgeting, pricing, payment, stratifying risks, and analytic reporting.

Ksenia's work in long-term care includes pricing, product development, valuations of blocks of business, filing, and large group offerings. Other recent projects include benchmarking and rate development for health plans.

Ksenia is a Fellow, Society of Actuaries, and a Member, American Academy of Actuaries. She received a BM (with distinction), Honors Actuarial Science, University of Waterloo

 
Doug Norris

Doug Norris
FSA, MAAA, PhD
Principal and Consulting Actuary

 

Doug is a principal and consulting actuary with the Denver office of Milliman. He joined the firm in 2004. Doug specializes in healthcare reform as it applies to commercial plans (including Exchange modeling, strategy, tactics, and ACA “3R” risk mitigation modeling), underwriting implementation, and behavioral healthcare issues including care coordination and integration.

His recent work includes strategic modeling for commercial plans as impacted by the Affordable Care Act (including strategy, tactics, and the modeling of the “3R” risk mitigation provisions), legislation impact modeling, TRICARE and USFHP contract negotiations, commercial large group pricing and strategy, CMS Innovation program payment and delivery modeling analyses, IBNR modeling, behavioral health integration and value opportunity analyses, and health underwriting implementation.

Doug is the past chair of the Society of Actuaries’ Predictive Analytics and Futurism section, and has a particular interest in predictive modeling techniques, complexity science, and hidden Markov models. He has extensive experience in probability and optimization techniques, and has spoken at many universities on topics ranging from Markov analyses to probabilistic forecasting.

Prior to joining Milliman, Doug was an assistant professor of mathematics at Westminster College (Salt Lake City), and an instructor in the department of mathematics at the University of Colorado at Boulder. He also worked for the National Center for Atmospheric Research in Boulder.

 
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