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Thursday,
February 3rd,
2011
1:00 to 2:20 PM Eastern (10:00-11:20 AM Pacific)
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Register
for $225
Call 209.577.4888 or
Click here to register |
Strategic, Operational and Financial
Implications of MLR Requirements
Positioning for Compliance, Opportunities and
Strategic Response
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Optimal specific next steps in responding to MLR
Key MLR compliance risks and strategic opportunities
Road map for collecting the right information for MLR
compliance
Future
initiatives for meeting MLR requirements
Implications of various inclusions, exclusions, and
adjustments included in the MLR regulations
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Faculty:
John Steele
Managing Director,
Healthscape Advisors,
LLC |
Faculty:
John Phelan, Ph.D.
Technology and Management
Consultant
Milliman, Inc. |
Faculty:
David M. Tuomala
Director, Financial Advisory
and Actuarial Services
Ingenix Consulting |
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Medical Loss Ratio requirements resulting from the Affordable Care
Act place significant compliance and financial risk on health plans, and
have significant strategic, operational and financial implications for
all stakeholders. As a result, immediate action must be taken for
stakeholders to properly respond and position for these regulations that
take effect in 2011.
Join us in this 80 minute webinar as three national experts
provide detailed insight, actionable information and recommendations
regarding the implications for stakeholders with MLR requirements:
John Steele, Managing Director of Healthscape Advisors will
discuss the near and long-term MLR implications that all plans should be
aware of, and what strategic alternatives health plans have in
responding to these requirements. John will also discuss why mitigating
these risks and addressing MLR requirements will require involvement
from all aspects of a health plan operations’ and what steps can be
taken to transform MLR into an opportunity to build your organization’s
competitive advantage. He will cover such areas as:
● What are industry best
practices that are being performed in order to meet the MLR requirements
● The common pitfalls and risks
facing health plans ● The key
business implications MLR will have on each organization
● How health plans should
utilize MLR to help form a long term business strategy
John Phelan, PhD, Technology and Management Consultant with Milliman,
Inc,
will address managing and reporting operational costs under MLR
rules. He will provide a detailed assessment process that permits
stakeholders to make the most advantageous changes to operations and
products in meeting regulatory requirements and in developing
product development and marketing strategies. Prior to the MLR
requirements, information at this level of granularity was simply
not needed to manage operations or estimate costs in regulatory
submissions. Therefore, such an assessment will likely be a new
activity for most insurers that requires careful attention and
likely administrative and financial reporting changes. He will cover
such areas as: How to conduct a baseline audit following MLR
guidelines
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Documenting costs under MLR
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Preparing for an audit
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Program initiatives that support compliance
David M. Tuomala, Director, Financial Advisory and Actuarial
Services, Ingenix Consulting will discuss financial and actuarial
implications of MLR regulations. He will cover the strategic and
practical implications of various key elements of the recent MLR
regulations and discuss ways that health plans should prepare for and
react to the changes. David will cover specific topics including: Impact
of inclusions and exclusions for Quality Improvement (QI) expenses and
the exclusion of state and Federal taxes from the MLR calculation
● Health plan implications of
aggregation levels for rebate calculations
● Impact of credibility
adjustments and three-year averaging for rebate calculations
● Implications of HHS process
for state-based transitional MLR adjustments for individual plans
● Next steps for health plans
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Strategic Implications: Medical
Loss Ratio Regulations
Thursday February 3, 2011
1:00 p.m. to 2:20 p.m. Eastern (10:00 a.m. - 11:20 a.m.
Pacific)
Click here
to find out what time your event starts in your time zone.
Webinar Agenda:
(Eastern Time)
- 1:00 pm - 1:05 pm
Introductions and logistics
- 1:05 pm - 1:30 pm
MLR Short Term and Long Range Implications and
Health Plan Strategic Alternatives in Response -
John Steele, Managing Director, Healthscape Advisors,
LLC
- 1:30 pm - 1:55 pm
Managing and Reporting Operational Costs Under
MLR Rules- John Phelan, Ph.D., Technology and
Management Consultant, Milliman, Inc.
- 1:55 pm - 2:20 pm
Financial and Actuarial Implications of MLR
Regulations - David M. Tuomala, Director,
Financial Advisory and Actuarial Services, Ingenix
Consulting
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Participants will be able to:
- Understand the optimal next steps in responding to MLR
- Understand what are other PPACA and industry factors that should
be considered when implementing MLR
- Identify the key MLR risks
- Learn the road map for collecting the right information
- Target opportunities under MLR
- Identify future initiatives for effectively meeting MLR
requirements
- Understand the implications of various inclusions, exclusions,
and adjustments included in the MLR regulations
- Understand the appropriate steps to take now and in the future
to prepare for and react to the MLR changes
- 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
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Interested attendees would
include:
- C-Suite Executives
- Actuarial and Underwriting Executives and Staff
- Finance Executives
- Operations Executives
- Sales and Marketing Executives
- Regulatory and Compliance Executives and Staff
- Strategy and Planning
Executives and Staff
- Business
Intelligence Staff
- Other Interested
Parties
Attendees would
represent organizations including:
- Health Plans
- Business Process Organizations
- Solutions Providers
- Government
- Associations,
Institutes and Research Organizations
- Media
- Other Interested
Organizations
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Individual Registration Fee: $225. 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!
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John Steele
Managing Diroector,
Healthscape Advisors, LLC
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John has been advising healthcare clients for nearly 15 years on
business growth, profitability improvement and risk mitigation
assignments. John began his consulting career at in Arthur Andersen, and
went on to become Managing Director at a
publically traded consulting company until he departed to co- found
HealthScape Advisors.
Recently, Steele has been assisting clients with the implications of
health reform with a specific emphasis on Medical Loss Ratios. He has
advised health plans, managed care organizations, and third party
administrators on a variety of performance improvement, financial,
operational, and regulatory topics. Steele has been involved in
assisting clients evaluate health reforms scenarios and developing
strategies to compete effectively in a post reform environment. He
continues to work with clients on creating sustainable top growth and
maximizing their bottom line.
Steele also has significant experience with Government health programs
including TRICARE, Medicare, Medicaid, and other federally funded
healthcare programs. Specifically, he has worked with clients to conduct
market, capability and environmental assessments in addition to leading
several large Government procurement pursuits.
John earned an MBA from the University of Chicago with a concentration
in Strategic
Management and Finance. He also received his Bachelor's degree in
Finance from University of Illinois Champaign-Urbana. He has published
articles in both AHIP Coverage and Modern Healthcare Executive and is a
speaker on industry issues.
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John Phelan, Ph.D.
Technology and Management Consultant, Milliman, Inc.
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John is a management and technology practice leader with Milliman. He
specializes in strategy, implementation, operations improvement,
technology initiatives, regulatory compliance, and provider network
management. He is responsible for the Milliman Security Management
System (MS2), robust security administration software that supports
state-of-the-art compliance, including HIPAA compliance. John works with
organizations in the for-profit, not-for-profit, and government sectors.
His clients range from the nation’s largest insurance carriers to state
governments to ERISA plans serving several hundred participants.
An accomplished speaker and author, John came to Milliman with two
decades of senior executive and consulting experience. This included
implementing and leading a multi-state managed care organization for a
NYSE- listed corporation that encompassed provider networks, medical
management, customer service, and claims. He has also managed a national
healthcare and workers’ compensation network with more than 300,000
providers. He has extensive experience with acquisitions, mergers and
business turnarounds and e-health program development.
As an executive at Well Point/Blue Cross of California, John developed
innovative reimbursement and provider contracting programs. At the Blue
Cross and Blue Shield Association, he worked extensively with member
plans on the impact of provider payment strategies, government
initiatives and compliance. Prior to the Blues, John consulted with
hospitals, physicians, health systems, and government on managed care
contracting, marketing, and product development. He also drafted and
helped implement state health and mental health legislation and started
and managed several community psychiatric facilities.
John's education includes a BA from the University of California,
Berkeley, a MSW from the University of California, Berkeley, and a PhD
from the University of Chicago
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David M. Tuomala
Director, Financial Advisory
and Actuarial Services
Ingenix Consulting
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David Tuomala is a Director in the Financial Advisory and Actuarial
Services practice of Ingenix Consulting. He joined the organization in
2007 and is located in the Eden Prairie, Minnesota, office.
Prior to joining Ingenix Consulting, he spent more than two years at
CIGNA HealthCare, overseeing the pricing of its consumer-driven
products. Before that he served for nearly five years as chief actuary
for Definity Health, one of the pioneers in developing and offering
consumer-driven health products. In this role, he was responsible for
pricing and underwriting activities. Earlier in his career, David spent
nearly ten years in a variety of actuarial roles with Wellmark Blue
Cross and Blue Shield in Des Moines, Iowa.
In addition to experience with consumer-driven health plan products,
David has previous experience with small and large group pricing and
experience analysis, individual and Medicare supplement product pricing
and rate filings, pharmacy benefit development and pricing, and state
and federal health care regulation and legislative initiatives.
David graduated from the University of Minnesota’s Institute of
Technology with a degree in mathematics. He is a fellow of the Society
of Actuaries, a fellow of the Conference of Consulting Actuaries and a
member of the American Academy of Actuaries. David currently serves as
the chair of the Defined Contribution Health Plan and the
Consumer-Driven Health Plans Emerging Experience work-groups of the
American Academy of Actuaries, and as vice-chair for the group health
examination committee of the Society of Actuaries. He has been a speaker
on consumer-driven health topics for meetings of the Society of
Actuaries, American Academy of Actuaries and the Conference of
Consulting Actuaries. |
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