1. The annual MAPD bid offers unrivaled access to new market opportunities. Getting it wrong, however, could
result in millions, if not billions, of lost revenue. With so much on the line, navigating the bid through the
assumptions and projections of development has never been more critical. This unique forum brings plans
together for step-by-step discussions on actionable bid implementations, resolving operational obstacles, and
attainable market advantages.
An Interactive Seminar focused on Aligning your Application Timeline to Competitive Outcomes
JANUARY 26-27, 2015 SANIBEL HARBOUR MARRIOTT RESORT & SPA FORT MYERS, FLORIDA
H E A LT H C A R E E D U C AT I O N A S S O C I AT E S P R E S E N T S
T O R E G I S T E R : C A L L 8 6 6 - 6 7 6 - 7 6 8 9 O R V I S I T U S A T W W W . H E A L T H C A R E - C O N F E R E N C E S . C O M
Tw
o
great
conferences,one
location!DUAL BIDS DUAL BIDSPBP
COMPLIANCE
SALES
MARKETING
MARKETING
NETWORK
EXPANSION
ENROLLMENT
PROJECTIONS
ENGAGEMENT
INCENTIVES
PLAN
DESIGN
REVISIONS REVISIONS
RISK
ADJUSTMENT
RISK
ADJUSTMENT
REVENUE
COST COST
UTILIZATION UTILIZATION
TRENDS
TRENDS
STAR
RATINGS
STAR
RATINGS
STAR
RATINGS
STAR
RATINGS
FINANCIAL
GOALS
FINANCIAL
GOALS
TESTING
TESTING
BENCHMARKS
BENCHMARKS
BENCHMARKS
BENCHMARKS
NETWORK
ADEQUACY
NETWORK
ADEQUACY
NETWORK
ADEQUACY
NETWORK
ADEQUACY
PART D
PART D
PART D
PART D
SILVER SPONSOR
A STRATEGIC
FRAMEWORK FOR THE
MAPD BID PROCESS

2. TWO OUTSTANDING MEDICARE ADVANTAGE CONFER-
ENCES AT ONE LOCATION! MEDICARE ADVANTAGE MEMBER
ACCOUNTING & RECONCILIATION ALONGSIDE STRATEGIC
FRAMEWORK FOR THE MAPD BID PROCESS!
After months of development, we’re excited to introduce Strategic
Framework for the MAPD Bid Process, a new conference set in
an interactive classroom environment! The frustrating and often
tangled process of filing your Medicare Advantage product sends
shockwaves across the company—pharmacy, network development,
finance, sales, product management, and marketing, just to name a
few— and lasts for months. The impact of the bid is astronomical;
getting it right positions you to leverage unique strategies for
revenue, quality, and cost containment. Errors and misjudgments,
however, can haunt your plan for at least a year. Small mistakes in
the bid process lead to major consequences.
We’re going to make the bid process a little clearer, a little easier,
and help you understand and attain some of the benefits available
to you through the bid.
Using the bid timeline as the basis for discussion, our speaking
faculty of Medicare Advantage Plan executives, actuaries, and
industry experts will take you step-by-step through best practices
and opportunities available throughout the bid. We’ll be highlighting
specific challenges plans encounter along the way, sharing
experiences, and by the end of it, we’ll have developed a mock
bid together. This is your opportunity to take home practical and
immediately applicable information, network with peers, and
participate in a unique interactive conference setting!
Simultaneously…
Experts from reconciliation, recovery, and revenue management
will be onsite to work through the challenges of Medicare
Advantage Member Accounting & Reconciliation. The monthly
process of balancing out Medicare Advantage reimbursements for
risk adjustment is still new to several plans, and a lot of the trends
and concepts are still developing—an equation ripe for mistakes.
Does your plan have the correct infrastructure in place to capture
an accurate reconciliation payment?
As the industry’s only accounting and reconciliation conference,
we take great pride in providing you with practical information for
maximizing the accuracy of your reimbursements.
Our speaking faculty will take you on a an in-depth journey
through the different protocols, calculations, and systems they use
for seamless reconciliation. The ever-changing regulatory landscape
and shifting CMS requirements have forced plans to develop a
holistic approach in rectifying disparities. Getting it wrong isn’t an
option.
Register today for either of these groundbreaking events! Call
(866) 676-7689 or online at www.healthcare-conferences.com.
Sincerely,
Josh Krenz, Conference Director
HEALTHCARE EDUCATION ASSOCIATES
Kevin Mowll
Kevin Mowll, Executive Director
RISE (Resource Initiative & Society for Education)
OUR RENOWNED SPEAKING FACULTY
• Jody Miller, CIGNA
• Jennifer Young, GORMAN HEALTH GROUP
• Sarah Dixon, KELSEY-SEYBOLD CLINIC
• David Meyer, SCAN HEALTH PLAN
• Denyse L. Wise, MADENA SOLUTIONS
• Diane Icard, CIGNA
• Magnolia Bobineau, HEALTH ALLIANCE PLAN OF MICHIGAN
• Szoa Geng, VNSNY HOSPICE
• David Neiman, WAKELY CONSULTING GROUP
• Matt Chamblee, MILLIMAN
• Mary Kaye Thibert, GORMAN HEALTH GROUP
• Ida Kwok, BLUE SHIELD OF CALIFORNIA
• Kevin D. Rease, ALPHA DELTA HEALTHCARE CONSULTING
• Maria Carolina Ruiz, TUFTS HEALTH PLAN
• Diane Hollie, GORMAN HEALTH GROUP
• Kyle Raeder, COMMUNITY CARE, INC
• Matt Kranovich, MILLIMAN
• Kevin Mowll, RISE
• Christopher Plummer, CAPITAL BLUE CROSS
THE CONFERENCE ORGANIZERS
Healthcare Education Associates is a division of Financial Research
Associates, LLC. HEA is a resource for the healthcare and
pharmaceutical communities to improve their businesses by
providing access to timely and focused business information and
networking opportunities in topical areas. Offering highly targeted
conferences, Healthcare Education Associates positions itself as a
preferred resource for executives and managers seeking
cutting-edgeinformation on the next wave of business opportunities.
Backed with over 26 years of combined conference industry
experience, the producers of HEA conferences assist healthcare
professionals, actuaries, attorneys, consultants, researchers and
government representatives in their professional endeavors. For
more information on upcoming events, visit us online:
www.healthcare-conferences.com
RISE (Resource Initiative & Society for Education) Vision:
To build a community and an educational system that promotes
successful careers for professionals who aim to advance the quality,
cost and availability of health care.
RISE provides:
• A forum to build professional identity and a network of colleagues
• A platform to capture and share knowledge and insights
• A venue to develop and share benchmarks and document
best practices
• Career track development support
• A channel for building alliances, partnerships and affiliations
that fulfill the vision
RISE (Resource Initiative & Society for Education) Mission:
RISE is the first national association totally dedicated to enabling
healthcare professionals working in organizations and aspiring to
meet the challenges of the emerging landscape of accountable
care and health care reform. We strive to serve our members
on four fronts: Education, Industry Intelligence, Networking and
Career Development. To learn more about RISE and to join, visit us
online: www.risehealth.org
“Good speakers. Very knowledgeable and
provided useful information. Event was well
organized and followed the schedule well.”
Anne Grimmius
South Country Health Alliance

3. IMPORTANT INFORMATION
VENUE DETAILS
Sanibel Harbour Marriott Resort & Spa
17260 Harbour Pointe Drive
Fort Myers, Florida 33908
800-767-7777
We have a limited number of hotel rooms reserved for the
conference. The negotiated room rate of $229 per night will
expire on December 23rd, 2014 although we expect the block to
sell out prior to this date. Book well before the expiration date to
ensure you receive a room at the negotiated rate. Upon sell out of
the block room rate and availability will be at the hotel’s discretion.
ABOUT THE VENUE
Experience the warmth of the Florida sun at Sanibel Harbour
Marriott Resort & Spa. Near Sanibel Island, our Florida resort is
located on 85 waterfront acres in Fort Myers. Also, our lovely
hotel has captivating views of Sanibel Island on Florida's southwest
Gulf Coast. With our gorgeous, waterfront location, world-class
amenities and convenient access to local activities, we look forward
to inviting you to enjoy the Sanibel Harbour Marriott Resort & Spa.
TEAM DISCOUNTS
• Three people will receive 10% off
• Four people will receive 15% off
• Five people or more will receive 20% off
In order to secure a group discount, all delegates must place their
registrations at the same time. Group discounts cannot be issued
retroactively. For more information, please contact Whitney Betts
at (704)341-2445 or wbetts@healthcare-conferences.com.
REFUNDS AND CANCELLATIONS
For information regarding refund, complaint and/or program
cancellation policies, please visit our website:
https://www.healthcare-conferences.com/thefineprint.aspx.
SPONSORSHIP AND EXHIBIT OPPORTUNITIES
Enhance your marketing efforts through sponsoring a special
event or exhibiting your product at this event. We can design
custom sponsorship packages tailored to your marketing needs,
such as a cocktail reception or a custom-designed networking
event.
To learn more about sponsorship opportunities, please contact
Jennifer Clemence at (704) 341-2438 or
jclemence@healthcare-conferences.com.
SPONSORS
SILVER
SILVER
Gorman Health Group, LLC (GHG) is a leading consulting and
software solutions firm specializing in government health
programs, including Medicare managed care, Medicaid and
Health Insurance Exchange opportunities. For nearly 20 years,
our unparalleled teams of subject-matter experts, former
health plan executives and seasoned healthcare regulators
have provided strategic, operational, financial, and clinical
services to the industry, across a full spectrum of business
needs. Further, our software solutions have continued to place
efficient and compliant operations within our client’s reach.
Find out more at www.gormanhealthgroup.com.
Madena is a Healthcare Enrollment firm that supports MAPDs
in navigating the challenges of Enrollment Reconciliation. Our
team consists of technologically minded entrepreneurs, veteran
enrollment analysts and industry regulatory experts. Our suite
of services and solutions includes a Reconciliation Tool for
complete enrollment audits as well as a Monthly Scorecard,
CASE, which provides MAPDs a comprehensive assessment of
the health of their current reconciliation system and an effective
process to rapidly improving it.
UPCOMING EVENTS
THE RISK ADJUSTMENT FORUM
Understanding Risk Adjustment in the Post-ACA Marketplace
November 17-19, 2014 - Coral Gables, FL
FDR OVERSIGHT BEST PRACTICES SUMMIT
Achieving Compliance through Advanced Training, Risk
Assessment & Performance Monitoring
December 8-9, 2014 – Baltimore, MD
STAR RATINGS MASTER CLASS
Strategizing an A+ Game Plan to Optimize Your Plan’s Quality
Culture and Boost Overall Ratings
December 8-9, 2014 – Carlsbad, CA
THE 2ND ANNUAL FORUM ON REVENUE MANAGEMENT
FOR THE HEALTH INSURANCE EXCHANGES
Examining Year One with a Strategic Eye Toward 2015
December 8-9, 2014 - Carlsbad, CA
THE 9th ANNUAL RISE SUMMIT
Best Practices and Results-Driven Tools for Managing Risk and
Improving Quality
March 25-27 2015 – Nashville, TN

4. 8:00 – 8:45 EXHIBITS SET-UP, REGISTRATION, AND
CONTINENTAL BREAKFAST
8:45 – 9:00 CHAIR’S WELCOME
9:00 – 10:00 FUNDAMENTALS OF MEMBERSHIP
ACCOUNTING AND RECONCILIATION
• Glossary of terms – sorting through the acronyms to understand how
everything in accounting and reconciliation fits together
• A detailed evaluation of the Monthly Membership Report and Model
Output Report—how will they affect your plan’s payments?
• What are the different reports and how are they used? How can
plans operationalize and leverage reports to improve their revenue
management stream?
• Understanding the various codes, membership files, and expectations
from CMS—what are you going to be exposed to most frequently?
How does it affect your reimbursement strategy?
Jennifer Young, Senior Consultant, GORMAN HEALTH GROUP
10:00 – 10:45 KEYNOTE TBD
10:45 – 11:00 MORNING BREAK sponsored by
11:00 – 12:00 BEST PRACTICES FOR ACCURATELY
CALCULATING MEMBER REVENUE
• Understanding the true impact of missed payments—how do you
ensure you are paid correctly the first time?
• Which MMR equations should you be accessing for optimal recovery?
• Where should you look to identify revenue? What commonly over
looked areas should be included in your recovery process?
• Spotlight on calculating Part D revenue— how can this laborious task
be optimized?
• Validating retro-enrollment, disenrollment, and termination to ensure
accurate reimbursements
Sarah Dixon, Manager, Medicare Revenue and Risk Adjustment
KELSEY-SEYBOLD CLINIC
12:00 – 1:15 LUNCHEON FOR ALL ATTENDEES
1:15 – 2:00 AVOIDING DATA PROBLEMS—CRITICAL STEPS
INHANDLINGANDMANAGINGYOURPROCESSES
• Strategic enrollment data validation—how to ensure accuracy in
enrollment processing
• What is the Transaction Reply Report? How about the Enrollment
Data Validation? How can Medicare Advantage plans activate these
tools to preserve accuracy?
• Ensuring accuracies of data, conduction validation audits, and finding
the root causes for errors
• Using reporting and KPS to ensure old errors don’t reoccur
Pending Final Confirmation
David Meyer, Vice President, SCAN HEALTH PLAN
2:00 – 2:45 RESOLVING DISCREPANCIES WITH EFFECTIVE
RETROACTIVE RECONCILIATION SOPS
• The impact of retroactive data on calculations, projections, payments,
and capitation
• Receiving correct retro-enrollment and retro-termination payments
for your membership
• Understanding Category 2 versus Category 3 submissions
• Are you getting the right indicators from your claims system?
• Navigating the gaps in time between CMS data and your plan’s data
Denyse L. Wise, Program Director, MADENA SOLUTIONS
2:45 – 3:00 AFTERNOON BREAK
3:00 – 4:00 BEST PRACTICES FOR MSP VALIDATION
• Best practices for achieving comprehensive MSP data collection –
review, recovery, and reconciliation
• Which tools are available for tracking and monitoring the MSP
verification process?
• What is the best way to determine if there is a primary payer?
Which data points should you be utilizing to verify if the member
does indeed have a primary payer?
• Effect on plan payment—what does and does not affect the payment?
• How do you manage the coordination of benefits?
Jody Miller, Operations Manager, Medicare Services Enrollment & Eligibility
CIGNA
Diane Icard, Claims Manager, CIGNA
4:00 – 4:45 MARx AND ECRS—CMS WEB TOOLS FOR
MEDICARE ADVANTAGE PLANS
• How do you accurately compare the CMS data with your own data?
• How to search for members and COB information in MARx
• Will the premium be adjusted back after MSP changes?
• Batch file versus manual ECRS updates
• How to submit MSP revisions and changes to COB
Magnolia Bobineau, Medicare Enrollment/ COB Manager, Government
Enrollment/ Coordination of Benefit Operation
HEALTH ALLIANCE PLAN OF MICHIGAN
4:45 – 5:45 COCKTAIL RECEPTION IMMEDIATELY FOLLOWING
Please contact Jennifer Clemence at (704) 341-2438 or jclemence@
healthcare-conferences.com for more information about our sponsorship
opportunities.
MEDICARE ADVANTAGE MEMBER ACCOUNTING & RECONCILIATION
OPERATIONALIZING THE COMPLEXITIES OF REIMBURSEMENT
DAY ONE: JANUARY 26TH
WHO SHOULD ATTEND?
Managers and Directors from Medicare Advantage Plans and
Prescription Drug Plans with responsibilities in the following areas:
• Finance
• Reconciliation
• Revenue management
• Enrollment
• Membership accounting
• Operations
• Part D operations and revenue
• Recovery
• Risk adjustment and HCC management
• Coordination of Benefits (COB)
TOP REASONS TO ATTEND
• Gain best practices for accurately calculating member revenue
• Determine what exactly you need to look for on claims to find
revenue
• Learn how to recognize and navigate the gaps between your
plan’s data and CMS data
• Examine best practices for achieving comprehensive MSP data
collection
• Master the key elements of risk adjustment reconciliation
• Gain a solid understanding of the MOR and MMR and how
they are used in the reconciliation process
• Learn how to calculate member risk scores and validate
against the MOR and MMR
• Determine how to effectively manage the complexities of
hospice reconciliation and payment accuracy

5. 8:00 – 8:45 CONTINENTAL BREAKFAST
8:45 – 9:00 RECAP OF DAY ONE
9:00 – 9:45 EFFECTIVE RISK ADJUSTMENT RECONCILIATION
– MASTERING THE KEY ELEMENTS
• Understanding the Model Output Report (MOR) and Monthly
Membership Reports (MMR)—how are they used in the reconciliation
process?
• What are the different risk adjustment payment models? How can
we better manage the complex calculations of member risk scores?
• Best practices in calculating and validating member risk scores
against the MOR and MMR
Sarah Dixon, Manager, Medicare Revenue and Risk Adjustment
KELSEY-SEYBOLD CLINIC
9:45 – 10:30 BUILDING A RECONCILIATION PROTOCOL TO
MATCH YOUR INTERNAL RESOURCES
• Various operational models that work… and a few that don’t
• Building and retaining experts by investing in people
• The trifecta—people, process, and technology
• Evaluating the model that will support your revenue, cost, and expertise
Denyse L. Wise, Program Director
MADENA SOLUTIONS
10:30 – 10:45 MORNING BREAK
10:45 – 11:30 CASE STUDY: CAPITAL BLUE CROSS IN-HOUSE
RECONCILIATION: ONE SUCCESS STORY
Determined to find a better system for member accounting and
reconciliation, Capital Blue Cross set out on a mission to build
their own protocol for navigating the complex process of balancing
out monthly reimbursements.
• How and why we “went it alone”? What factors necessitated
a new way of looking at reports?
• Obstacles encountered and overcome—what challenges did
you face heading into the project? Were there any surprises
along the way?
• Training,transitioning,andonboarding—makingitallcometogether
• What outcomes have been demonstrated? What additional
savings opportunities exist beyond the dollars?
• New opportunities discovered along the way and what’s on
the horizon?
Christopher Plummer, Director, Medicare Programs Member
Support and Administration
CAPITAL BLUE CROSS
11:30 – 12:15 RESOLVING CHANGES TO DUAL ELIGIBILITY
• How to perform accurate member eligibility reconciliation using
plan, state, and CMS data
• What information can you use to identify duals member based on
this data along?
• Evaluating the key differences between SNP plan vs. non-SNP
• Handling the loss of dual status—how does it impact your accounting
and reconciliation process? What are the other ramifications?
12:15 – 1:30 LUNCHEON FOR ALL ATTENDEES
1:30 –2:15 ESRD AND SPECIAL STATUS CASES: INCREASING
RECONCILIATION ACCURACY
• Understanding the MSP ESRD coordination period
• Accurate MSP coordination of benefits information
• Primary vs. secondary payer responsibility
• Understanding ESRD Medicare premium recovery
• How to maximize MSP ESRD return
Magnolia Bobineau, Medicare Enrollment/ COB Manager, Government
Enrollment/ Coordination of Benefit Operation
HEALTH ALLIANCE PLAN OF MICHIGAN
DAY TWO: JANUARY 27TH
GET ANSWERS TO THESE IMPORTANT QUESTIONS
• What’s the true impact of missed payments? It can send shockwaves
throughout your Medicare Advantage plan—are you certain your
plan is being paid correctly the first time?
• Which tools are available for improving accuracy in ESRD cases?
• Are there easier and more effective ways to pay for Part D drugs for
hospice? What measures can be employed to secure the correct
hospice payments?
• How can your team verify that the right indicators are getting into
your claims system as early as possible?
• What steps can be taken to proactively identify data errors and avoid
future discrepancies?
• Is there a better way to achieve comprehensive MSP data collection?
• Which operational models have the greatest impact on enhancing
the reconciliation protocol? Are they maximizing access and alignment
to existing resources?
RAVE REVIEWS
“Real plan experience on the various topics.”
Lori Wendland, uCARE
“Lots of info presented pertinent to my plan.”
Tedd Smelson, Commonwealth Care Alliance
“I was able to get some things that
will be helpful.”
Rick Kelly, South Country Health Alliance
“It was extremely informative, moved smoothly,
resources and venue were impressive!”
Shelley Hopkins, Blue Cross Blue Shield Rhode Island
“I learned more detail on the work I’m doing,
and some understanding of the ‘why’.”
Marilyn Durbon, Denver Health
2:15 – 3:00 NAVIGATING MEDICARE PART D CHANGES:
THE HOSPICE PERSPECTIVE
• The evolution of Medicare Part D payment changes
• Prior authorization process for Part D beneficiaries enrolled in hospice
• Provider point of view: operational and clinical impact of Part D changes
• Working with hospices on a seamless transition “on” and “off” hospice
Szoa Geng, Associate Director of Hospice Access
VNSNY HOSPICE
3:00 END OF SUMMIT

6. 8:00 – 8:45 EXHIBITS SET-UP, REGISTRATION, AND
CONTINENTAL BREAKFAST
8:45 – 9:15 CHAIR’S WELCOME AND ORIENTATION
GLOSSARY OF TERMS, ROLES, AND TIMETABLES
Inordertounlockbestpracticesandcompetitivestrategieshiddenthroughout
the bid process, we have crafted a seminar-long scenario to be played out
from session-to-session. Using hypotheticals that mirror actual scenarios and
frustrations in the bid process, our speaking faculty will work through the
entire bidinaninteractiveworkshop,highlightingsolutionsandopportunities
while sharing real-life experiences and methods with attendees.
• Why is the bid process a big deal?
• Who gets involved with the bid process and at which point? How big
should the core team be?
• Organizing cross-functional team supports to create a successful bid—
oversight, communication, and governance
• What are the key decisions and deadlines along the way?
Kevin Mowll, Executive Director
RISE (Resource Initiative & Society for Education)
9:15 – 10:00 LOOKING AT THE EARLY PARTICIPANTS
IN THE BID PROCESS
In order to unlock and implement key strategies, our panel will
evaluate and deconstruct the roles, responsibilities, challenges
initial players face in assembling early bid inputs.
• Evaluating the outcomes and objectives of last year’s bid
• Key strategies, obstacles, assumptions, and decisions regarding:
- Network management service area expansion—
stratifying markets based on relative attractiveness
- Network adequacy tests—tips for submitting exception
requests
- Pharmacy management and formulary development
• How to catch up if your pre-January work is incomplete
David Neiman, Senior Consulting Actuary
WAKELY CONSULTING GROUP
10:00 – 10:45 CONSEQUENCES OF THE RX FORMULARY ON
STAR RATINGS
• How do formulary decisions impact plan design?
• Amplifying the impact of drugs coming off patent
• Developing a pharmaceutical strategy to improve quality outcomes for
members, the plan, and STARs
• Staying compliant—what key factors should you have your eye on?
10:45 - 11:00 MORNING BREAK sponsored by
PRE-JANUARY
11:00 – 12:00 SALES ENROLLMENT PROJECTIONS --
ANALYZING THE STRATEGIC
ENVIRONMENT
How do teams assemble and analyze information about the
shifting market? How does this information inform sales and
marketing decisions? What techniques can the product
managementteamusetoleveragethisinformationforacompetitive
advantage?
PART A: NETWORK DEVELOPMENT
• Assumptions in staking out the territory
- Service area
- Provider network
• What are the needs of the real consumer? How are wants
and needs changing for consumers?
• Using segmentation in an actionable way
• Bid input – identifying the providers and capacity
- Current network – retained and open contracts
- Current area – additions and deletions
- New service area
Matt Chamblee FSA, MAAA, Consulting Actuary, MILLIMAN
PART B: MAPPING OUT THE COMPETITIVE LANDSCAPE
• Competitor positions
• Market share
• Product position
• Historical growth
• Bid input
- Future enrollment
- Attrition
Mary Kaye Thibert, Senior Vice President, GORMAN HEALTH GROUP
Diane Hollie, Senior Consultant, GORMAN HEALTH GROUP
12:00 - 1:00 LUNCHEON FOR ALL ATTENDEES
1:00 – 1:45 EXECUTING A PLAN—SIZING UP THE
INVESTMENT
Now that information has been aggregated, our team will show
you how data becomes action.
• The methodology and context of gross add projections
- Current service area
- New service area
- Understanding the impact of cost per lead on the bid
- Channel mix
- Historical
• What is an acceptable close rate?
• How many leads will be required to hit our objectives?
• What will our spend be in gross dollars?
Ida Kwok, Senior Actuarial Analyst, BLUE SHIELD OF CALIFORNIA
JANUARY
WHO SHOULD ATTEND?
• Product Management
• Medicare Advantage and Senior Products
• Government Programs
• Product Development
• Special Needs Plans
• Medicare Part D Plans
• Quality / Compliance
• Operations
• Risk Adjustment
• Revenue Management and Analysis
• Finance
• Actuaries
• Marketing and Sales Departments
• Network development
• Care management
• Consultants
TOP REASONS TO ATTEND
• Participate in the development of a mock bid—we’re going step-by-step
through the process! By the end of day two you’ll have access to a
whole new tool box!
• Understand key steps towards injecting quality and revenue initiatives
into your plan’s design
• Learn best practices in operationalizing the bid-- manage parties from
across department lines to meet important deadlines!
• Unlock critical steps in evaluating projections as they become significant
decisions—what will be the impact on risk adjustment, STARs, plan
design, and revenue?
• Hear how plans are building engagement strategies into their bid design
• Discover solutions for navigating state and CMS requirements for dual
eligible plans
• Access new avenues of revenue for your sales and marketing teams
• Evaluate the impact of the formulary on PBPs—how should pharmacy
tiers be matched up against performance objectives?
A STRATEGIC FRAMEWORK FOR THE MAPD BID PROCESS
AN INTERACTIVE SEMINAR FOCUSED ON ALIGNING YOUR APPLICATION TIMELINE TO COMPETITIVE OUTCOMES
JANUARY
DAY ONE – JANUARY 26TH

7. 11:30 - 12:15 RESPONDINGTOTHEFINALCALLLETTER
• Revenue projections
- Brief overview of the ins-and-outs of the final rate
- STARs – how does the rating fit into the bid? How
confident are we about October announcements on
these ratings?
- Risk Adjustment—how does the work-in-progress and
work plan initiatives fit into bid considerations?
• How do actuaries use the information?
- Finalclaims—weighingconcernsaboutcompletionfactors
- Trend-mitigation—weight given to business initiatives as
planned?
Matt Kranovich, Actuary, MILLIMAN
12:15 - 1:30 LUNCHEON FOR ALL ATTENDEES
1:30 - 2:15 TESTING PERFORMANCE AGAINST
FINAL GOALS
• BestpracticesforPBPtestingforaccuracyacrossmultipleusers
• OOPC and MOOP—best practices balancing out trade-offs in
the portfolio of products offered. What information should
you use to make these decisions?
• Using product strategy goals and positioning of Part C and
Part D to access buy down
• Understanding the sensitivity of Risk Adjustment, STARs, and
Plan Design against the benchmark
• Actuarial tips of the trade for optimizing revenue within the
bid methodology
• Testing your bid against your financial goals
• Uploading and testing for acceptance and working with HPMS
Kevin Mowll, Executive Director
RISE (Resource Initiative & Society for Education)
2:15 - 3:00 AUDITS, NABA, APPROVAL, AND
TRAINING
• Can you implement changes after filing? What is the revision
and resubmission process?
• Understanding desk review and the bid audit—what went
wrong? What can we do better for next time?
• What kind of shockwaves should you expect from the NABA
release and approval?
• Using the rebate reallocation process from the Part D average
bid to your advantage
• Training other departments on new changes and lessons for
next year
Matt Kranovich, Actuary, MILLIMAN
3:00 END OF SUMMIT
8:00 – 8:45 CONTINENTALBREAKFAST
8:45 – 9:00 RECAPOFDAYONE
9:00 – 10:00 ASSEMBLING THE STRAW MAN
• Establishing product options—how many should you include?
Where do you look to start trimming down options?
• Evaluating preliminary claims info and Rx claims
• Forecasting risk scores – how does this affect your preliminary
bid design?
• Understanding early risk adjustment projections and the
impact on your portfolio and financial goals
- Dollars per-member-per-month revenue
- Sweeps and lump-sum payments
• Gathering reactions to the straw man from the team—who
has input? How do you filter this information in a constructive
way?
• Administrative dollar assumptions – how much money are
you allocating to your operating costs?
- Department staffing
- Marketing spend
- Change in budget historical analysis
• Other trends in healthcare costs worth considering for your
initial straw man
Maria Carolina Ruiz, Manager of Product Planning and Strategy,
Senior Products
TUFTS HEALTH PLAN
10:00 - 10:30 KEY CONSIDERATIONS FOR DUALS PLANS
Because they’re filed with CMS and the State, DSNP bids carry their own
unique set of challenges. Coordinating two different sets of timelines is no
easy feat.
• What differentiates DSNP from MA bids? Are there extra steps? What
variables need to be factored into the decision?
• Are there different decisions being made along the timeline?
• How does the state’s review alter the bid?
Kyle Raeder, Director of Reimbursement and Financial Planning
COMMUNITY CARE, INC
10:30 - 10:45 MORNING BREAK
10:45 - 11:30 BUILDINGENGAGEMENTINCENTIVESINTOTHE
BIDTOIMPROVEHEALTHOUTCOMES
Member engagement is a core objective in a new era of health. Aligning this
strategy with your bid development process allows you to evaluate areas of
improvement. As with all things, however, it’s easier said than done.
• How do you identify areas of potential value add? What are some of the
outcomes?
• Which member incentives are allowed by CMS?
• Utilizing market segmentation within the bid to create innovative
engagement incentives
4:00 – 4:45 DISCUSSIONS SURROUNDING THE RX
WRAP UP
• Evaluating the impact of the formulary changes and contract
with PBM on the PBP matrix
• What information do we have on the generics pipeline and
howcanweuseittoaffecttotalcost? Whataboutspecialtydrugs?
• Uploading the formulary to CMS and working with HPMS to
resolve discrepancies
David Neiman, Senior Consulting Actuary
WAKELY CONSULTING GROUP
4:45 – 5:45 COCKTAILRECEPTIONIMMEDIATELYFOLLOWING
Please contact Jennifer Clemence at jclemence@healthcare-conferences.com
or (704) 341-2438 to hear more about our sponsorship opportunities.
APRIL–MAYAPRIL–MAYJUNEANDBEYOND
1:45 – 2:45 RESPONDING TO THE CMS
PRELIMINARY CALL LETTER AND
FINALIZING THE NETWORK
• Tips,tricks,andcriticalstepsinuploadingthenewnetworktoCMS
• Provider HSD Tables – Service area pass or no pass?
• Working with HPMS to resolve rejects and errors
2:45-3:00 AFTERNOON BREAK
3:00 – 4:00 UNITDOLLARS,TRENDS,ANDUTILIZATION
– SETTLING HEALTHCARE COSTS
• Unit cost inflation levels
• Contracting initiatives and the impact to trend
• Cost of management initiatives and their impact to trends
• Utilization trends
• Healthcare economics vs actuaries: what weight is given in the
bid to business plan goals and objectives not yet completed?
Kevin D. Rease, ASA, MAAA, President & Consulting Actuary
ALPHA DELTA HEALTHCARE CONSULTING
FEBRUARYMARCH
FEBRUARY
FEBRUARY
DAY TWO – JANUARY 27TH

8. HEALTHCARE EDUCATION
ASSOCIATES
200 WASHINGTON ST. SUITE 201
SANTA CRUZ, CA 95060
ATTENTION MAILROOM:
If undeliverable, please forward to
Finance, Product Development, or
Member Accounting
INCORRECT MAILING INFORMATION: If you are receiving multiple mailings, have updated information or would like
to be removed from our database, please fax our database team at 704-341-2641 or call 704-341-2387. Please keep in
mind that amendments can take up to 8 weeks. Conference Code: H246
Please Mention This Priority Code When Registering
Make checks payable to Healthcare
Education Associates, and write
H246 on your check.
Name
Company
Address
City
Phone
State
Email
Zip
Title
Payments must be received no later than January 18, 2015
Please bill my: MC VISA AMEX DISCOVER
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Four Ways to Register
704-341-2641 866-676-7689
www.healthcare-
conferences.com
HEA, LLC
18705 NE Cedar Drive
Battle Ground, WA 98604
Fax Call Web Mail
A STRATEGIC
FRAMEWORK FOR THE
MAPD BID PROCESS
The annual MAPD bid offers unrivaled access to new market opportunities. Getting it wrong, however, could
result in millions, if not billions, of lost revenue. With so much on the line, navigating the bid through the
assumptions and projections of development has never been more critical. This unique forum brings plans
together for step-by-step discussions on actionable bid implementations, resolving operational obstacles, and
attainable market advantages.
An Interactive Seminar focused on Aligning Your Application Timeline to Competitive Outcomes
JANUARY 26-27, 2015 SANIBEL HARBOUR MARRIOTT RESORT & SPA FORT MYERS, FLORIDA
T O R E G I S T E R : C A L L 8 6 6 - 6 7 6 - 7 6 8 9 O R V I S I T U S A T W W W . H E A L T H C A R E - C O N F E R E N C E S . C O M
H E A LT H C A R E E D U C AT I O N A S S O C I AT E S P R E S E N T S
MAPDBIDPROCESS
STANDARDRATE
MAPDBIDPROCESS
PLAN/PROVIDERRATE
*SUBJECTFROMHEAAPPROVAL
MAPDBIDPROCESS
GOVT., NOT-FOR-PROFIT
COMMUNITY SERVICE RATE
$2095 $1795* $895*
A STRATEGIC FRAMEWORK FOR THE MAPD BID PROCESS
Tw
o
great
conferences,one
location!