The World Congress 3rd Annual Health Care Reform Congress on Health Insurance Exchanges
Educational Underwriter
Partners
Media Partners
Health Plan Market Trends Letter
Strategic Partner
WHCC Health Innovations

Pre-Summit Workshop

Tuesday, July 24, 2012
8:00 am -
11:00 am
Health Insurance Exchange Pre-Summit Workshop:
Workshop A: Creating a Health Plan for Dual Eligibles

Dual Eligible Health Plans will have to meet the same requirements as those outlined by CMS for Special Needs Plans.

  • How do health plans meet the Medicare Advantage Requirements of a Special Needs Plan required for dual eligible operations?
  • Fulfilling quality requirements, grievances and appeals
  • What elements need to be considered in planning, strategy and product development
  • Discuss Medicaid and Medicare Advantage Contracting
  • Explore Home and Community Based Waivers- what do they look like?
Speaker Photo Unavailable Suzanne Gore
Director, Integrated Care for Dual Eligibles
Center for Health Care Strategy
Speaker Photo Unavailable Beth Marootian
Director Business Development
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
Workshop B: Building and Implementing a Qualified Health Plan

Recent guidance on Essential Benefits gave states the ability to allow for flexibility in the designing of a qualified health plan. If the goal is increased access, affordability and choice and the more you standardize, the less choice you have, how much is enough and how much is too much?

  • How will states determine how much flexibility to give?
  • Discuss Actuarial Evaluations in Qualified Health Plans: How Much Wiggle Room is there?
  • What is the best way for insurers to design a plan that is effective original, draws participation but falls within medal valuations?
  • What critical points and factors need to be determined in plan design to differentiate your product and still fall within the law?
  • What considerations need to be made in regards to how an individual exchange archetype will shape your QHP model?

Logistics, Challenges and Opportunities for Creating a Qualified Health Plan

  • Analyze the business case for standardized products and an Exchange environment?
  • Discuss the consumer and small business implications on Exchanges
  • What are the implications for Qualified Health Plans?
  • Explore the strategic and transformational issues that Qualified Health Plans need to grapple with as they prepare for Exchanges
Catherine Hamilton, PhD
Vice President of Planning
Blue Cross Blue Shield Vermont