• Health care economics across Medicare, Medicaid and State Exchanges
• The pressure on law makers to rein in costs while improving quality and access

• Hear what is being done to overhaul insurance infrastructure to help consumers understand their healthcare costs
• Why are these changes important, regardless of regulatory developments and possible changes?
• How can these changes to insurer business models contain costs and improve quality of care for customers?

• Hear from two states from the CMS pilot program on Duals
• Understand how different states are approaching program development
• What are the challenges and opportunities?

• Critical need for data integration
• Importance of structural integration to support data integration
• 3 Projects Demonstrate the Linkage: Star - focused member survey with care management implications [engaging members with needs], risk adjustment implications [in identifying undercoded/underdiagnosed groups], and network management implications [engaging groups/IPAs in improvement projects]
• CHAs with CM implications
• Low RAF members in CM to risk adjustment dept., high RAF not in CM in Predictive Modeling
• Correlation between RAF and health care costs

• ACOs
• Medical Homes
• Bundled Payments
• Provider/plan collaboration for quality, yet high-value patient care
• Transitioning seamlessly into a new payment model

• Examining the relationship between MTMPs and star ratings
• Managing the pharmacy/payer relationship
• Successfully managing CMS' adherence mandates
• Comprehensive Medication Review update
• Medicare reporting mandates

This session will discuss the historical and current state of enrollment of dual eligibles in Medicare Advantage and Medicaid managed care plans. The session will examine how many dual eligibles are currently enrolled in Medicare Advantage plans, as well as the demographic characteristics of the dual eligibles in Medicare Advantage plans in each state. The session will wrap up by assessing the overlap of Medicaid managed care plans and Medicare Advantage plans, including how many dual eligibles are enrolled in both types of plans, and the demographic and health characteristics of the dual eligibles that tend to be enrolled in both types of plans.

• How many dual eligibles are enrolled in Medicare Advantage plans, and where they are enrolled in 2012
• How enrollment of dual eligibles in Medicare Advantage plans has changed over the past decade
• What types of dual eligibles and how many are enrolled in Medicare Advantage and Medicaid managed care plans

• Review and discuss unique clinical model to manage acute and post-acute care through a partnership between physicians, hospitals and post-acute care management company
• Clinical model and partnership will be leveraged through collaborative relationships with payers and providers that will maximize value in acute and post-acute care through bundled payments arrangements, commercial shared savings programs, and ACOs.

• Learn why authenticity in advertising works better than worn out approaches like “celebrity spokespeople”
• Music is the joyous, hip-shaking, memory-making, synapse-firing connective tissue of the Baby Boomers. But there’s a right way and a wrong way to use it in advertising
• Life is funny. People are funny. The greatest movies, TV shows and ads are funny. So why, then, is there such a dearth of humor in Medicare advertising? Learn how you can harness the power of humor
• The biggest change to the Medicare marketing paradigm will be an appeal to hope, not fear. Learn how to effectively use hope to attract your members of the future

• Impact of eliminating the tax advantaged status of retiree drug subsidies
• Growth in 340B eligibility attributable to Medicaid expansion
• Pharma and payer perspectives on each

• New payment approaches
• Solving the SGR issue
• Impact on physician pay and drug payments
• How cuts across MAs will be managed by CMS
• Health Plan Response
• Provider Strategy

Pilot Project Overview:

• 305 patients seen in 12-months
• 1174 recommendations made for medication changes
• 666 changes implemented and sustained
• $603,580 in medication cost savings realized by the health plan
• $165,971 in co-pay savings to members
• Decrease in ER visits and hospitalizations
  

Principles needed to successful fulfill the spirit of the MTM mandate:

• Highly trained clinical pharmacists able to provide patient centric MTM
• Direct communication with member and provider
• Software that provides actionable clinical intelligence, patient specific information and facilitates collaboration between the pharmacist, patient and their provider