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How Provider Groups Can Move Into Medicare Advantage: Right and Wrong Ways to Do It

August 8, 2013 Webinar - Listen On-Demand or Get a CD!

A rapidly growing number of provider organizations, especially those involved in accountable care organization (ACO)-type arrangements, are deciding to get into Medicare Advantage. But finding the best path to take can be complex, with the choice varying based on the kind of organizations and markets involved. There are right and wrong ways of doing everything from risk contracting to transaction processing to compliance, and picking the wrong routes could thwart any chances of success. Find out which path is likely to be most effective for your organization, what pitfalls to watch for, and what the likely impact will be for providers and Medicare Advantage plans and their partners.

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The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.

Co-hosted by Gorman Health Group and Atlantic Information Services, Inc., publisher of Medicare Advantage News, ACO Business News and AIS’s Health Reform Week

Now that many provider organizations have gotten an introduction to bearing risk via ACO-type arrangements with the government and/or commercial health plans, they are exploring how to get greater rewards from mastering these strategies. Medicare Advantage (MA) is a logical target for doing this, but requires a host of skill sets, resources and knowledge providers traditionally do not have. And they will be facing in MA a new kind of competitor that has those attributes in spades.

Among the many decisions provider groups face are whether and how to convert an organization to MA. If they do decide to convert, they need to gain the reserves and expertise for obtaining and using an insurance license, learn risk adjustment and enrollment reconciliation, meet federal compliance requirements for MA plans, process transactions, and develop relationships with agents and brokers. And there are avenues short of operating MA plans that could meet many of the providers’ objectives, such as via “shadow capitation” arrangements and partnerships.

Get practical advice on the best ways of getting into the MA market from three top Gorman Health Group consultants with many years of high-level experience in Medicare Advantage plans, provider organizations and government regulation. You’ll get specific suggestions on how to rapidly and most efficiently take the needed steps in areas such as:

  • Obtaining an insurance license, including meeting the requirements for substantial reserves;
  • Setting up effective MA-specific sales and marketing operations, including broker training;
  • Gearing up for enrollment reconciliation;
  • Handling risk adjustment;
  • Processing transactions for capitated entities and getting the actuarial expertise needed for setting rates for capitation or shadow capitation;
  • Understanding what documents are necessary for the MA plan application and how to proceed with a successful submission;
  • Developing 24/7 audit readiness via policies and procedures, training and documentation;
  • Meeting and exceeding standards for customer service and handling of complaints, appeals and grievances; and
  • Conceptualizing and implementing effective programs for star quality ratings that will qualify for bonuses from CMS.

Gorman Health Group’s the Point is teaming up with Atlantic Information Services, Inc. on an exclusive series of webinar presentations designed to provide the timely and meaningful information the Government health care industry needs to implement health reform. From expert analysis on the latest regulatory updates to war stories and best practices from our seasoned consultants, these webinar presentations deliver what you need to transform regulatory policy into operational reality. Members of GHG’s the Point attend the live webinar presentations at a discounted rate. Claim your discount now. Not a member yet? Learn about all the benefits of joining the Point.


AARON EATON is Chief Development Officer at Gorman Health Group, LLC. Prior to joining GHG, Aaron was the acting director of the Division of Finance and Operations for the Medicare Drug Benefit Group at CMS, where he directed the formulary, Part D benefit and Part D marketing teams through the first year of the Medicare drug benefit. Dr. Eaton received his Pharm.D. from the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He completed his pharmacy residency at AdvancePCS in Hunt Valley, Md.

WILLIAM A. MACBAIN is Senior Vice President, Finance at Gorman Health Group, LLC. He has more than 25 years of experience in senior management positions in the health care industry, including serving as chief financial officer of Capital District Physicians’ Health Plan in Albany, N.Y., and senior vice president and chief operating officer of Geisinger Health Plan in Danville, Pa. Mr. MacBain has been a board member of the American Association of Health Plans (the predecessor to AHIP), a member of the Medicare Payment Advisory Commission and president of the Managed Care Association of Pennsylvania.

REGAN PENNYPACKER is Senior Director of Compliance Solutions at Gorman Health Group, LLC. Ms. Pennypacker specializes in providing hands-on operational and compliance expertise in various aspects of the Medicare Advantage and Part D programs. She guides clients by providing innovative solutions and best practices for both meeting CMS requirements and exceeding industry standards. Ms. Pennypacker received her bachelor of arts degree from the College of the Holy Cross in Worcester, Mass. She earned her Managed Healthcare Professional designation from America’s Health Insurance Plans in 2004.

Moderator: Jim Gutman, managing editor of Medicare Advantage News and AIS’s Health Reform Week

Designed Especially For

  • ACO and other provider organization CEOs, chief operating and financial officers, directors of managed care, government affairs and compliance executives, risk managers, attorneys and accountants.
  • Medicare Advantage and Part D plan CEOs, CFOs, chief operating officers, provider relations executives, government affairs directors, new-business developers, product development directors, market research managers, attorneys and accountants.
  • Pharmaceutical and pharmacy benefit management executives
  • Attorneys, actuaries and consultants

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The On-Demand Recording will be delivered as a link within a PDF file of the accompanying written materials. Shipping will NOT be charged for this item.

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*On-Demand recordings will be available within a week of the conference and CDs will be available within two weeks.

Written Materials

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How Provider Groups Can Move Into Medicare Advantage: Right and Wrong Ways to Do It

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