Private and public exchanges, accountable care organizations (ACOs) and narrow-network insurance products are about to dramatically reshape the health insurance marketplace. For health insurers and self-funded employers, the ability to engage consumers and accurately benchmark provider rates will be essential. While millions of uninsured people are expected to gain coverage beginning in 2014, the health of the overall risk pool, limits on age-ratings bands and participation fees for exchanges will pressure premiums. But consumers are expected to choose coverage based on price, rather than on provider networks or brand recognition. In response, carriers will emphasize narrow-network products, cost-saving ACOs and other models. And calculating out-of-network rates will be critical. Benchmark data also are invaluable when communicating the value of insurance exchanges to consumers who have limited or no experience with health insurance. Innovative uses of data will set organizations apart as the industry continues to evolve. Hear a highly informative presentation of how different data sources may be used to set out-of-network rates in exchanges, ACOs and narrow networks.
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.
It’s been nearly five years since New York’s attorney general investigated the state’s out-of-network reimbursement system and concluded it was flawed. UnitedHealth Group and 10 other insurers contributed nearly $100 million to a 2009 settlement, a portion of which was used to launch FAIR Health, Inc., a not-for-profit entity that has become a national clearinghouse for claims-based data.
Since then, the health insurance marketplace has undergone its greatest transformation since HMOs were introduced 40 years ago, with ACOs, narrow networks and insurance exchanges redrawing the national landscape.
Hear all the specifics about how FAIR Health and other data alternatives can be used for ACOs, insurance exchanges and narrow-network products. You’ll hear directly from FAIR Health’s president and a leading consulting actuary who specializes in provider contract review and benchmarking. You’ll get answers to these and other questions:
ROBIN GELBURD is president of FAIR Health, Inc., a national, independent nonprofit with the mission of bringing fairness and transparency to health care costs and insurance reimbursement. FAIR Health uses its database of more than 15 billion billed medical and dental procedures to power a free website that enables consumers to estimate and plan their health care expenditures. In addition to its consumer offerings, FAIR Health licenses data to insurance plans, third party administrators, brokers, benefits advisors, government agencies, healthcare providers, and researchers. Ms. Gelburd joined the organization when it was founded in October 2009. Before she was recruited to FAIR Health, Ms. Gelburd served for eight years as General Counsel of a foundation dedicated to the promotion of biomedical research. Ms. Gelburd also served as Chairperson of a statewide coalition that had as its mission the promotion of state funding and support for stem cell research. Prior to her tenure as General Counsel, Ms. Gelburd was a health law partner at Kalkines, Arky, Zall & Bernstein (now Manatt, Phelps & Phillips LLP). During her 10 years at that firm, she represented a wide array of health care-based clients on a variety of strategic, regulatory, policy, governance, business, and contractual matters. Previously, Ms. Gelburd worked as a litigation and corporate associate at the international law firm Morrison & Foerster. She began her legal career as a federal appellate law clerk to the Honorable Francis D. Murnaghan, Jr. from the Court of Appeals, 4th Circuit.
ROBERT PARKE is a principal and consulting actuary in the New York City office of Milliman, where he provides actuarial and consulting services to a broad range of clients, including Blue Cross and Blue Shield plans, HMOs, commercial insurers, government agencies and health care providers and vendors. Mr. Parke’s work includes rate development and review, provider contract review and benchmarking, evaluations of pay-for-performance and disease-management programs and the development of risk-sharing and reimbursement arrangements for physician groups and other integrated delivery systems. Prior to joining Milliman in 1995, Mr. Parke worked at Tillinghast, a Towers Perrin Company. In addition, he has worked extensively in health insurance in the United Kingdom and South Africa.
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*On-Demand recordings will be available within a week of the conference and CDs will be available within two weeks.
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