Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges

AIS Virtual Conference: Wednesday, September 17, 2014 – 11 a.m. to 5 p.m. (Eastern)

There is finally a substantial number of CMS-backed and state initiatives up and running for Medicare-Medicaid dual eligibles. And these startups are beginning to generate a wealth of evidence about what is working and where participating plans and states must now focus to solve remaining problems.

What’s at stake? A largely untapped market of about 9 million duals who are in desperate need of truly integrated care and account for hundreds of billions of dollars in annual health care spending. Duals comprise 16% of Medicare enrollees but account for 27% of Medicare costs, and 15% of Medicaid enrollees but 40% of Medicaid spending.

Preliminary results are already available. Some states and participating plans are now reporting initial results related to passive enrollment, coordination between Medicare and Medicaid, medical services utilization, cost savings and more. When you attend this unique virtual conference from the convenience of your own office on Sept. 17, you and your management team will hear the details of bottom-line solutions from 11 of the nation’s top duals experts from the private and public sectors — speakers on the front lines of existing and developing duals programs.

In one information-packed afternoon, you’ll gain valuable practical intelligence and strategic insights on topics such as:

  • Succeeding in voluntary and passive enrollment in the duals programs, including a case study on what has (and hasn’t) worked in getting duals into the programs that are right for them — and keeping them there.
  • Getting Medicare, Medicaid and community resources to truly coordinate care for duals and assure that beneficiaries are accessing the right providers, including for behavioral health.
  • Controlling medical-services utilization so that cost-savings objectives can be achieved.
  • Containing plans’ administrative and other costs so that relatively low payment rates and quality withholds don’t make continued participation infeasible.

Each of the conference's four sessions concludes with Q&A segments devoted to your individual questions. Register Now!


The Virtual Experience: Get intensive training from the convenience of your own office or conference room. No travel required! Gather your entire management team for the most cost-effective training in the industry. Register Now!


Schedule at a Glance

Go to AGENDA for full descriptions and speaker details on each session

AIS Virtual Conference: Wednesday, September 17, 2014

11 a.m. – 12:30 p.m. Lessons Learned: An Overview of What Has Worked (and What Hasn’t) From Initial CMS and State Duals Programs (90 minutes)
Experts from both the Medicare and Medicaid sides of the industry will give you a fast-paced status report on what has already taken place on implementation of the duals initiatives, how well the programs have fared, and what has worked best and worst. They’ll analyze how voluntary and passive enrollment has worked, why experiences have differed from one state to another, which strategies for enrollment and outreach have been most effective, and which have failed.
See full agenda and speakers

12:45 p.m. – 1:45 p.m. Case Study: Implementation of the California Duals Initiative (60 minutes)
Two veterans of the California demo — the head of the firm serving as the state’s duals consultant and a top executive of a large health plan participating in multiple counties — analyze the specifics of California’s CMS-backed program. You’ll get an inside look at how it has gone so far and why. Which outreach efforts have been most and least successful? Why have some opt-out rates been very high while others haven’t? What have the state and plans done to ensure that the right providers are participating in the program?
See full agenda and speakers

2:15 p.m. – 3:15 p.m. Initial Behavioral Health and Pharmacy Experiences in Duals Initiatives (60 minutes)
Two of the biggest determinants of whether duals initiatives will be successful in improving care and saving money are how the often-abundant behavioral-health needs of beneficiaries are dealt with and how effectively their pharmacy benefits are handled. The combined prevalence of mental-health and substance-abuse problems in the duals population is about 17%. And one of the keys to successful care integration for this population is tied to proper access to and use of pharmaceuticals.
See full agenda and speakers

3:30 p.m. – 5 p.m. What’s Next for Duals Initiatives? (90 minutes)
Share a crystal ball with an all-star panel peering into the future of duals initiatives. There is a consensus that initiatives for integrating care for duals have only just begun to find ways that will improve outcomes and save money, so what directions will they head in later and how quickly?
See full agenda and speakers


Speakers at a Glance

Robb Cohen, Gorman Health Group • John Gorman, Gorman Health Group • Peter Harbage, Harbage Consulting • Austin Ifedirah, DDS, Gateway Health • Mary Kennedy, the Association for Community Affiliated Plans • Thomas Lutzow, Ph.D., Independent Care Health Plan (Icare) • Shuchita Madan, Medicaid Health Plans of America • Cynthia Pigg, Magellan Medicaid Administration • Lisa Rubino, Molina Healthcare • Brian Wheelan, Beacon Health Strategies • Robert Wychulis, Inovalon

Go to SPEAKERS for detailed speaker information


Who Should Attend?

  • Health plan
    • CEOs
    • CFOs
    • Chief operating officers
    • Government affairs and compliance directors
    • Product development and sales and marketing executives
    • Contracting and provider relations directors
    • Medical and clinical services directors
    • Accountants and actuaries
  • Provider organization
    • CEOs
    • Administrators
    • Directors of managed care contracting
  • Pharmaceutical and pharmacy benefit company executives
  • Financial analysts
  • Health care IT vendors
  • State health officials and leaders of patient-advocacy organizations
  • Attorneys, consultants and actuaries

AIS Virtual Conference: Wednesday, September 17, 2014 – 11 a.m. to 5 p.m. (Eastern)

Agenda

11 a.m. – 12:30 p.m. Lessons Learned: An Overview of What Has Worked (and What Hasn’t) From Initial CMS and State Duals Programs (90 minutes)

Experts from both the Medicare and Medicaid sides of the industry will give you a fast-paced status report on what has already taken place on implementation of the duals initiatives, how well the programs have fared, and what has worked best and worst. They’ll analyze how voluntary and passive enrollment has worked, why experiences have differed from one state to another, which strategies for enrollment and outreach have been most effective, and which have failed. You and your management team will hear informed answers to these and related questions:

  • Which states have already launched major duals initiatives? How far along are they in implementation? What overall lessons have been learned thus far?
  • How effective have voluntary enrollment campaigns been? What strategy changes would make them more effective?
  • How have passive-enrollment processes worked and why? What tools have been used for “intelligent assignment” of duals? How effectively have they worked in limiting opt-outs?
  • What do the initial indicators tell us about continuity of care, use of community resources, and how much and where medical services utilization is taking place?
  • How is the financial picture shaping up in relation to achieving efficiencies and meeting cost-savings and quality-withhold targets? How much impact have lower-than-anticipated plan payment rates had on this?

Presenters:
ROBB COHEN, Senior Vice President, Public Policy, Gorman Health Group, LLC
SHUCHITA MADAN, State Affairs Manager, Medicaid Health Plans of America
ROBERT WYCHULIS, President, Inovalon, Inc. and formerly President, HealthPlus unit of WellPoint, Inc.

15-minute break

12:45 p.m. – 1:45 p.m. Case Study: Implementation of the California Duals Initiative (60 minutes)

Two veterans of the California demo — the head of the firm serving as the state’s duals consultant and a top executive of a large health plan participating in multiple counties — analyze the specifics of California’s CMS-backed program. You’ll get an inside look at how it has gone so far and why. Which outreach efforts have been most and least successful? Why have some opt-out rates been very high while others haven’t? What have the state and plans done to ensure that the right providers are participating in the program? You’ll hear the details of:

  • Where is California in its implementation of the duals initiative? What have been the most difficult challenges? What are the big tasks left? How has the timetable changed in recent months and why?
  • Why was the initial opt-out rate in the first county (San Mateo) so high? How are things different in Los Angeles and other counties?
  • What are the characteristics of the beneficiaries who are staying in versus opting out of the demo? What does this mean for the potential for adverse selection?
  • What strategies have proven successful for gaining provider participation in networks to serve the dual eligibles?
  • What is known thus far on medical services utilization? How are appeals of coverage determinations being handled?

Presenters:
PETER HARBAGE, President of Harbage Consulting and California’s consultant on its dual-eligibles initiative
LISA RUBINO, Senior Vice President, Medicare, Duals and Marketplace, Molina Healthcare, Inc., a multi-county participant in the California demo

30-minute break

2:15 p.m. – 3:15 p.m. Initial Behavioral Health and Pharmacy Experiences in Duals Initiatives (60 minutes)

Two of the biggest determinants of whether duals initiatives will be successful in improving care and saving money are how the often-abundant behavioral-health needs of beneficiaries are dealt with and how effectively their pharmacy benefits are handled. The combined prevalence of mental-health and substance-abuse problems in the duals population is about 17%. And one of the keys to successful care integration for this population is tied to proper access to and use of pharmaceuticals. Hear from two industry experts on what the initial evidence suggests on:

  • To what degree are duals initiatives excluding extra-difficult populations such as the developmentally disabled? How frequently are the demos intending to exclude the developmentally disabled but not winding up accomplishing that?
  • To what extent have key behavioral-health providers been willing to participate and actually been included in the provider networks for duals? To what extent is the participation occurring in the primary care setting?
  • How successfully are the duals initiatives dealing with behavioral-health-linked issues such as adequate housing and transportation?
  • What does the initial evidence indicate about the use of pharmacy benefits by duals? What have been the biggest obstacles?
  • What are the duals plans doing so far to ensure beneficiary compliance with medication regimens?

Presenters:
BRIAN WHEELAN, Executive Vice President, Corporate Strategy and Development, Beacon Health Strategies
CYNTHIA PIGG, Senior Vice President, Pharmacy at Magellan Medicaid Administration, Inc.

15-minute break

3:30 p.m. – 5 p.m. What’s Next for Duals Initiatives? (90 minutes)

Share a crystal ball with an all-star panel peering into the future of duals initiatives. There is a consensus that initiatives for integrating care for duals have only just begun to find ways that will improve outcomes and save money, so what directions will they head in later and how quickly? You’ll hear details on these and other future-looking questions:

  • What is likely to happen after the CMS duals demonstration ends?
  • To what extent are the current duals initiatives expected to meet the savings goals of the states? What is likely to happen if they fall short?
  • How effective are the quality withholds likely to be in rewarding plans that do well? Can duals plans meet their financial needs without receiving much from these withholds?
  • To what extent and via what methods will duals plans and states be able to improve the handling of appeals and grievances?
  • How effective will duals plans and states be in tailoring benefit designs to the needs of duals?
  • What approaches are likely to be successful in dealing with the key issue of long-term care for duals? What are the critical success factors?

Panelists:
JOHN GORMAN, Executive Chairman, Gorman Health Group, LLC
AUSTIN IFEDIRAH, DDS, Vice President, Medicare and Strategic Planning, Gateway Health Plan
MARY KENNEDY, Vice President, Medicare and Managed Long Term Care, Association for Community Affiliated Plans
THOMAS LUTZOW, Ph.D., President and CEO, Independent Care Health Plan (iCare)

AIS Virtual Conference: Wednesday, September 17, 2014 – 11 a.m. to 5 p.m. (Eastern)

Speakers

ROBB COHEN is Senior Vice President, Public Policy at Gorman Health Group, LLC, focusing on health policy and its relationship with health plan operations, including on dual eligibles and long-term care. He joined Gorman in 2013 after serving as chief government affairs officer and a founder of XLHealth Corp., an operator of Medicare Advantage Special Needs Plans that was acquired by UnitedHealth Group in 2012. Before coming to XLHealth, Mr. Cohen was a founder and president of Phoenix Healthcare Consulting for six years.

JOHN GORMAN is Executive Chairman of Gorman Health Group, LLC, a company he founded under another name in 1996. Under Mr. Gorman’s direction, Gorman Health Group has become a leading professional services and solutions firm for government-sponsored health care programs. His work focuses on strategy, cultural transformation, governance and turnaround situations in health plans. Prior to founding his firm, Mr. Gorman served as assistant to the director of the Office of Managed Care at CMS-predecessor HCFA, where he provided day-to-day management and served as the external liaison for the Medicare and Medicaid managed care programs.

PETER HARBAGE is President of Harbage Consulting and serves as California’s consultant for its dual-eligibles initiative. Before starting his firm, which works largely with government agencies and nonprofit foundations, Mr. Harbage served as the senior health policy advisor to presidential candidate and former U.S. Sen. John Edwards (D-N.C.). His prior positions include assistant secretary for health at the California Health and Human Services Agency under Gov. Gray Davis and special assistant to the administrator of HCFA in the Clinton administration. Mr. Harbage started his career as a Medicaid budget analyst at the U.S. Department of Health and Human Services.

AUSTIN IFEDIRAH, DDS, is Vice President, Medicare and Strategic Planning at Gateway Health, responsible for the direction, execution and implementation of all Medicare products, including Special Needs Plans. Before joining Gateway in 2011, Dr. Ifedirah served as senior director of operations, market head and director of Special Needs Plans for XLHealth Corp. Prior to that, he was manager for business development for Elder Health HMO, Inc., where he led a three-county expansion and was in charge of strategy formulation, due diligence, market entry/development, network expansion and regulatory filings. In the early 1990s, Dr. Ifedirah practiced general dentistry and oral surgery.

MARY KENNEDY is Vice President, Medicare and Managed Long Term Care, at the Association for Community Affiliated Plans (ACAP), which represents “safety net” health plans. She returned to ACAP in 2010 after a 10-month stint as senior policy advisor on health reform at HHS’s Center for Medicaid, CHIP, Survey and Certification, CMSO. Before originally joining ACAP in 2008, Ms. Kennedy was senior vice president for the Evercare unit of UnitedHealth Group, focusing on integrated care for dual eligibles. Before that, she held a variety of positions in Minnesota health care programs, including serving as the state’s Medicaid director from 1997 to 2004.

THOMAS LUTZOW, Ph.D., is president and CEO of Independent Care Health Plan (iCare), a duals plan that is a joint venture between Humana Inc. and a local Milwaukee rehabilitation agency. Dr. Lutzow was an original architect of this initiative that started in 1992. He has served on its board of directors since inception, and became president and CEO in 2008. iCare operates a dually eligible Special Needs Plan with more than 5,000 members and is an integral part of the Wisconsin Family Care Program for long-term care.

SHUCHITA MADAN is State Affairs Manager for the Medicaid Health Plans of America (MHPA) trade association and leads the group’s state-related initiatives. This includes working on policy issues related to dual eligibles and long-term care populations. She represents MHPA with states and provides analysis of state activity and trends to MHPA member firms. While earning her master’s degree in public health, she worked for the Pharmaceutical Research and Manufacturers of America trade group and George Mason University’s Center for Health Policy Research and Ethics.

CYNTHIA PIGG is Senior Vice President, Pharmacy, at Magellan Medicaid Administration, Inc. Before joining Magellan in 2010, Ms. Pigg was executive director and CEO of the Foundation for Managed Care Pharmacy for more than five years. Prior to that, she spent 15 years at CIGNA Healthcare, serving as part of the senior leadership team for that insurer’s pharmacy benefit manager and health plans. Her final position at CIGNA was Vice President, Pharmacy Services. Ms. Pigg also is a past president of the Academy of Managed Care Pharmacy.

LISA RUBINO is Senior Vice President, Medicare, Duals and Marketplace, at Molina Healthcare, Inc. In her role, Ms. Rubino is responsible for the overall strategic direction and implementation enterprise-wise of duals, exchanges and Medicare expansion. Previously, she served as senior vice president of health plans – western region, and before that was president of Molina Healthcare of California. Prior to joining Molina, Ms. Rubino was a member of the Blue Shield of California executive leadership team. She has more than 30 years of experience in health care operations.

BRIAN WHEELAN is Executive Vice President, Corporate Strategy and Development, for Beacon Health Strategies, which specializes in behavioral health management, working with health plans to serve more than 11 million lives across 25 states. He leads the company’s sales, marketing, development, partnering and acquisition activities and formerly was Beacon’s chief financial officer. Before joining Beacon, Mr. Wheelan was a manager at financial firm Bain & Co., where he specialized in corporate strategy development and mergers and acquisitions. Prior to that, he was assistant secretary for policy and planning and the deputy director of Medicaid for Massachusetts’ Executive Office of Health and Human Services.

ROBERT WYCHULIS is President of Inovalon, Inc., a leading health care data analytics firm. In that role, he serves as the company’s general manager. Before joining Inovalon this spring, Mr. Wychulis was president of HealthPlus, a New York government programs health plan in the Amerigroup unit of WellPoint, Inc. In that capacity, he was responsible for the full profit-and-loss management of its $1.9 billion product portfolio. Prior to that, he served as president and CEO of the Florida Association of Health Plans and, before that, president and CEO of HealthPlan Southeast, a North Florida managed care company.

Moderator: Jim Gutman is managing editor of AIS’s Medicare Advantage News and helped develop and launch AIS’s health reform publications. Jim has more than 35 years of experience in business journalism and has been overseeing Medicare Advantage News and its predecessor for 13 years. He joined AIS in 2001 after serving 10 years as president, editor and publisher of Business Information Services, Inc., which published six managed care newsletters along with ancillary products. His prior positions included managing corporate publications for Johnson & Johnson and serving as business editor of the Milwaukee Sentinel and assistant financial editor of the Baltimore Sun daily newspapers.

AIS Virtual Conference: Wednesday, September 17, 2014 – 11 a.m. to 5 p.m. (Eastern)

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Last minute change in your plans? Your registration includes a free On-Demand Recording of the entire conference, so even if you miss some of the conference as it’s happening, you’ll have the full recording available after the event. Or if you prefer, you can change your registration and free On-Demand Recording to an order for the CD and printed materials. Both the On-Demand Recording and CD include the entire audio presentations and a printed copy of the slideshow presentations and any additional materials. On-Demand recordings are available within one week of the event and CDs are available within two weeks.

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On-Demand recordings are delivered as a link contained within a PDF file of the accompanying printed materials. Shipping will NOT be charged for this item.

  • If you order the On-Demand recording before the conference date (complimentary with a registration to the live event), you will be sent an e-mail with the PDF file attached once the recording is available — approximately one week after the event.
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CDs are available approximately two weeks after the event. CD recordings (and accompanying printed materials) are shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes). You should receive the shipment within two weeks of placing your order (or two weeks after the event if you preordered the CD). Shipping and handling cost for CDs is $12. Rush Orders: Please call us at 800-521-4323 to place a rush order. We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

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AIS Virtual Conference: Wednesday, September 17, 2014 – 11 a.m. to 5 p.m. (Eastern)

The Virtual Experience

Get intensive training from the convenience of your own office or conference room. No travel required! Gather your entire management team for the most cost-effective training in the industry.

Register today for the live event and get a complimentary On-Demand Recording of the entire conference. For more information, go to Virtual Conference Details or call AIS Customer Service at 800-521-4323.

Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges

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