New Medicare Advantage Rates: Health Plan Strategies for Bids Due in June

Recording and written materials of
AIS's Webinar on April 8, 2010

New Medicare Advantage Rates: Health Plan Strategies for Bids Due in June

Final Medicare Advantage payment rates for 2011 came out April 5, and they contain both expected and unanticipated changes from the preliminary rates released Feb. 19. Although basic MA pay rates for next year are frozen under the terms of the new health reform law and while the coding-intensity adjustment did not change, the “normalization” factor went up big time. MA plans now must figure out quickly what these and other rate-related changes for 2011 mean, and they must add in the potential effect of risk adjustment data validation (RADV) audits on rates and the impact of the continuing substantial rise in medical costs. This is all extremely complex, and there is little time to sort it out since bids for 2011 are due in early June. Map out your organization’s strategy for dealing with these major changes ahead for MA sponsors.

Sponsored by Atlantic Information Services, Inc., publisher of Medicare Advantage News and Health Plan Week

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	CD ($329) Pub code: C0A10T
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Medicare Advantage plans will have their basic pay rates frozen for next year under terms of the new health reform law, but that’s only part of the 2011 rates story. Under the terms of the final rates issued by CMS on April 5, there are a host of other changes affecting pay rates. Some of those changes were expected, and some were not. With bids for 2011 due June 7, MA plans have very little time to sort out the major changes ahead and formulate their benefits and premiums strategies for the Annual Election Period in the fall.

In this Webinar recorded on April 8 — just three days after those final rates are released — you'll get expert assistance, from an industry veteran who knows all the ins and out of MA financial analysis, on:

Figuring in trend, prior-year corrections, fee-for-service normalization and budget neutrality
The big increase in the normalization factor, and the postponement of the recalculation of Hierarchical Condition Category (HCC) codes, and what they mean for your strategy
The current status of the “doc fix” and what it means for your planning
How to figure in reforms affecting payments in 2012 and later years
RADV audit exposure and its impact on payment rates
Overall strategic implications for benefits and bids

Speaker

WILLIAM A. MACBAIN is senior vice president, finance of 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. He 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.

Moderator: Jim Gutman, managing editor of AIS’s Medicare Advantage News

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