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Health reform legislation enacted in March is a game changer for Medicare Advantage, and there is little time to adjust your strategies if you want to thrive — or even survive — in the topsy-turvy new environment. While the big cuts in MA pay rates don’t start until 2012, you must begin planning now to make sure your organization is in the right service areas and products based on the new payment structure. And the time is now to begin getting the required evidence of quality needed to boost MA plan payments. Plans that are nimble, data-driven, member-centric and committed to strong provider relationships should emerge from reform with a strong bottom line; those that fall short in these areas may be casualties sooner rather than later. The question is not whether — but rather by how much and when — your revenue per MA plan enrollee will decrease. The answers are complex and depend on factors such as where you operate, what the prevailing pay rates are now, what you can do to meet the criteria for quality and efficiency bonuses, and what your plan-specific risk scores and enrollment demographics are. Hear from John Gorman and Bruce Fried, two experts on the MA reform law and its implications for health plan business strategies, on how reform will impact plans and their partners, and what steps you should take now and in the future to deal with the huge changes ahead. Among the topics they cover are:
BRUCE MERLIN FRIED is a partner in the national Health Care and Public Law & Policy Strategies groups at law firm Sonnenschein Nath & Rosenthal LLP, where he counsels health plans and physician groups. His more than 30 years of health care law and policy experience includes serving as director of the Center for Health Plans and Providers at HCFA (now CMS), where he was responsible for policy and operations for the Medicare program. Before that, he was director of HCFA’s Office of Managed Care. Before joining the government, Mr. Fried was vice president of federal affairs at health plan operator FHP International Corp. He also was chief coordinator of the 1992 Clinton/Gore campaign’s Health Care Advisory Group. JOHN GORMAN is founder and CEO of Gorman Health Group, LLC, the leading consulting firm specializing in Medicare managed care and Part D. Before starting his company in 1996, Mr. Gorman served as assistant to the director of HCFA’s Office of Managed Care under two directors. Prior to that, he was staff director for U.S. Rep. John Conyers, Jr. (D), then chairman of the House Government Operations Committee. Moderator: Jim Gutman, managing editor of AIS’s Medicare Advantage News and Health Reform Week
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