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Creating Medicare Part D plan bids for 2006 was especially challenging for sponsors because they didn’t have any data to support benefit designs or premium levels. As a result of this void in their knowledge and experience, most plans wound up owing huge sums of money to CMS — a total of $4 billion industry-wide. Now plans have the data, but many lack the tools and strategies required to fix this year’s problems and make sure next year’s bids are more accurate.

A plan’s own data include everything necessary to ensure successful PDE reconciliations and prepare accurate bids for the future, but most plans need workable strategies for tracking and using the data. It is important that plans cure the problem, not just deal with the symptoms, by looking at the metrics and tracking PDEs submitted, duplicated, rejected, and accepted.

Hear Jana Furda of Plan Data Management share the specifics of winning strategies for PDE data tracking and reconciliation, in time to prepare more accurate bids in the spring. Topics covered include:

• How to manage plan-to-plan data and processes
• Effective techniques for combining PDE cost data with prospective payment data
• The best methods to calculate and track reconciliation amounts (low-income cost-sharing, reinsurance, risk share, etc.)
• Techniques for accessing data more effectively
• Strategies for resolving systematic issues
• Ways your plan can forecast bids for next year more accurately

Speaker

Jana Furda is vice president of product development for Plan Data Management, Inc., where she helps develop an enterprise decision system to assist medical management, network development, finance, underwriting and sales functional areas. The company offers fraud and abuse detection services through proactive data mining and analytics, prospective investigation of suspect claims, retrospective fraud and abuse investigations, resolution of fraud and abuse issues, and consulting services. Prior to joining PDM, Ms. Furda worked as an independent consultant providing business strategy and development services to CIGNA. She has five years experience on the health plan side working for Prudential Health Care, where she was responsible for network strategy and reporting, strategic financial analysis and medical cost reduction initiatives. Before this, she was a manager in the HealthCare Consulting Practice of Deloitte & Touche providing financial and operational services to the managed care industry, including development of Medicare+Choice plans.

Moderator: Barbra Golub, JD, managing editor of Medicare Part D Compliance News and The HCCA-AIS Medicaid Compliance News.

Designed Especially For

Compliance officers, auditors, legal counsel, government-relations executives, financial executives, program managers, provider-relations managers, and other managers with Part D responsibilities at:

• Stand-alone Medicare Prescription Drug Plans (PDPs)
• Medicare Advantage plans
• Pharmaceutical companies
• Pharmacy benefit management companies
• Lawyers and consultants

Written Materials