Audiotape and written materials of AIS's audioconference on July 29, 2004

Emerging Product Strategies for Medicare Advantage and Part D

In a critical step for implementation of the Medicare Modernization Act (MMA) of 2003, CMS on July 21 released vital details about possible service areas for regional PPOs and Prescription Drug Plans (PDPs) along with guidance for organizations considering those products. Moreover, proposed Medicare Advantage (MA) regulations would require organizations to take steps immediately in order to get a competitive advantage. For health plans, PBMs, providers and a host of other entities, that means getting prompt guidance from experts with both private- and public-sector experience.

Sponsored by AIS's Managed Care Week, Medicare Advantage News, and Drug Benefit News

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Two uniquely qualified authorities on Medicare managed care provide a fast-paced strategy discussion, focusing on emerging opportunities and pitfalls for PPOs and PDPs, and how to get positioned. They analyze the latest regulatory developments with an eye toward steps you can begin taking immediately in light of the new details from CMS. And they present three strategies for long-term survival: product design, multiple products, and disease management.

Their analysis follows a key July 21 CMS meeting they attended in which the agency elaborated on its strategy for implementing the regional definition requirements of the MMA. The law mandates that there be between 10 and 50 PDP regions, which must be the same as MA plans "to the extent practicable."

As CMS itself notes, "the sizes and configuration of regions will themselves impact the entry behavior of plans." For PDPs, CMS notes, the implications of the regional definition "include the trade-off of conforming to existing markets versus encouraging plan choice in areas projected to be underserved."

Get a "back of the envelope" financial analysis of the regional configurations. And hear how the new developments affect the overall attractiveness of the opportunities for PDPs and MA plans.

Find Out…

 

Speakers

JOHN GORMAN is president and CEO of Gorman Health Group, the leading consulting firm specializing in Medicare managed care. 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., then chairman of the House Government Operations Committee. Mr. Gorman specializes in strategic planning and business development for the health care industry, with particular emphasis on federal programs and regulation.

TOM ANDERSON is a principal in Gorman Health Group. Prior to joining Gorman, he served eight years as senior vice president of strategies and planning for United Healthcare and guided the growth of United's Medicare business from $300 million in annual revenue to $3.5 billion within four years. His team pioneered the development of United's first managed prescription drug program and its introduction of PPO products into the Medicare+Choice program. Before his work at United, Mr. Anderson held several key positions for health plan operator FHP, Inc., including vice president of marketing.

Moderator: Jim Gutman, vice president and executive editor of Atlantic Information Services, Inc.

 

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Written Materials

The audiotape is accompanied by practical written information about opportunities in the 2003 Medicare reform law.