FLY-IN: Medicare Advantage (MA) Bid Design & Supplemental Benefits

01/29/2025 12:00 PM - 4:30 PM

Connect, ask questions, and gain valuable insights from an industry expert!

Melissa Smith, Founder, Newton Smith Group
Star Ratings strategy, operational improvement, quality performance.

01/29/2025 12:00 PM - 12:15 PM

01/29/2025 12:15 PM - 1:45 PM

This session provides a rapid overview of key regulatory and market considerations for the 2026 pricing season. Topics include:

• Post-Election Landscape: Analysis of potential policy changes under a new administration, including past actions of the Trump administration and potential legislative vehicles for future changes.
• Inflation Reduction Act (IRA): Review of key provisions, emerging 2025 trends, and implications for 2026, including negotiated drug prices.
• PBM Reform: Exploration of bipartisan efforts and potential impact on the 2026 rate cycle.
• Risk Adjustment: Examination of V28 implementation and evolving coding behaviors.
• Advance Notice & VBID: Outlook on the Advance Notice and strategic implications of the VBID program sunsetting.



Speaker(s):
Tim Murray, Principal & Senior Consulting Actuary
Eric Williams, Senior Consulting Actuary
Casey Gardener, Consulting Actuary II
Wakely Consulting




---

01/29/2025 1:45 PM - 2:30 PM

This session dives into advanced bid preparation strategies, focusing on regulatory changes and optimizing plan performance. Key areas include:

• Regulatory Updates: Review of critical CMS and BPT changes, including new documentation requirements, increased scrutiny of DIR and risk-sharing arrangements, and the new negative margin requirement.
• MA Bid Components: Analysis of benchmark growth rates, medical trend, risk adjustment, risk sharing, and administrative costs/margins.
• PD Bid Components: Examination of negotiated drug pricing (impacts of the IRA), formulary changes, rebates, dispensing fees, PD-specific risk adjustment, M3P influence, induced utilization, and pharmacy trend.
• Rebate/Subsidy Strategies: Discussion of rebate reallocation and direct subsidy complexities, including planning for subsidy range uncertainties and risk mitigation strategies.



Speaker(s):
Tim Murray, Principal & Senior Consulting Actuary
Eric Williams, Senior Consulting Actuary
Casey Gardener, Consulting Actuary II
Wakely Consulting




---

01/29/2025 2:30 PM - 3:00 PM

01/29/2025 3:00 PM - 3:45 PM

This session focuses on optimizing bids for sustainable growth by aligning product design with market opportunities and leveraging actuarial insights. Highlights include:

• Product Design & Competitive Analysis: Aligning product design with growth strategies, analyzing national and local plan strategies, and leveraging actuarial analysis for competitive premiums and benefits.
• Bid Process Optimization: Best practices for a year-round bid process, including calendar/deadlines, efficient workflows, and stakeholder engagement.
• Benefit Landscape Analysis (Part C & D): Review of Part C supplemental benefits (including VBID), premiums, Star Ratings, Open Enrollment results, Part D deductible/coinsurance changes, VBID, formulary strategies, direct subsidies, and market exits.
• Key Bid Considerations: Analyzing the impact of assumptions on outcomes and strategic considerations for managing ESRD members and MOOP limits.



Speaker(s):
Tim Murray, Principal & Senior Consulting Actuary
Eric Williams, Senior Consulting Actuary
Casey Gardener, Consulting Actuary II
Wakely Consulting




---

01/29/2025 3:45 PM - 4:30 PM

This session explores actuarial strategies and financial modeling for effective cost management and long-term financial stability. Key topics:

• Efficient Utilization: Designing product portfolios to encourage efficient member utilization.
• High-Cost Member Management: Techniques for identifying and managing members driving 80% of costs.
• Cost Ratio Optimization: Strategies for optimizing medical and administrative cost ratios.
• MLR Management: Strategies for predicting and managing Medical Loss Ratios.
• Long-Term Cost Sustainability: Tools and strategies for achieving long-term financial health.



Speaker(s):
Tim Murray, Principal & Senior Consulting Actuary
Eric Williams, Senior Consulting Actuary
Casey Gardener, Consulting Actuary II
Wakely Consulting




---

01/29/2025 6:00 PM - 8:00 PM

01/30/2025 7:30 AM - 8:30 AM

01/30/2025 8:30 AM - 8:45 AM

01/30/2025 8:45 AM - 9:45 AM

Gain valuable insights from Deft Research into the Medicare Advantage (MA) population, including their shopping trends and the key factors influencing their purchasing decisions. Explore the role of benefit design and understand the importance of specific supplemental benefits to seniors, as well as how these benefits drive shopping and switching behaviors.

Speaker:
Rob Lourenco, VP of Client Services
Deft Research

01/30/2025 9:00 AM - 1:00 PM

Connect, ask questions, and gain valuable insights from an industry expert!

Wakely Consulting Team
All things MAPD: deep dives on IRA concepts, benefit strategy, bid 101

01/30/2025 9:45 AM - 10:45 AM

Explore the critical decisions operators face in benefit design. This session will examine the evolving landscape of benefit funding, helping you identify what should be prioritized, what could be trimmed, and what must remain to meet member expectations and stay competitive.

Speaker:
Melissa Smith, Founder
Newton Smith Group

01/30/2025 10:45 AM - 11:00 AM

01/30/2025 11:00 AM - 12:00 PM

Explore the critical decisions operators face in benefit design. Gain actionable insights into balancing cost-effectiveness with value, ensuring your benefits resonate with senior populations while driving growth and retention.

Speaker:
Melissa Smith, Founder
Newton Smith Group

01/30/2025 12:00 PM - 1:00 PM

01/30/2025 1:00 PM - 2:00 PM

In this interactive breakout session, participants will engage in dynamic small-group discussions to address key challenges and uncover practical solutions. Drawing on the diverse experiences and insights of the group, this collaborative space will foster innovative thinking, idea-sharing, and actionable strategies that can be immediately applied to real-world scenarios.

Facilitated by:
Wakely Consulting and Melissa Smith, Newton Smith Group

01/30/2025 2:00 PM - 2:45 PM

This session will explore how SelectHealth is evolving its approach to measuring medical, drug, and supplemental benefit expenses, focusing on balancing spending to manage populations effectively across plans. Wakely will provide insights on using market comparisons to evaluate spending efficiency, including projected costs and other benefits. Learn strategies for leveraging internal pricing and market data to optimize benefit allocations.

Speaker:
Kaleb Holt, Director of Medicare Programs
SelectHealth

Sion Hughes, Senior Consultant II
Wakely Consulting

01/30/2025 2:45 PM - 3:00 PM

01/30/2025 3:00 PM - 4:00 PM

This session provides a forward-looking perspective on Medicare's future, exploring key trends and potential changes. Focus areas:

• Medicare in 2029: Exploration of potential future directions, considering demographics, technology, and policy.
• MedPAC Recommendations: Quick analysis of MedPAC recommendations and their potential impact on Medicare policy.
• Evolving Bid Process: Examination of potential changes to bid submission, evaluation, and the competitive landscape.



Speaker(s):
Tim Murray, Principal & Senior Consulting Actuary
Eric Williams, Senior Consulting Actuary
Casey Gardener, Consulting Actuary II
Wakely Consulting




---