Fly-in: Medicare Advantage VBID 2.0

2:30pm

Welcome and Kick Off (4^th floor, Conf room 4506)

Kristin B. Rodriguez, Chief Knowledge Officer

Health Plan Alliance

2:40 – 3:10pm

Background and Motivation for VBID in MA

A. Mark Fendrick, Director, V-BID Center

3:10 – 4:00pm

Expert Panel: VBID’s evolution and current role in MA

VBID’s CMMI architects consider the early experience and current role of VBID in MA, including a discussion of the amendment of the Uniformity Rule and the MA VBID model evaluation report

Steve Jenkins, LMI

Adam Finkelstein, Manatt

4:00 – 5:00pm

Reverse Case Studies

Alliance members workshop their specific sticking points when it comes to making any progress on VBID. Reverse case study presenters will leverage the group’s collective knowledge and receive feedback on the specific analyses, workflow, or executive communication challenges they face today.

SelectHealth: How do you make the numbers demonstrate what you know intuitively?

It makes sense that removing barriers will increase compliance in patient populations with chronic diseases. But when creating a model for clinically-nuanced benefit enhancements it can be difficult to translate expectations (from intuition to published studies) into cost savings you can rely on. In this reverse case study, SelectHealth’s MA program manager shares the roadblocks they’ve hit so far in modeling clinically-nuanced benefits. They seek to learn from workshop participants how others are sharpening their pencils to design enhancements that actuaries can get behind, and how they are measuring success once the benefits are implemented. Specific examples will include benefits to reduce falls risk and avoid surgery for lower back pain.

Health Alliance Plan: The challenges of perception and process

In any value based or condition specific product design approach at HAP, the cross functional team responsible has a careful process of selecting the conditions, modeling the potential opportunity and makes a recommendation to move forward based on the analytics. For the VBID model, the initiative has never been able to move past this step. The barriers for decision makers could include concerns about too much risk, or a perception that there are not enough proven results, or perhaps that it will be too hard to administer. Our reverse case study presenter shares her experience with internal dialogue regarding VBID and wants to know from workshop participants how other plans been able to overcome the hurdles to move initiatives like these forward? What advice or recommendations do plans have to approach differently?

Interested in workshopping your health plan’s reverse case study? Contact Kristin Rodriguez to learn more.

Kaleb Holt, Medicare Advantage Program Manager, SelectHealth

Lori Rund, VP-Product Mgt & Mkt Intelligence, Health Alliance Plan

5:30 – 8:00pm

Happy Hour/Networking Dinner

All attendees

7:30 – 8:00am

Breakfast

Alliance Offices (4th floor, Conf Rm 4505 & 4506)

8:00 – 8:30am

Welcome Back! Attendee introductions

Kristin B. Rodriguez, Chief Knowledge Officer

Health Plan Alliance

8:30 – 10:00am

Case Study: UPMC’s journey with the VBID demo

Hear firsthand how UPMC implemented VBID design in their Medicare Advantage product. They provide an overview of the journey from beginning to today, and highlight successes, failures, learnings, and results to date.

Hazem Alsahlani, UPMC Health Plan

10:00 – 10:30am

Break

10:30 – 11:30am

Technical Break Out Workshops

The UPMC case study provides a high level framework of the health plan journey – now attendees take that discussion deeper into the strategies and tactics that make an initiative like this possible. Three break out groups, one each for Financial decision-makers, Product owners, and Medical leaders, dive into specific challenges such as:

• How the financial analysis of a VBID design incorporates less tangible factors like impact on Stars and member retention
• How the VBID program is implemented operationally, and how it is administered
• How the clinically nuanced care approach impacts care management teams, physicians and patients directly

All attendees

11:30 – 12:00pm

Technical break out workshop debrief

The group discussion continues as we uncover the decision-making processes plans have used when it comes to VBID. We explore sticking points such as the financial analysis, securing buy-in from leadership, and the disconnect between medical case studies and claims analyses.

All attendees

12:00 – 1:00pm

Networking Lunch

1:00 – 2:00pm

CMMI Town Hall

Attendees engage in an open discussion of the VBID 2.0 model. Learn how CMMI views the transformative updates, and why today’s architects believe they will increase choice, lower cost, and improve the quality of health care for Medicare beneficiaries.

Mark Atalla, VBID design lead, the Center for Medicare and Medicaid Innovation (CMMI), CMS

2:00 – 3:00pm

To Demo, or not to Demo? Open Discussion

The group reflects on the workshop’s content and engages in ideation on additional resources, workshops, and tools which will continue to support health plans as they work through these models and decisions.

All attendees