Health-Based Risk Assessment and Adjustment for Managed Care Organizations

Venue: Minneapolis

Location: Minneapolis, Minnesota, United States

Event Date/Time: Oct 21, 2002 End Date/Time: Oct 22, 2002
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Health-based risk assessment and adjustment methodologies based upon diagnosis and/or pharmacy data are promising to yield far more accurate and useful measurements of health status than older models solely based upon demographic data. Managed care organizations need to prepare for the financial impact of payers’ growing adoption of risk adjustment payment models, but also, and as importantly, must learn how to apply these powerful tools internally throughout the organization, from financial to clinical areas of operation.

The Institute for International Research is proud to present Health-Based Risk Assessment and Adjustment for Managed Care Organizations. This conference is designed to demonstrate how to utilize health-based risk assessment and adjustment methodologies, known commonly as "groupers," for a variety of purposes, including underwriting, provider reimbursement, quality and resource management, identifying high-risk members for case management, and pharmacy benefit design. We also focus on the implications for MCOs of payers’ burgeoning use of risk adjustment. Our faculty includes nationally prominent experts who provide practical advice on implementing health-based risk assessment and adjustment methodologies, while exploring the pros and cons in a neutral forum.

On Day One, October 21, 2002, we begin by presenting an overview of health-based risk assessment and adjustment. Next, the faculty offer case studies on actual efforts by MCOs to implement groupers for a variety of purposes, describing the benefits but also pitfalls to avoid, and prepare MCOs for a changing landscape as more payers shift to risk adjustment payment models. Highlights include examples of how to apply groupers in:

Underwriting commercially insured populations
Provider contracting and network management
Profiling providers
Identifying future high-utilizers
Pharmacy benefit design
In addition, David J. Knutson, Principal Investigator for the Robert Wood Johnson Foundation-funded Risk Adjustment Impact Study, shares current findings regarding the financial impact of health-based risk adjustment on managed care organizations.

On Day Two, October 22, 2002, we examine Medicare’s revised risk adjustment payment model and discuss how the design elements chosen by CMS likely will influence employers’ choices in the commercial market. We also focus on the other major public payer, Medicaid, as many of the technical and administrative challenges faced by state Medicaid programs that have implemented groupers are applicable to MCOs as well. Additionally, the second day of the conference includes a spotlight on the various models available. Robert B. Cumming, co-author of a newly released Society of Actuaries study that compares claims-based methods of health-based risk assessment for commercial populations, explains the important differences among the various models and yields tips on selecting the best model for particular applications. Finally, delegates hear from vendors about the future of health-based risk assessment and adjustment technologies in a conference-closing panel discussion.

Designed for managed care industry professionals, we are delighted to announce numerous case studies and presentations by managed care industry professionals. Our faculty includes:

Bruce D. Bowen, PhD, Principal, Multimetrics
Robert B. Cumming, FSA, MAAA, Principal and Consulting Actuary, Milliman USA
Steven S. Eisenberg, MD, Medical Director, Blue Cross Blue Shield of Minnesota
Steven C. Johnson, Director of Research and Development, Center for Health Program Development and Management, UMBC
Teresa Keane-North, Director of Performance Reporting, Group Health Cooperative
David J. Knutson, Director, Health System Studies, Park Nicollet Institute
Soyal Momin, MS, MBA, Senior Research Scientist, Blue Cross Blue Shield of Tennessee
Robert P. Power, Senior Director/Senior Medical Economist, HealthPartners
Randall K. Spoeri, PhD, Vice President, Quality and Medical Informatics, HIP Health Plans
Post-Conference Workshop:
The Nuts and Bolts of Implementing a Health-Based Risk Assessment and Adjustment Methodology

Workshop Leaders:
Barbara Johnson, Senior Consultant, Reden & Anders, Ltd.
Sandra Hunt, Partner, PriceWaterhouseCoopers, LLP

Learn from our distinguished faculty and take advantage of this key opportunity to network with industry colleagues. As a delegate, you also receive a set of program documentation.

Register today!