Health insurance industry leaders gathered in Nashville, Tennessee, earlier this month to take a deep dive into risk adjustment, quality ratings and compliance at the annual RISE Summit. Not surprisingly, politics was a hot topic at the event, too—especially since Republicans dropped their draft ACA replacement plan, The American Health Care Act, mid-week. FierceHealthcare, a RISE media partner, was there to chronicle the reaction to that news, as well as some of the trends, strategies and policy talk that came out of the event.
In case you missed it, here's a roundup:
Keynote address: RISE Summit 2017 kicks off with talk of Trump, politics, ACA
On Monday, keynote speaker Howard Fineman—an NBC/MSNBC political analyst and global editorial director of The Huffington Post Media Group—offered an insider’s view of the current climate within the Beltway now that President Donald Trump is in power.
“Nobody has come in knowing less about how it all works than the Trump people,” he said. “I’ve never seen the city this divided into warring, distrustful and mutually exclusive camps.”
GOP Senators I talked to cautious at best abt success of repeal-&-replace #Obamacare effort; worried will lose votes on both party edges— Howard Fineman (@howardfineman) March 6, 2017
Fierce Exclusive: Ceci Connolly—concerns about new ACA repeal and replacement bill include money, Medicaid
While Ceci Connolly sees some positives in House Republicans’ healthcare bill, she’s skeptical about the practical implications of the legislation.
Connolly, president and CEO of the Alliance of Community Health Plans, is encouraged, for instance, that some of the major policy changes included in the bill won’t be effective until 2020, which gives health plans and their customers more time to adjust, she said in an interview with FierceHealthcare at the summit.
However, “we’re still very concerned that there’s just not enough money in there to cover and care for 20 million people,” she said. “A $2,000 tax credit, what is that going to buy you?”
Reporter’s notebook: Heard in Nashville: 6 healthcare leaders weigh in on GOP bill
Speakers at the conference offered analysis and opinions about the GOP’s new healthcare bill even in sessions on the conference’s primary focus areas of risk adjustment, quality ratings and compliance:
During a featured panel on the impact of the new administration across the healthcare spectrum, Osato Chitou, the Medicare compliance officer for Gateway Health, highlighted the business challenges tied to the uncertainty surrounding the impending healthcare policy shift. “Things have been so up in the air that it’s just hard to plan and project for the future,” she said.
“My concern when I look at this, is healthy people are going to do OK,” said fellow panelist Ana Handshuh, vice president of managed care services for Ultimate Health Plans. “Who’s not going to do well are people who have traditionally fallen through the cracks and now are going to fall through the cracks even further.”
Keynote address: Time for providers, payers to embrace 'community population health'
As it has moved from focusing solely on clinical care to embracing population health, the American healthcare system has already taken a step in the right direction, according to John Lumpkin, M.D., senior vice president of the Robert Wood Johnson Foundation.
But, he argued, the industry must go even further by moving from “clinical population health” to the broader “community population health.”
This is vital because while the United States has some of the best clinical science in the world, it lags behind other industrialized countries when it comes to healthcare quality, outcomes and even life expectancy, according to Lumpkin. Thus, “we have to think about health and healthcare in a different way,” he said.
Session report: In policy update, CMS official touts collaboration with insurers
Jeffrey Grant, director of payment policy and financial management for the federal Center for Consumer Information and Insurance Oversight, talked repeal and replace, too—but he also discussed another important regulatory issue: risk adjustment.
For Grant’s group at CCIIO, he said he’s whittled down its diverse responsibilities to focus on a simple motto: “Pay right, pay on time, every time.”
The goal of paying on time, for example, can translate to federal regulators striving to collect payments promptly rather than having to charge interest or ultimately refer unpaid debts to the Treasury. “This year, we have a goal that we will refer no debt to Treasury,” he said.
Insurers can help improve the accuracy of risk adjustment transfers, he said, if they improve their data management.
Data is one of the cornerstones of the star-rating success Blue Cross Blue Shield of Michigan has achieved for its Medicare Advantage plans. “To us, it really comes down to having predictive modeling capabilities, as well as marrying that with a really strong ability to think about how … we interpret that data and use that data in a timely manner” to design appropriate interventions, Suriya Grima, senior director of Medicare strategy and growth for BCBSM, said during a panel at the event.BCBSM has achieved at least four stars on its MA plans from 2012 to 2015.
Other keys to success include having a broad suite of product offerings with customization options, as well as conducting comprehensive and detailed reporting.