Health Care Program as of 7/01/08 (Please check back for updates)

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Health Care Program as of 7/01/08 (Please check back for updates) Health Care Sessions Reasonable and Customary There seem to be different benchmarks for determining what charges are reasonable and

1 Health Care Program as of 7/01/08 (Please check back for updates) Health Care Sessions Reasonable and Customary There seem to be different benchmarks for determining what charges are reasonable and customary. What are the most sound and excepted methods of determining what charges are reasonable and customary? What are the difficulties with determining reasonable and customary charges? SPEAKERS: Stacy Borans, MD Chief Medical Officer Advanced Medical Strategies (AMS) Thomas A. Croft Attorney at Law King & Croft LLP Linda Ludwick Executive Director Mountain States Administrative Services, Inc. Pharmacy Benefit Management- An Rx for Success in an Era of Industry Schizophrenia The world of pharmacy benefits continues to evolve at a rapid pace. Plan sponsors are asking questions: What PBM contract options are best for me? What do the terms and conditions really mean? What are the unique plan designs that are out there? What is coming up in the future that I don t know about that can bite me on pharmacy benefit costs or cause service issues for my plan members? This session will look at the current and future dynamics of the industry and the potential strategies that plan administrators need to consider in their role as advisors and risk managers for plan sponsors. John Adler National Practice Leader TriCast, Inc. Personal Health Records The panel will discuss what a Personal Health Record is, and what it is not, and will explore how the PHR creates value for the various stakeholders (individuals, payers, providers, etc.) Why is the PHR particularly valuable for self-funded organizations and the TPA's and vendors that service them? What will be the impact of new platforms such as Dossia, Microsoft HealthVault, and Google Health? How are PHR's affected by standards and regulations such as HIPAA and HL7 and who owns the data?

2 SPEAKERS: Greg Orr Clinical Health Solutions and Product Manager WorldDoc, Inc. Ryan Tarzy Medikeeper, Inc. Renal Cases Out of Control: Understanding Why and What You Can Do Renal Dialysis is a growing problem for the self-funded employer markets. We will examine the various causes for this increase, why it has impacted the self-funded market and what you can do to reduce your exposures both on a proactive and concurrent basis to keep you competitive in the marketplace. Gerald A. Young, Esquire Outsourcing Insights for a Business Growth Strategy Outsourcing strategies historically focus on labor arbitrage and cost-reduction, although today many companies are starting to use outsourcing as a strategic business tool. Learn how one growing TPA has leveraged outsourcing in a collaborative manner to improve service performance while gaining instantaneous business scale. Our speaker will address how they ve evolved their outsourcing relationship to include personnel, training, plan design and workflow, as well as I.T. to drive continuous process improvements with expanded service competencies. Catherine Lucas Director of Technical Development Health Plans, Inc. Integrated Data Analysis to Improve Benefit Plan Design, Cost-Savings and Incentives This session will be a case study on how one TPA is applying an integrated data analysis of medical and pharmacy claims combined with health risk assessments to not only improve plan design, but to enhance wellness programs and incentives. The discussion will illustrate how integrated health claims and risk assessment information leads to improved self-insured plan management, serving as a strategic client and broker tool to model cost-savings as well as provide metrics on wellness compliance and data trend measures. SPEAKERS: Felicia S. Wilhelm, RN CEO Prairie States Enterprises, Inc. Michou Reichelsdorfer Prairie States Enterprises, Inc. So You Want to Move from Fully Insured to Self-Funded But You Need the Claims Data Change the Game! Many fully insured carriers refuse to provide timely claims and eligibility data to their customers even though it is the customer s data. If you are tired of the runaround, then it s time to Change the Game! You can get the data if you are persistent and take a disciplined approach. This session will: Provide a toolkit that can be used in any domicile, regardless of the laws on the books, to get carriers to produce full and timely data.

3 Highlight the recent legislative success of the Texas Association of Benefit Administrators and outline how you can make the same thing happen in your state. Deliver first hand success stories about how TPAs in Texas are using the new law. SPEAKERS: Sam Francis Executive Vice /General Counsel The JI Companies Robyn Jacobson Chief Executive Officer & Founder EnCore System Professionals, Inc. GASB 45- A 360 Degree Perspective In 2004, the Governmental Accounting Standards Board published an accounting standard for Governmental Entities requiring reporting and disclosure of the present value of their future promise to provide retiree health benefits. (OPEBS) The national GASB liability is estimated to exceed $1.75 trillion. This session will discuss the regulation and identify the challenges and opportunities for Administrators and SIIA members. Stephen F. Rasnick Self Insured Plans LLC Ask the Actuary This session will represent an interactive opportunity for the audience to ask burning questions about trends impacting their stop loss blocks of business. This is a rare opportunity to hear this panel of actuarial industry leaders express their opinions on a variety of topics ranging from what drives trends today and how should contracting be factored in, what is the right specific deductible, does DM really work and what is its impact on the specific rates, to mention a few. SPEAKERS: Mike McLean, FSA Medical Risk Managers, Inc. (MRM) David Olsho Actuary Milliman, Inc. David Wilson, FSA, MAAA, FCIA Windsor Strategy Partners, LLC Beyond the ABCs of Self-Insured Health Plans In the first of this two-part session we will delve more completely into the fundamental underpinnings of self-funded plans regarding plan design, financing, and stop loss. In the second session, we ll look at analyzing reports, ensuring appropriate reserve, and dealing with how to evaluate return on investment with an emphasis on value-added consulting and risk management. Ronald K. Dewsnup & General Manager Allegiance Benefit Plan Management, Inc.

4 The World is Flat but Health Care is Still an Upward Slope In a global economy with increasing mobility in health care, how will it change our delivery system and employer benefits? How will Medical Tourism and the future of onsite clinical specialists affect benefits? What is Genome s influence coverage? Are we moving to individual plans rather then employer coverage? A national expert will review these and other behind-closed-door discussions about our future. Alexandra Jung Senior Vice Aon Consulting The Well Workplace Most organizations offer wellness programs simply because they think the benefit is worth the cost. Yet employers continue to ask themselves how to control huge annual increases in health insurance premiums and health care costs. The Well Workplace Process can help answer this question. To Be Announced What are the Benefits of Subrogation Recoveries by the Self-Funded Health Plan and Their Impact on the Bottom Line? A review of plan language, enforcement and recovery efforts in the ERISA context and changing media climate, this seminar will examine actual subrogation cases and the changing legal landscape involving recovery efforts. Daran P. Kiefer, Esq. Chair, Amicus Committee National Association of Subrogation Professionals (NASP) The Major Costs of Minor Miracles: Technology on the Horizon Throughout 2008, healthcare spending has increased. This increase is expected to continue through 2009 and beyond. Higher healthcare costs are largely due to the rise in treated prevalence of disease and the use of newer treatment technologies. As technology evolves, patients lives are prolonged and it is important to consider how and where the technology is applied. Technological progress and the increased spending associated with it do not need to have a negative connotation. This presentation will examine some of the new technology on the horizon, the clinical indications for them, the benefit to the patients and the anticipated costs. Stacy Borans, MD Chief Medical Officer Advanced Medical Strategies (AMS) The Changing Landscape of PBM and the Specialty Pharmacy Marketplace Learn about upcoming changes and solutions with proven track records with both pharmacy benefit and Specialty Pharmacy. The benefits of Value Based Plan Designs, Auditing, and how certain Disease Management programs have produced negative trends for some plan sponsors will be discussed. Understand how TPA s have experienced simplicity while adopting the in-sourced PBM model and how in-sourcing can produce a new revenue source for TPA s, produce savings for the employer and include broker incentives. Jennifer Kingsley-Wilson CEO ARMSRx

5 Cost-Based Reimbursement: A Rational Approach This session will address the relationship, or lack thereof, of healthcare charges and the cost to provide the services. Explore new and innovative cost-based reimbursement strategies and understand how a cost based reimbursement methodology will result in a payment that is rational and fair to the payer, the provider, and the consumer. SPEAKERS: Lisa Jamsen Vice National Care Network Araby Thornewill Data Advantage Using Medicare Set Asides to Help Save Claims Dollars All Medicare Set Asides (MSAs) are not created equal. Do not be the self-insurer who gets stuck with a $250, WCMSA when it should have been a zero allocation. Depending on the legal interpretation of the salient issues involved in controverted claims, claims dollars can be either needlessly wasted or prudently conserved. Our presentation will give some real life examples of the difference between isolating the compensable medical issues and those that are not. Therein lies the key to saving substantial claims dollars. SPEAKERS: Susan V. Mason Attorney, MSCC Poerio, Walter & Mason, Inc. Jack Rodgers First Review Inc. Self-Insurance the Right Way A Case Study from the State of Arizona The State of Arizona operates a self-insured group health plan that covers more than 130,000 active, retiree and dependent participants and has an annual budget of more than $600 million. Learn how the state balances performance measures, monitoring of operations, data collection, and authorization controls to achieve a comprehensive benefit package with a low (less than 5%) overhead. This will be a unique case study presentation that will be of interest to anyone responsible for the set-up and/or administration of self-insured health plans. Stacy Hutton Contracts and Compliance Manager, Arizona Department of Administration State of Arizona Additional sessions to be announced

Health Care Program as of 8/26/08 (Please check back for updates)

Health Care Program as of 8/26/08 (Please check back for updates) Health Care Sessions H1: Reasonable and Customary There seem to be different benchmarks for determining what charges are reasonable and