Live- Stratifying Members As They Arrive Through the Exchanges

Webinars - Live
5/16/2017 12:00:00 PM - 1:00:00 PM (CST)

In the zero sum ACA marketplace, properly identifying exchange members is critical to plan success and viability. With the right analytics, UPMC Health Plan has outperformed its competition, recording 18 percent higher average risk scores than the rest of the plans in its risk corridor. UPMC recognized immediately that their participation in the ACA Marketplace meant that they had to establish a sophisticated, technology-driven process that could scale with their growing membership. This presentation walks the audience through the steps they underwent to achieve superior exchange outcomes. Attendees learn how UPMC was able to create a process to correctly identify, outreach, and engage high risk plan members by answering the following questions:

  • What data is available as members enroll through state and federal exchanges?
  • How are new members processed and properly stratified? What operational considerations need to be put into place?
  • Can we effectively reach out to these members to gather more data and increase their health literacy?
  • Are there any regulatory concerns plans should be mindful of when looking at FFM data?
  • What other information can be derived from this process?

During this session, attendees will gain an understanding of the "three R's" of the ACA model, the overall risk challenges of operating an ACA plan, and the UPMC analytics framework for identifying patients in high cost categories. Additionally, they will learn about the underlying UPMC technology enabling their data-driven approach, the results of UPMC's process, and the key takeaways for plans facing similar circumstances.



  • Discuss the UPMC Health Plan and its technology-driven process.
  • Show the results of their new process.
  • Look at the ACA marketplace, model, and the impacts on operating an ACA plan.
  • Provide key takeaways for plans facing similar circumstances.


Who Should Attend

Healthcare Data Analyst, Healthcare Informatics Professionals, HIM Director, Healthcare Business Analyst, Revenue Cycle Director

Attending a live seminar: Audio seminars last 60 minutes, beginning at 12:00 noon Central Time. Registrants receive instructions for login at least 24 hours before the live event, along with a link to access the seminar resource book.

Registration fee: Pricing for these webinars start at $99 for members and $119 for nonmembers. > Volume discounts are available (will open in new window or tab).

To fax or mail your order instead of using this online store, > Click here to download a printable order form (PDF) (will open in new window or tab).


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