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
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
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
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
fee: Pricing for
these webinars start at $99 for members and $119 for nonmembers. > Volume
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