Managed Care Educational Sessions

Managed Care, Financial

A Primer on Medicare Advantage

With the onset of the new Medicare drug benefit and the increase in financial support from Congress, the Medicare Advantage program is taking on a new role in the life and times of home care. Increasing enrollment in Medicare Advantage (MA) has home care rethinking how to do business with the various types of plans. This program provides a primer on the MA program: the variety of MA plan types, the scope of the home health benefit, provider qualifications, provider payment rate requirements, provider contracting requirements, beneficiary cost-sharing standards, notice and appeal rights, MA marketing limitations, enrollment/disenrollment standards, and more.

Objectives:

• Identify the types of Medicare Advantage plans available.
• Describe the responsibilities of MA plans with respect to the scope of the home health benefits.
• Explain the nature of the discretion that MA plans have on establishing provider payment rates and beneficiary cost-sharing.

Faculty: Christine C. Rinn, Esq., Partner, Crowell & Moring LLP, Washington, DC;

Course Level: Novice; 1.8 nursing CEs (MNA Approval Pending);

Managed Care, Financial, Leadership

Maximizing Opportunities in a Managed Care Environment

In order to position their agencies to the greatest advantage, key home care staff must have a firm grasp of the growing trends that will affect their standing in the market. Among the trends of greatest concern is the movement of Medicare patients from fee-for-service to the managed care sector. This workshop will provide a broad view of the changes taking place in the Medicare marketplace, the potential impact these changes can have on the provision of home health services, and guidance on ways to position your business to best take advantage of the emerging coverage and payment trends.

Objectives:

• Identify legislative and regulatory changes that encourage a shift from fee-for-service to managed care under Medicare.
• Describe the impact this shift could have on the traditional delivery of home health services.
• Outline ways that agencies can best position themselves for success in the changing financial environment.

Faculty: Jim Hamilton, CPA, Managing Director, David-James LLC, Baltimore, MD; Gary Bowers, CPA, Owner, John Gary Bowers, CPA, Long Green, MD;

Course Level: Intermediate; 1.8 nursing CEs (MNA Approval Pending); 1.0 CPEs (NASBA/SKA);

Managed Care, Financial, Leadership

Look Before You Leap: Best Practices in Managed Care Contracting

Many home health agencies are finding that increasing numbers of their patients have enrolled in managed care plans, while others are watching the enrollment growth trends and putting forth efforts to contract with managed care organizations to provide vital home health services. As was learned during the managed care boom of the 1990s, it's important to look before you leap. This session will provide important guidance on contracting with managed care entities from a seasoned professional.

Objectives:

• Identify steps an agency should take prior to beginning discussions with a managed care organization.
• Describe key considerations for agencies in managed care negotiations.
• Explain different methods for pricing services for managed care contracts.

Faculty: Sherl Brand, Executive Director, The Home Care Association of New Jersey, Princeton Junction, NJ;

Course Level: Intermediate; 1.8 nursing CEs (MNA Approval Pending); 1.0 CPEs (NASBA/SKA);

Managed Care, Financial

Lessons Learned: Agencies' Experiences with Managed Care

Implementation of the new Medicare prescription drug benefit has granted new opportunities for health maintenance organizations to expand and market their Advantage plans. As enrollment goes up, an increasing number of home health agencies are facing numerous financial, operational, and clinical challenges that accompany contracting with managed care organizations (MCOs). This panel of home care leaders will share their agencies' experiences and challenges, and the insights and perspectives they have gained from their recent dealings with MCOs.

Objectives:

• Identify financial challenges that accompany contracting with MCOs.
• Describe operational changes to better manage managed care patients.
• Discuss adaptations to clinical practice for managing patient care under managed care plans.

Faculty: Kristy A. Wright, BSN, RN, MBA, FAAN, President/CEO, VNA of Western Pennsylvania, Butler, PA;

Course Level: Intermediate; 1.8 nursing CEs (MNA Approval Pending); 1.0 CPEs (NASBA/SKA);

Financial, Managed Care

Magic Bullets: Saving Costs without Sacrificing Patient Care

Cost efficiencies in the delivery of home care and hospice can be achieved without compromising health care services and the quality of care. With pressures increasing for providers to cut costs coming from Medicare, Medicaid, and managed care, a comprehensive cost control plan is essential. This program offers proven techniques for analyzing existing costs, exploring alternatives, implementing changes in spending, and evaluating the outcomes of a cost control plan in financial and patient service terms. Attendees will gain the insights gleaned from successful efforts to secure real cost savings without sacrificing patient care.

Objectives:

• Identify methods for evaluating existing costs for new efficiencies.
• Identify typical areas of cost that warrant control.
• Recognize the processes needed to assess whether cost controls affect care outcomes.

Faculty: Kristy Wright, BSN, RN, MBA, FAAN, President/CEO, Visiting Nurse Association of Western Pennsylvania, Butler, PA; Robert Simione, BS, Principal, Simione Consultants, Hamden, CT;

Course Level: Intermediate; 1.8 nursing CEs (MNA Approval Pending); 1.0 CPEs (NASBA/SKA);

Managed Care, Leadership, Financial

What a Plan Wants: Medicare Advantage Plans' Perspectives on Home Health

Home care providers express frustration that managed care organizations fail to recognize that home care is highly valuable - it saves money by keeping patients out of costly institutions and provides care management, as well. So, what's the resistance to paying adequately for these important services? In this session a panel of managed care organization (MCO) representatives will provide their views on the role of home care in managed care, and what they look for when contracting with home care agencies.

Objectives:

• Explain the value of home care from a MCO's point of view.
• Identify characteristics that increase a home care agency's attractiveness to a managed care plan.
• Describe management issues MCOs must deal with in contracting for and overseeing home care services.

Faculty: Panel of Medicare Advantage Plan Representatives ;

Course Level: Intermediate; 1.8 nursing CEs (MNA Approval Pending); 1.0 CPEs (NASBA/SKA);