MCRA 2015 – Terranea Resort, Los Angeles

Our meeting kicked off Monday with an opening reception on the beautiful terrace of the Terranea Resort.

After breakfast on Tuesday, our opening speaker, Blake Leeper, an Olympic/Paralympic Medalist and the American Bladerunner, shared his story of how though he was born a bilateral below-the-knee amputee, he was raised to believe the only disability in life is a bad attitude. He went on to medal in several events, including the U.S. Paralympics Track & Field National Championships. His sights are set on Rio 2016! Not only did he inspire us with his story, but also awed us with an amazing sprint across the room in his blades!

Terry Rice, President of Factor Support Network, helped us understand hemophilia and the risks and costs. As a hemophiliac himself, he was able to share his story on a very personal level. We learned that people born with hemophilia have greatly reduced or no circulating clotting factor, and approximately 22,000 individuals live with hemophilia. The average cost of care for a person with hemophilia ranges from $100,000 to $150,000 annually. An adult with severe hemophilia can consume an average of $400,000 per year.

Jay Hazelrigs with OptumInsight, gave us an ACO update. His summary wrapped it up with:

1. ACOs continue to grow and become more relevant healthcare stakeholders
2. ACOs will need to continue to build their core competencies
3. ACOs (and payers) have been cautious about risk transfer…..but the “risk” train is on the track and we can see the light
4. Big data is going to play a role in healthcare, just too early to tell exactly how Brian Wroblewski with ClearHealth Strategies, helped us sort through Reference-Based Pricing.

In summary, referenced-based pricing means paying medical claims on the basis of some industry-wide benchmark, such as Medicare. All claim types and sizes can be managed through RBP programs.

Rick Lassow, Director Risk Adjustment & Health Reform with BCBS, shared his presentation of “Risk Adjustment: ACA Behind the Scenes.” With a show of hands, it was discovered that more than half of the audience was unfamiliar with risk adjustment. Risk adjustment is a process under which the actual or expected cost of coverage for one or more specified risks is shared by all the system’s coverage providers in such a way that the providers should be indifferent to the presence of certain risk characteristics. Good education for the group!

Our evening group events are always a big hit and this year was no exception! We had an iron chef challenge where several teams, under the supervision (well, somewhat!) of the Terranea Resort staff, created masterpieces to share and compete. Congrats to our winning team!

We wrapped up the evening with s’mores at the Terranea fire pit.

After breakfast on Wednesday, we started our meeting with Stephen Ringlee with Centesimus Capital. He shared lessons learned with CoOportunity Health. Hearing the failures of CoOportunity helped us better understand how many other CO-OPs are experiencing the same fate. The vision of CO-OPs was to fill the need for more competition in the individual and small-group markets. It was to change the dynamics of the competitive market by forcing dominant carriers to adapt and respond. But CO-OPs started with major limitations including their inability to use federal funds for marketing; stringent federal oversight; and the inability to seek external capital due to federal loan terms.

David Tuomala, VP with OptumInsight, was able to update us on information he shared a couple years ago at MCRA. His focus was with the Exchange populations and risks, including emerging experience and the impact of the “3 Rs.” Numbers provided illustrate that enrollment appears to be running well below prior projections. We also heard some of the issues facing both the individual and small group markets.

Our meeting ended with a presentation from David Muhlestein, Senior Director of Research & Development with Leavitt Partners. He shared great detail on the evolution of health care in America, including general trends for providers, payment models, payers, risk-bearing, and population demographics.

Our MCRA conference is successful due to our generous sponsors, knowledgeable speakers, supportive attendees, and our volunteer board members.