The first speaker of the day was Gary Earl, VP, Benefits for Caesars Entertainment, Inc. speaking on “The Healthcare Challenge of 2004." Gary’s presentation concentrated on self-funded plans and the challenges one faces in maximizing employee benefits and keeping costs at bay.  A huge part of Caesar’s success was the establishment of wellness and preventive programs along with consumer education. The consensus of the audience was that Gary was an excellent opening speaker, interesting and dynamic. He definitely brought a refreshing approach to employee benefit management.

"Providing Healthcare for Clients and Employees” was a presentation facilitated by Jack London, Sr. Consultant for NiiS/APEX with Providers Dr. Rudy Manthei, Board Certified Ophthalmologist and Todd D. Meek, President and CEO of NevadaCare participating in the discussion. This dialogue focused on healthcare cost drivers; including hospital costs, PBM’s, technology, and the cost of a provider to do business.  Solutions, from this group’s perspective included patient education, cost sharing and again preventive care and wellness programs.

The third speaker of the day was M. Donald Kowitz, SVP/COO, St. Mary’s Health Plans in Reno Nevada.  Mr. Kowitz’s presentation “Managing Risk in a Small Provider Owned Plan” provided us all with insight on how his leadership turned St. Mary’s, from a steady string of losses into profitability in 2002 and 2003. He, like many provider groups, faces the same challenges whether providing services to clients or employees. Mr. Kowitz credited much of his success in the industry to developing a four-step approach, which included seeking guidance from experts.  Benefit plans offered by St. Mary’s, also include a focus on wellness, disease management along with in-network or negotiated hospital services.

The Roundtable Discussion started Monday’s afternoon session.  The panel included Michelle Fallahi, VP, ING Reinsurance, Tracy Hoffman, VP, One Beacon, Dave Kalb, VP, Evergreen Re and Ollie Landsman, VP, Marsh Global.  This panel, comprised of brokers and carriers brought a lot of expertise on a wide range of subjects pertinent to us all in the reinsurance industry.  They looked at where the market has been and where it appears to be going.  The feeling was that brokers need to provide more services and carriers need to be more flexible in coverage and price.  Price seems to be all-important as Providers are looking for the right coverage at the right price.  Other trends discussed were higher deductibles, no MDA’s, the need for CAT coverage, and possibly multi year contracts. This group needless to say, generated a lively discussion from the audience.

Monday ended with Tim O’Donnell, VP, Aveta Health Inc. and his presentation of  “Yes, But My Patients are Sicker a.k.a. The Medicare Risk Adjustment Revolution.”  Tim’s presentation focused on the technical aspects of Medicare reimbursement, as we will come to know it in the near future. Medicare plans as a rule have been profitable and this is expected to continue.  The new reimbursement methodology will be driven by HCC risk adjustment factors.  It will now fall to the providers to accurately code, as this will drive their reimbursements. Tim’s vast experience, excellent presentation skills along with his enthusiasm were evident throughout his presentation and caused one member of the audience to remark to Mr. O’Donnell, “you have taken an incredibility dry topic and turned it into a very interesting talk”. 

Tuesday morning opened with a presentation by Cassandra Moore, SVP of Converium Re speaking on “The Reinsurance Market.”  Sandi is a dynamic and entertaining speaker and was well received by the audience.  She covered a variety of topics, which demonstrated her enormous knowledge in several areas of the reinsurance market.  Some of the topics that Sandi discussed were pricing for the future and not today, the high costs of healthcare that affect reinsurance today, the need for single occurrence coverage, and disease management.  She believes that Special Risks may be the market of the future.

Following Ms. Moore, Dr. Richard Migliori, CEO of United Resources Network presented his views in respect to the need for “Specialized Solutions for Complex Medical Conditions.”  Dr. Migliori is a seasoned professional in the healthcare industry as well as transplantation.  His presentation touched on several areas of complex medical conditions, including the continued growth in the area of transplants.   He also discussed the need for specialized care and the conditions that are best served, such as pediatric cardiac surgery and CHD, cancer management, infertility and multiple births.

“Actuarial & Underwriting Issues for Healthcare Reimbursement (HRA) Product” was presented by James Drennan, Principal, Redden and Anders.  Jim has over 30 years of life and health experience. His talk focused on HRA’s and the methodology to underwrite this type of risk.  He discussed the fact that this kind of plan can be advantageous because it makes  members think about their benefits and better manage them.  Potentially making this a preferable choice for the healthy as they can keep the money if healthcare is not needed.  The draw back, however, could be a diminished amount of well care initiatives since again the member can keep the money not used. 

Adria Garneau, AVP and Steve Murphy, SVP at NiiS/APEX teamed up for the last presentation of the conference, “Difficult Claim Issues and Tactics for Resolution”.  This dynamic duo once again brought their expertise and challenged ours in the realm of claims processing.  Ambiguity in matrices, policy schedules, and definitions were all discussed.   Three case studies, a new twist added this year to the claims presentation, invited audience participation.  After hearing this presentation, it definitely makes one want to go back and ensure that all the i’s are dotted and the t’s are crossed in ones own policies. As always, a thought provoking and informative claims presentation.

The MCRA Board would like to thank the speakers, the sponsors and each of you who attended the 2004 conference.  You all contributed to the success of this year’s conference.

The MCRA Board is already looking to the future and the Conference of 2005.  Information will be sent as soon as the details are finalized.  We look forward to seeing you in 2005 for another great conference.