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Pre-Conference Workshop
Workshop A — Medicare Managed Care Think Tank: Deep Dive into the Latest Legal and Regulatory Developments
Mar 28, 2023 9:00am – 12:30 PM
Speakers

Sandra Durkin
Member
Strategic Health Law

Rachel Alexander
Partner
Wiley Rein LLP
Day 1 - Wednesday, March 29, 2023
Day 2 - Thursday, March 30, 2023
8:00 |
Registration Opens |
8:45 |
Conference Chair’s Opening Remarks |
9:00 |
From the Office of the Inspector General: Emerging FWA Risks, and Key Priorities for 2023 and Beyond |
9:45 |
FCA Outlook: Top Trends and Enforcement Activity for MCOs to Watch |
10:30 |
Morning Coffee and Networking Break |
10:45 |
Arbitration, Mediation and Mixed Modes: Perspectives on ‘Switching Hats’ to Resolve Managed Care Disputes |
11:30 |
MCOs on Trial: War Stories, and Winning Strategies from In-House and Outside Counsel |
12:15 |
Networking Luncheon |
1:15 |
The Future of Mental Health Coverage, Access and Litigation |
2:15 |
Afternoon Coffee and Networking Break |
2:45 |
PBMs ‘Put on Notice’: How the FTC Review and Further Government Scrutiny Will Impact the Managed Care Landscape |
3:30 |
Private Equity in the Provider Market: Assessing Investment Trends and the Impact on the Managed Care Industry |
4:15 |
Nuts and Bolts of Value-Based Payment (VBP) Contracting |
5:00 |
Conference Concludes |
Day 1 - Wednesday, March 29, 2023
7:45 |
Registration Opens |
8:45 |
Conference Chair’s Opening Remarks![]() Akure Paradis ![]() Archana Rajendra |
9:00 |
Managed Care Policy Briefing: Assessing Midterm Election Aftermath, and What the New Political Agenda Could Mean for MCOs![]() Philo D. Hall Join us for an in-depth discussion and analysis of what the Mid -Term results mean for the MCO community. This forward-looking session will dissect how the flip to a Republican controlled House, and a Democratic majority in the Senate will impact the legislative agenda and the Biden administration’s health policy priorities. Key topics to be discussed include:
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9:30 |
Payor Risks in a Post-Dobbs World: How to Navigate the Complexities of Reproductive Health Coverage and Pinpoint Potential Litigation![]() Heather Richardson ![]() Thomas J. Sullivan On June 23, 2022, the Supreme Court in Dobbs V. Jackson Women’s Health Organization decision overturned fifty years of precedent on abortion laws in America. The legal consequences of this monumental decision will require close attention from stakeholders across the healthcare industry including MCOs. This session will focus on:
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10:15 |
Morning Coffee and Networking Break |
10:45 |
FOCUS ON THE NO SURPRISES ACT - PART IThe Next Chapter in the NSA Saga—Analyzing the Evolution of the No Surprises Act and How it’s Playing Out in Practice for MCOs![]() Ray Walker ![]() Alexandra M. Lucas
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11:15 |
PART II: ROUNDTABLE DISCUSSIONNavigating the NSA: Open Discussion on Key Challenges, and Takeaways from Recent Experiences with the Dispute Resolution Process![]() Alexandra M. Lucas ![]() Ray Walker Contribute to the conversation on the No Surprises Act with this special opportunity to engage around the table with in-house and outside counsel. Share takeaways from a recent experience with the IDR process, raise questions and provide perspectives on the future of the NSA and how to prepare as an organization. |
11:45 |
Trends in Payor-Provider Disputes and Industry Tested Techniques for Managing Them More Effectively![]() Kevin D. Feder ![]() Evan Neadel ![]() Matt Ryan
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12:30 |
Networking Luncheon |
1:30 |
LIVE POLLINGWhat Every MCO Lawyer and Executive Needs to Know about ESG![]() Lindsay Fetzer ![]() Archana Rajendra
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2:00 |
DEI Leadership Think Tank: How Individual Action Can Drive Change at Managed Care Organizations![]() Brian P. Seaman ![]() Jason J. DeJonker This interactive breakout session will explore how you can move the dial on DEI at your organization. Engage with in-house and outside counsel on how to build and support diversity within your legal teams. Key these to be explored include:
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3:00 |
Afternoon Coffee and Networking Break |
3:15 |
Medical Loss Ratio: Key Data Reporting Considerations and Risk Areas for MCOs![]() Elizabeth M. Bock ![]() Alex Oliphant
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4:00 |
Uncovering COVID-19 Schemes: How Payors Should Approach Recovery Opportunities Post-Pandemic![]() Tim McMichael ![]() Adam J. Petitt
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4:30 |
HIPAA Compliance and Cyber Security: Best Practices for MCOs in the Age of Mobile Apps and Data Tracking Technology![]() Kirk J. Nahra
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5:15 |
Cocktail Reception |
Day 2 - Thursday, March 30, 2023
8:00 |
Registration Opens |
8:45 |
Conference Chair’s Opening Remarks![]() Akure Paradis ![]() Archana Rajendra |
9:00 |
From the Office of the Inspector General: Emerging FWA Risks, and Key Priorities for 2023 and Beyond![]() Carolyn Kapustij The OIG is heavily focused on fighting fraud, waste, and abuse within managed care. To that end, recent oversight efforts have focused on Medicare Advantage risk-adjusted payments, health risk assessments, chart reviews and the accuracy of provider data. In this session hear directly from the HHS-OIG on 2023 initiatives, emerging areas of risk for MCOs, and key takeaways from recent compliance audits. |
9:45 |
FCA Outlook: Top Trends and Enforcement Activity for MCOs to Watch![]() Brett Barnett ![]() Jay Dewald ![]() Jed Wulfekotte
|
10:30 |
Morning Coffee and Networking Break |
10:45 |
Arbitration, Mediation and Mixed Modes: Perspectives on ‘Switching Hats’ to Resolve Managed Care Disputes![]() Elliot K. Gordon ![]() Barbara Reeves ![]() Emily Wey Lawyers and their clients come into arbitration or mediation wanting a result. They want to win, but they also want expeditious and less expensive dispute resolution. Combining a mixture of mediation and arbitration in the same case with the same neutral is a useful technique to understand. Just as drivers on a multi-lane highway shift from lane to lane as circumstances require while reaching their destination, disputants can move from settlement modes to arbitration and back again as circumstances warrant. This session will explore when, and how to effectively engage these and other dispute-resolution tools in the managed care environment. Panelists will provide insights on:
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11:30 |
MCOs on Trial: War Stories, and Winning Strategies from In-House and Outside Counsel![]() Jamie Kurtz ![]() Jason Joffe ![]() Matthew R. Varzally ![]() Ben McCoy The trial is where the in-house outside counsel relationship is put to the test. In this session learn best practices for working together to secure a favorable outcome, and the pitfalls to avoid along the way. |
12:15 |
Networking Luncheon |
1:15 |
The Future of Mental Health Coverage, Access and Litigation![]() Brad Lerner ![]() Heather D. Redmond ![]() Jen Romano ![]() Amanda G. Schreiber Moderator:![]() Kara Wheatley There is bipartisan support in congress for mental health reform. Examine how these ambitious policies are shaping up and the implications for the legal landscape. Part one of this panel discussion will explore the future of mental health policy, including continuing enforcement challenges related to mental health parity and potential policy actions that could help improve access to mental health and SUD care. Part two will take a closer look at burgeoning legal challenges, and strategies for defending a MHPAEA claim. Key points of discussion include:
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2:15 |
Afternoon Coffee and Networking Break |
2:45 |
PBMs ‘Put on Notice’: How the FTC Review and Further Government Scrutiny Will Impact the Managed Care Landscape![]() Mike Cowie ![]() Nicholas John ![]() Joseph Miller PMBs have come under fire. “The FTC has launched a review of PBM services, including the role of vertical integration and the impact of PBMs on drug pricing. This panel will discuss the role of the FTC and other government actors and how to assess claims made by opposition groups. |
3:30 |
Private Equity in the Provider Market: Assessing Investment Trends and the Impact on the Managed Care Industry![]() Devin Cohen Private equity investment amidst healthcare provider consolidation continues to pose challenges and opportunities for the managed care industry. Particularly following COVID-19, successful transactions often hinge on payor-provider alignment, network adequacy, and reimbursement. In this session, we will explore:
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4:15 |
Nuts and Bolts of Value-Based Payment (VBP) Contracting![]() David E. Kopans
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5:00 |
Conference Concludes |
Workshop A — Medicare Managed Care Think Tank: Deep Dive into the Latest Legal and Regulatory Developments

Sandra Durkin
Member
Strategic Health Law

Rachel Alexander
Partner
Wiley Rein LLP
What is it about?
Registration opens at 8:30am
Medicare Advantage and Part D programs have become a dominant force in the managed care market.
Both represent a large and growing area of business for MCOs with nearly half of the Medicare eligible population enrolled in a Medicare Advantage plan, a figure that amounted to nearly 28 million people in 2022, and 49 million Medicare beneficiaries in a Part D plan. At the same time that the opportunity associated with this market is growing, federal oversight of these programs is also on the rise. MCOs with government lines of business must navigate a complex web of federal statutes, regulations, and sub-regulatory guidance in their administration. In this workshop, we will facilitate deep discussion of the key issues facing Medicare Advantage and Part D plans today. Come prepared to discuss:
- Current regulatory hot topics and key issues facing plans today, such as marketing, risk adjustment, and prior authorization, with strategies for managing risk and implementing new requirements; and
- Current and upcoming implementation challenges, including implementing key prescription drug pricing provisions in the Inflation Reduction Act and preparing for the changes proposed in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage program.