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2025 Medicare, Medicaid, Duals & Commercial Markets Forum

Dates:
Mar 25 - 27, 2025
Location:
Baltimore, MD

Registration is now closed - The 2025 Medicare, Medicaid, Duals & Commercial Markets Forum focuses on the most pressing policy priorities, emerging issues and regulatory updates for Medicare, Medicaid, Duals, and the commercial market.

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Sessions

March 25, 2025

, Continental Breakfast

, General Sessions

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    What’s Next for Medicare, Medicaid, & the Commercial Markets?

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    The health care landscape is on the brink of significant transformation. Speakers in this session will explore the future of Medicare, Medicaid, and the Commercial Markets, focusing on evolving policies, regulatory shifts, and emerging issues that will shape our health care delivery system in the years to come. Gain insights on key developments expected to influence health care delivery, cost management, and coverage options.

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    Fireside Chat with John Brooks, CMS Deputy Administrator & Chief Policy, and Regulatory Officer

    • Learn more about John Brooks
      John Brooks
      ,
      CMS Deputy Administrator & Chief Policy, and Regulatory Officer
      , Centers for Medicare & Medicaid Services (CMS)
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    Navigating What’s Next for Health Care Delivery Innovations

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    Health plan leaders will share their vision and priorities to improve access, quality, and outcomes through the use of innovation and technology.

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    Forecast for Employer-Provided Coverage

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    This session will explore the evolving landscape of health care benefits, including the impact of new regulations, emerging technologies, and changing employee expectations. A panel of experts will examine the shift toward personalized and value-based care, as well as how employers are adapting to rising health care costs and mental health support demands.

, Concurrent Sessions

  • SERIES 1

    • Medicare Advantage & Part D

      Building and Maintaining Successful Working Relationships with Regulators

      Speakers
      Details

      Speakers in this session will discuss strategies and best practices for building and maintaining effective relationships with CMS leadership and staff.

    • Commercial Market & Employer-Provided Coverage

      Surprise Billing: What’s Next

      Speakers
      Details

      Speakers in this session will discuss lessons learned since the No Surprise Act was enacted, as well as the latest litigation and enforcement challenges.

    • Medicaid Managed Care & Dual Eligibles

      Unlocking Potential in the D-SNP Market through Integration

      Presented by Optum – An AHIP Select Member
      Speakers
      Details

      The D-SNP market is changing rapidly, due to federal and state regulatory changes. Join this session to explore critical strategies to successfully participate in the D-SNP market from developing Medicaid RFPs to establishing CMS D-SNP contracts. Also, gain insights to ensure operational integration and successful development of consumer-focused products and clinical models are tailored to the needs of dual-eligible sub-populations.

    • Closing Gaps in Coverage & Care

      Expanding the Frontier of Health Care Access: Innovation in Medicare & Medicaid

      Presented by Nomi Health
      Speakers
      Details

      The US health care system faces unprecedented challenges. Despite all the debate around health policy, millions of Americans still lack access to basic care. Join this session to hear thought leaders examine innovation in the current health care landscape and highlight opportunities for meaningful change. Explore strategies for advancing health care across a wide range of audiences and gain insights into a framework for programs that improve patient outcomes and close gaps in care.

, Lunch & Learns

    • Medicaid Managed Care & Dual Eligibles

      Driving Network Adequacy for Dual Eligibles: Challenges and Solutions

      Presented by Quest Analytics
      Speakers
      Details

      Dual eligible populations face unique challenges accessing care due to the complexities associated with Medicare and Medicaid coordination. This session will explore strategies focused on network adequacy and accuracy tailored to dual eligibles, state oversight, regulatory compliance, and innovative solutions. Attendees will learn to address provider gaps, improve member access, and optimize network performance to enhance care for this vulnerable population.

    • Medicare Advantage & Part D

      The Medicare Advantage Industry: A Lesson in Agility

      Speaker
      Details

      In an environment where the rules keep changing, the population is growing, and carrying a heavier illness burden, successful Medicare Advantage plans are those that remain nimble and adaptable. Speakers in this session will explore key strategies they are leveraging to engage providers, address social determinants of health and adapt processes to address the ever-evolving business challenges facing the Medicare Advantage industry

    • Care Delivery Innovation

      Eliminating Barriers to Deliver Personalized, Preventive Diabetes Care

      Presented by CCS Medical – An AHIP Select Member
      Speakers
      Details

      Over the last few decades, diabetes diagnoses in this country have sharply increased, making it one of the most expensive chronic conditions in the U.S. Despite advancements in technology and clinical knowledge, complex interactions between health plans, providers, manufacturers, and suppliers have created significant barriers impacting effective care. Join this session to explore best practices and solutions to eliminate these barriers through innovative collaborations and personalized care.

    • Closing Gaps in Coverage & Care

      Effective Strategies to Solve Social Needs at Scale

      Presented by Ground.Game Health
      Speakers
      Details

      Addressing social needs is critical to improve outcomes and requires sustainable partnerships between health plans and community benefit organizations. Join this session for real-world examples of how social needs (food, housing, transportation, finances, etc.) are solved for members through human-to-human connections, one person at a time. Health plan executives will gain actionable insights to transform members’ lives by removing the barriers preventing them from better health and well-being.

, Concurrent Sessions

  • SERIES 2

    • Medicare Advantage & Part D

      MA and Part D Compliance Audits: Best Practices and Lessons Learned

      Speakers
      Details

      Speakers will discuss latest common findings from CMS’ Medicare Part C and Part D compliance audits and provide insight on tools and best practices that MA organizations and Part D plan sponsors can implement to improve performance.

    • Medicaid Managed Care & Dual Eligibles

      Evolving Medicaid Managed Care Policy Landscape

      Speakers
      Details

      This session explores current challenges and opportunities that exist for Medicaid Managed Care across the regulatory landscape. The panel will also identify best practices for Managed Care plans to consider over the next several years.

    • Commercial Market & Employer-Provided Coverage

      What’s Next for the Individual Market?

      Speakers
      Details

      The individual market has experienced significant growth in recent years, including over 21 million individuals enrolled in the Marketplaces. Regulatory reforms and potential legislative changes, including expiration of the enhanced premium tax credits, could meaningfully reshape this market. Speakers will discuss potential policies and their implications for consumers, insurers, and health insurance markets. Topics will include program integrity, enhanced tax credits, risk pool dynamics, ICHRAs, state waiver flexibilities, and other policies that could shift the landscape of the individual market.

    • Market Strategy & Operational Excellence

      Simplifying and Enhancing the Member Journey by Leveraging AI

      Presented by Sagility – An AHIP Select Member
      Speaker
      Details

      The business of health care is conducted over the phone, chat, text, and email. Technology is enabling these channels to become more efficient, accessible, and helpful to members and providers alike. However, health plans are often faced with the challenge of how to get started with AI and where to invest. Join this session to learn about best practices to deploy generative AI solutions in health care, anticipate obstacles and address common challenges.

  • SERIES 3

    • Care Delivery Innovation

      Building Member Trust – A Comprehensive Community-Based Approach

      Presented by Wider Circle
      Speakers
      Details

      Trust is the foundation of effective patient-centered care. Join this session to explore an innovative model that builds trust with our most vulnerable members in the communities where they live. Acquire deeper insight into how community-based groups can improve communication with members to address inequities and encourage them to be more proactive about their health, which can lead to better health outcomes, higher quality care, and increased member satisfaction and retention.

    • Market Strategy & Operational Excellence

      Navigating the Future of Prior Authorization

      Presented by Optum – An AHIP Select Member
      Speaker
      Details

      The prior authorization landscape is evolving with new regulations and tight timelines. Join this session to learn how to accelerate decision-making, meet mandates, and streamline the process. Discover how AI can revolutionize information gathering, reduce burdens, and shorten turnaround times. Gain strategies for digitizing policies and key considerations for evaluating AI solutions, such as understanding how models are trained and the significance of clinical validation.

, General Sessions

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    An Rx for Affordability and Access for Everyone

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    A panel of experts will discuss current and emerging trends in prescription drug spending and offer perspectives on drug policy solutions to incentivize innovation, competition and increase access and affordability.

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    Outlook for Budget Reconciliation in 2025

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    This session will explore the evolving landscape of federal fiscal policy, including the implications of new reconciliation bills for government health programs and health care spending.

March 26, 2025

, Continental Breakfast

Key Ballroom South Foyer, Level 2

, General Sessions

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    Strengthening Primary Care for a Healthier Future

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    Primary care is essential to achieving better health outcomes and reducing health disparities. Consistent access to primary care leads to better overall care, more coordination among health services, improved outcomes, and lower costs. In this session, a panel of experts will explore approaches, solutions and strategies to reinforce primary care infrastructure and workforce to meet the evolving health care demands of the U.S. population.

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    Closing Gaps in Coverage and Care

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    This fireside chat brings together industry leaders to discuss the evolving health care landscape and strategies to address gaps in coverage and care. The panel will explore both successes achieved and ongoing challenges in the health care system, focusing on populations disproportionately impacted by disparities. Speakers will share their unique perspectives on policy shifts, system-level changes, and opportunities to improve health care access and outcomes. Gain insights into navigating the changing health care environment while continuing to serve vulnerable populations effectively, balancing financial constraints with the delivery of high-quality care.

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    Tech Policy Landscape in 2025 and Beyond: Implications for Health Plans

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    As technology continues to transform health care, the policy landscape is rapidly evolving—shaping how health plans leverage innovation, data, and AI-driven solutions. What key regulatory and legislative developments should health plans prepare for in 2025 and beyond? Speakers in this session will provide an in-depth analysis of emerging tech policy trends, including cybersecurity and privacy regulations, AI oversight, interoperability mandates, and digital health.

, Concurrent Sessions

  • SERIES 4

    • Medicare Advantage & Part D

      MA and Part D Advance Rate Notice/Regulation: Implications for 2026 and Beyond

      Speakers
      Details

      In this session, speakers with expertise in Medicare Advantage (MA) will review key elements of the 2026 Advance Rate Notice and proposed regulations for MA and Part D and share insights on the impact and implications for health plans.

    • Medicaid Managed Care & Dual Eligibles

      MACPAC Update: Emerging Trends and Policy Recommendations

      Speakers
      Details

      In this session, speakers from the Medicaid and CHIP Payment and Access Commission (MACPAC) will comment on the status of the Medicaid program and MACPAC’s initiatives and priorities for 2025.

    • Care Delivery Innovation

      The Tipping Point for Value-Based Care

      Presented by Davita Kidney Care
      Speaker
      Details

      Value-based care (VBC) is a core tenet for the future of health care, but the term is over-used, impeding adoption of a revitalized care model at scale. Join this session to learn how to design VBC models that collectively benefit patients, providers, and payers. Gain insights from value-based kidney care to help develop care models that support improved outcomes, foster trust with physicians and can be replicated across the industry.

    • Market Strategy & Operational Excellence

      Creative and Cost-Effective Approaches to Managing Obesity

      Presented by Teladoc Health
      Speakers
      Details

      Obesity is a prevalent, financially burdensome, and complex chronic health issue that is affecting an increasing portion of the population. As federal and state regulators consider new coverage policies, including expanded coverage for GLP-1 medications, the costs associated with managing obesity will continue to grow. Join us to explore the innovative use of virtual care solutions to transform obesity management, especially for Medicare, Medicaid, and Duals lines of business.

, Lunch & Learns

    • Care Delivery Innovation

      Optimize VBC: Leverage Analytics to Enhance Care Delivery & Improve Outcomes

      Presented by Gray Matter Analytics
      Speakers
      Details

      In alternative payment models and value-based contracts, quality and outcomes improvements are balanced with optimal utilization and costs. Using advanced analytics, health plans can improve member engagement and capture actionable insights on health outcomes, utilization, cost efficiency and overall quality of care. Join this session to learn how advanced analytics can help identify risks, project financial performance, and predict health outcomes to maximize value-based partnerships.

    • Market Strategy & Operational Excellence

      Leveraging AI to Improve Outcomes and Reduce Costs Through Imaging Innovation

      Presented by Covera Health
      Speaker
      Details

      The U.S. health care system is moving toward value in all aspects of care delivery, including imaging advancements to expedite accurate diagnoses. Discover how AI-driven imaging advancements are transforming care delivery. Learn to improve radiology quality, reduce misdiagnosis costs, and enhance outcomes. Gain insights on analyzing routine imaging to identify diagnostic gaps and accelerate the detection of 40+ conditions, driving better care at lower costs.

    • Medicaid Managed Care & Dual Eligibles

      AI Advancements Bridge the Gap to Dual Eligibility Enrollment

      Presented by Optum – An AHIP Select Member
      Speakers
      Details

      Of the 66 million current Medicare beneficiaries, 37% live at or below the poverty level, but only 12.2 million of them are dual-enrolled. Dual eligibility enrollment remains challenging due to the differences in each state’s qualification process, but AI advancements are helping to overcome these challenges and optimize benefits for members in need. Learn how one health plan leveraged AI technology to increase dual-eligibility conversion and make a positive impact on its members.

    • Closing Gaps in Coverage & Care

      The Future of 1115s: Progress Made and What’s at Stake

      Speakers
      Details

      This session explores the increase of innovative 1115 waivers over the years and the impact a changing federal landscape may have on current and future waiver applications.

, Concurrent Sessions

  • SERIES 5

    • Medicaid Managed Care & Dual Eligibles

      Policy Agenda for Medicaid Managed Care

      Speakers
      Details

      Join us for an in-depth conversation on the future direction for Medicaid, CHIP and Duals policy. Our panel will provide a deep dive into potential regulatory action Medicaid Managed Care could see over the next 4 years.

    • Commercial Market & Employer-Provided Coverage

      Prioritizing the Whole Person in Employee Benefits

      Speakers
      Details

      As the workplace and workforce have both rapidly evolved, employers are increasingly recognizing the importance of addressing the "whole person" when designing and offering health benefits. This panel discussion will explore how leading American companies have reimagined and expanded employee benefit offerings beyond traditional health benefits to a more holistic approach that considers the physical, mental, emotional, and social well-being of their employees and their families.

    • Care Delivery Innovation

      Transforming Chronic Care through Daily, Async Video Coaching

      Presented by Scene Health
      Speakers
      Details

      When members struggle with adherence to prescribed treatment, the impacts can be significant. This session spotlights a video coaching model that can improve clinical measures and hospitalizations while strengthening member trust. Hear real patients share how daily video engagement helped reshape their medication habits and chronic conditions. Explore how to integrate a high-touch, high-tech approach to drive measurable improvements in medication adherence, cost savings, and member satisfaction.

    • Market Strategy & Operational Excellence

      Health Plans at a Crossroads: Transforming Health Plans with AI

      Presented by Healthplans.AI
      Speakers
      Details

      While AI holds immense potential to revolutionize healthcare, it can also seem risky and complex. By securely leveraging AI, plans can dramatically improve operational efficiencies and enhance member experience. Join this session to learn from specific use cases how plans that serve Medicare and Medicaid beneficiaries, and dually eligible individuals can leapfrog by leveraging AI to drive tangible business and ROI outcomes. Explore strategies to turn AI adoption into a game-changing opportunity.

  • SERIES 6

    • Medicare Advantage & Part D

      Part D in 2025: Impacts of the Benefit Redesign

      Speakers
      Details

      Speakers will discuss the impacts and implications of the changes to Part D that took effect in 2025 and provide insights into what’s next for the Part D program.

    • Market Strategy & Operational Excellence

      Enhancing Payer-Provider Collaboration for Better Outcomes and Business Results

      Presented by Cognizant Technology Solutions
      Speakers
      Details

      As the health care ecosystem evolves, health plan leaders must navigate new data exchange standards and regulatory requirements that impact daily decision-making. Initiatives like FHIR, TEFCA, and Da Vinci are reshaping interoperability, requiring professionals to align operations for compliance and efficiency. Join this session to gain insights to help shape your company’s approach, streamline operations, and improve outcomes.

    • Medicaid Managed Care & Dual Eligibles

      What’s Happening in HCBS?

      Speakers
      Details

      This session will feature a trio of national policy leaders who will discuss current issues facing Medicaid managed long term services and supports (MLTSS) plans and states including addressing the growing demand for home- and community-based services (HCBS).

, General Session

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    Current Issues in Medicaid: Insights from State Medicaid Directors

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    This session will explore trends and emerging issues in Medicaid programs and priorities of state Medicaid directors. Learn how health insurance providers can partner with states to improve outcomes for Medicaid beneficiaries.

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    Prevention in the Context of Behavioral Health

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    A panel of experts will explore evidence-based strategies to reduce the risk of mental health disorders and substance abuse. Speakers will examine early intervention practices, the role of community and family support, and the importance of addressing social determinants of health. They will also discuss effective use of technology, access to measurement-informed care, and the integration of behavioral health into primary care, with an emphasis on collaborative efforts across providers, health plans, policymakers, and community leaders to create effective and sustainable efforts to improve prevention in the context of behavioral health.

March 27, 2025

, Continental Breakfast

, General Sessions

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    Implications of Recent Supreme Court Decisions on Health Care Regulations

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    In this session, legal experts will discuss the implications of recent U.S. Supreme Court decisions on health care regulations.

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    Fireside Chat with Peter Nelson, CMS Deputy Administrator & Director, CCIIO

    • Learn more about Peter Nelson
      Peter Nelson
      ,
      Deputy Administrator & Director, Center for Consumer Information and Insurance Oversight (CCIIO)
      , Centers for Medicare & Medicaid Services (CMS)
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    Improving Care for Complex and At-Risk Populations

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    Health plan leaders will discuss strategies and solutions to bridge gaps in coverage and care for patients with chronic conditions or facing other health challenges.

, Concurrent Sessions

  • SERIES 7

    • Medicare Advantage & Part D

      Current Legal Issues in MA and Part D

      Speakers
      Details

      Legal experts will review the current landscape of legal issues affecting the policy and regulatory agenda for Medicare Advantage and Part D plans.

    • Closing Gaps in Coverage & Care

      Place-Based Care: Novel Approaches to Increase Access and Improve Outcomes

      Speakers
      Details

      This session will explore innovative place-based approaches to health care delivery that enhance access and health outcomes for vulnerable populations.

    • Care Delivery Innovation

      Preventing and Treating Chronic Conditions in Children and Adolescents

      Speakers
      Details

      As many as 20 million American children suffer from chronic conditions, including asthma, obesity, epilepsy, and behavioral health conditions, among others. These conditions require ongoing medical attention and may limit activities of daily living, posing significant challenges for young people and their families as well as costs to the nation. Learn about how we can address root causes of these conditions and ensure that those who need help managing their conditions receive it.

  • SERIES 8

    • Medicare Advantage & Part D

      Value of Medicare Advantage: Latest Evidence that Makes the Case

      Speakers
      Details

      In this session, speakers will showcase the latest evidence that demonstrate that Medicare Advantage delivers better services, better access to care, and better value.

    • Care Delivery Innovation

      Achieve Quality Improvement Through Effective Pharmacy Care Management Programs

      Speaker
      Details

      High performing quality performance can be difficult to achieve in Medicaid managed care. This session will showcase how one Medicaid managed care plan was able to achieve top in state quality scores on the asthma medication ratio (AMR) measure. The speaker will highlight the use of telehealth and telephonic interventions along with community partnerships to discuss disease and medication education. Explore how various digital tools can be leveraged for effective pharmacy care management outreach programs.

    • Commercial Market & Employer-Provided Coverage

      ACA Innovation Waivers

      Speakers
      • Daniel Meuse, Princeton School of Public and International Affairs
      • Randy Pate, Centers for Medicare & Medicaid Services (CMS)
      Details

      The ACA established flexibilities for states to establish programs that address the unique needs of their markets or experiment with alternate models of providing health insurance coverage to their residents. This session will examine opportunities and considerations for applications of Section 1332 State Innovation Waivers and Section 1333 Health Care Choice Compacts as states seek to improve access to affordable coverage in the individual market.

, General Luncheon Sessions

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    Key Strategies for Payer-Provider Partnerships in Chronic Care Management

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    Speakers in this session will illustrate how payer-provider partnerships and effective value-based care can meaningfully impact chronic disease management. See how an integrated team model paired with community outreach can improve outcomes for the most complex Medicaid members.

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    Congressional Policy Priorities in 2025 and Beyond

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    A panel of D.C. insiders will offer insights on priorities for the 119th Congress.