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Conferences

2025 Medicare, Medicaid, Duals & Commercial Markets Forum

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

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 Filters

Sessions

March 25, 2025

, General Sessions

, Concurrent Sessions

  • SERIES 1

    • Medicare Advantage & Part D

      Building and Maintaining Successful Working Relationships with Regulators

      Speakers
    • Commercial Market & Employer-Provided Coverage

      Surprise Billing: What’s Next

      Speakers
    • 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.

, 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.

    • 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
    • Commercial Market & Employer-Provided Coverage

      What’s Next for the Individual Market?

      Speakers

  • 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.

    • Medicaid Managed Care & Dual Eligibles

      Unlocking Health Equity: Social Drivers of Health in Medicaid Populations

      Presented by Ovia Health – An AHIP Select Member
      Speaker
      Details

      Social drivers of health play a critical role in shaping health outcomes for Medicaid populations. This session will highlight innovative strategies, share best practices, and explore collaborative efforts to effectively meet underserved communities' needs. Gain insights into actionable approaches to achieve health equity and improve the health of Medicaid members.

    • 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.

    • Medicaid Managed Care & Dual Eligibles

      Improving Outcomes for the Dual Eligible Population through Value-Based Care

      Presented by Evernorth Health Services
      Speakers
      Details

      As the dual eligible beneficiary population continues to grow, health care providers have an opportunity to enhance the quality of care and improve health outcomes for individuals with complex medical needs. Join this session to explore the challenges and opportunities that providers in value-based care arrangements encounter when caring for dual eligible patients and examine how value-based care can drive quality outcomes.

, General Sessions

March 26, 2025

, General Sessions

  • ,

    Strengthening Primary Care

  • ,

    Closing Gaps in Coverage and Care

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    Innovation Spotlight

  • ,

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

    ,

    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
    • Medicaid Managed Care & Dual Eligibles

      MACPAC Update: Emerging Trends and Policy Recommendations

      Speakers

    • 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.

    • 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

      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.

    • 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.

, Concurrent Sessions

  • SERIES 5

    • Medicaid Managed Care & Dual Eligibles

      Policy Agenda for Medicaid Managed Care

      Speaker

  • SERIES 6

    • Medicare Advantage & Part D

      Part D in 2025: Impacts of the Benefit Redesign

      Speakers
    • Closing Gaps in Coverage & Care

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

      Speaker
    • 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.

, General Session

March 27, 2025

, General Sessions

  • ,

    Implications of Recent Supreme Court Decisions on Health Care Regulations

  • ,

    Priorities and Future Directions for Dual Eligibles

  • ,

    Innovation Spotlight

  • ,

    Improving Care for Complex and At-Risk Populations

    ,

    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.

    • Medicaid Managed Care & Dual Eligibles

      Updates on Policies Supporting Dual Eligible Individuals

      Speaker

  • SERIES 8

    • Medicare Advantage & Part D

      Value of Medicare Advantage: Latest Evidence that Makes the Case

      Speakers
    • Closing Gaps in Coverage & Care

      Prevention in Behavioral Health

      Speaker

, General Luncheon Session

  • ,

    Key Strategies for Payer-Provider Partnerships in Chronic Care Management

  • ,

    Congressional Policy Priorities in 2025 and Beyond

    ,

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