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What to Expect from Exchanges: How One-Stop Shopping Will Shape the Future of Health Care


Product Code - LGA179
Speaker(s): Joel S. Ario, Manatt Health Solutions; Melinda J. Dutton, Manatt, Phelps & Phillips, LLP; Scott Falk, Bloomberg BNA; Lisa Rockelli, Bloomberg BNA
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By creating a marketplace in which consumers have multiple choices among products and web-based tools for comparison shopping, health care exchanges will become the public face of the Affordable Care Act (ACA) when they open for business in 2014. The ultimate vision is to create an Amazon-like experience, leading to a health insurance system that is more transparent, easier to navigate and more responsive to consumers’ needs. On the path to achieving that goal, both public and private exchanges are experimenting with a variety of approaches and models—and all of the healthcare stakeholders, from payers to providers to pharmaceutical companies—are re-thinking how they’ll operate in the changing environment.

The faculty for this program will take an in-depth look at the emerging exchange marketplaces and how they are transforming health insurance and the broader patient care landscape. Attendees will learn about:

• The three government exchange models—state-based, federally facilitated and partnership—as well as which states have chosen which approaches and their differing versions of implementation, spanning the spectrum from single payer to privatization

• The four core functions of exchanges, with a detailed look at eligibility and enrollment, financial management, plan management and consumer assistance

• The options and opportunities in individual and small-group markets, including exploring risk pools, tax credits and the Small Business Health Options Program (SHOP)

• The role exchanges will play in the marketplace, including their function as active purchasers or clearinghouses for all Qualified Health Plans (QHPS), their interactions with state departments of insurance and state Medicaid programs and their competitive position vs. private Exchanges

• The details of premium stability programs, including risk adjustment, reinsurance and risk corridors

• The part agents, brokers, navigators and assistors will take in guiding consumers through the new system

• Certification standards for QHPs

This program provides an opportunity for everyone in the healthcare chain—from payers to providers to drug manufacturers to employers—to better understand the evolving exchange landscape, as well as their options, obligations and opportunities in this new market. Participants will get a close-up look both at the regulatory requirements defining exchanges and how they are playing out in the real world.

Educational Objectives:

• Gain a full understanding of the exchange marketplace, its regulations and requirements—as well as the responsibilities of relevant players.
• Explore the models states are implementing and the range of potential approaches.
• Discover the roles the exchanges will play in the healthcare system across key functions, from providing access to affordability programs to managing funds to monitoring QHP performance to assisting consumers.
• Learn the latest information on certification and enforcement issues.
• Examine how exchanges will interact with other key players, including Medicaid and state insurance departments—as well as how public Exchanges may relate, both competitively and cooperatively, with private Exchanges in the market.

Who would benefit most from attending this program?

The changes in the healthcare environment that reform is driving have broad interest across stakeholders. Counsel/legal departments, regulatory affairs management and executives involved in strategy and planning for health insurance/managed care firms, provider organizations/health systems, life sciences companies and health-focused foundations and associations all will benefit from gaining a deeper understanding of the exchange marketplace and how it will impact the U.S. health system.

Program Level: Intermediate.

Joel S. Ario, Manatt Health Solutions; Melinda J. Dutton, Manatt, Phelps & Phillips, LLP; Scott Falk, Bloomberg BNA; Lisa Rockelli, Bloomberg BNA

Joel S. Ario, Manatt Health Solutions
Joel Ario, a managing director of Manatt Health Solutions, has 30 years of experience helping to shape and implement public policy, including two decades devoted to leading health insurance reform efforts at the state and federal government levels. He provides strategic consulting and policy analysis to assist state governments, health plans and foundations in preparing for the broad implications of health care reform, with a particular emphasis on planning for and implementing the new exchange-based marketplaces.

Mr. Ario previously served as Director of the Office of Health Insurance Exchanges at the U.S. Department of Health and Human Services (HHS), where he worked closely with states and other stakeholders in leading HHS efforts to develop the regulatory framework for exchanges, including the rights and responsibilities of the states in establishing exchanges and preserving their authority over the private insurance marketplace.

Prior to his federal service, Mr. Ario was Pennsylvania Insurance Commissioner from 2007 to 2010 and Oregon Insurance Commissioner from 2000 to 2007. He served on the Executive Committee of the National Association of Insurance Commissioners (NAIC) for a decade and was an NAIC officer from 2003 to 2005. Mr. Ario also serves as an advisor to the Robert Woods Johnson Foundation on their state exchange work and is a member of the Leavitt Partners Future Panel.

Mr. Ario earned a J.D. from Harvard Law School, an M.Div. from Harvard Divinity School, and a B.A. from St. Olaf College.

Melinda J. Dutton, Manatt, Phelps & Phillips, LLP
Melinda Dutton is a partner within the healthcare division of Manatt, Phelps & Phillips, LLP and also plays a leadership role within Manatt Health Solutions, an interdisciplinary policy and business advisory practice within the firm. Ms. Dutton’s practice concentrates on advising clients in the healthcare industry with respect to regulatory, public policy and business matters.

Ms. Dutton has extensive experience working with public health insurance programs and the healthcare safety net, and represents a broad array of healthcare clients in navigating the legal, regulatory and political challenges of Medicaid, SCHIP and other public programs. She assists health centers, hospitals, home care agencies and other providers with issues related to business strategy and reimbursement, as well as licensure and regulatory compliance. Ms. Dutton also provides strategic counsel, policy analysis and research support to foundations, think tanks and advocacy organizations for children, the disabled and other vulnerable populations. She has written extensively on the laws and systems that govern public health insurance programs, particularly as they relate to eligibility, benefit delivery and reimbursement, and is currently advising foundations, state governments and provider groups on the implications of health reform.

Ms. Dutton has been engaged in a wide variety of projects involving use of health information technology to improve the quality and efficiency of healthcare. She has supported statewide, multi-stakeholder health information exchange planning efforts in several states. She served as an adviser to New York State on the Health Information Privacy and Security Collaboration, where she identified laws, policies and business practices that support the private and secure exchange of health information, and has assisted states in developing strategic and operational plans to support both statewide health information exchange and implementation of Medicaid incentives under HITECH. Prior to joining Manatt, Ms. Dutton served for nine years at the Children’s Defense Fund in New York, where she helped develop and secure passage of legislation expanding publicly funded health insurance programs for children. Ms. Dutton started her legal career at South Brooklyn Legal Services, where she helped establish a health law practice serving low-income populations.

Ms. Dutton has served as a guest lecturer for numerous health law and policy courses at colleges and universities, including New York University School of Law, Columbia Law School and New York Medical College, and she has served as a practitioner-in-residence at Saint Louis University School of Law, the top-ranked healthcare law program in the country. She earned a J.D. from Columbia Law School and a B.A., cum laude, from Kansas State University.

Scott Falk, Bloomberg BNA
Scott Falk is Executive Editor of the health care division at Bloomberg BNA. He has been with BNA since 1987, holding various editorial positions with the Health Care Daily Report, Health Law Reporter, Medicare Report, and the Bloomberg BNA Health Law Resource Center. Prior to joining BNA, Mr. Falk worked as a paralegal at Bredhoff & Kaiser P.L.L.C. in Washington. He earned a masters degree in education from Brown University and a bachelor’s degree from Wesleyan University.

Lisa Rockelli, Bloomberg BNA
Lisa Rockelli is a Managing Editor for Bloomberg BNA's Medicare Report, Health Care Fraud Report, Health Insurance Report, and Health IT Law & Industry Report. She is a well-respected member of the Bloomberg BNA team and has a high level of expertise in health care-related products. Ms. Rockelli earned a Bachelor’s Degree in Journalism and Political Science from the George Washington University.

This program’s CLE-credit eligibility varies by state. Bloomberg BNA is an accredited provider in the states of New York*, California, Pennsylvania, Texas and Virginia, and most other jurisdictions grant CLE credit on a per-program basis. At this time, Bloomberg BNA does not apply directly to the states of Florida, Rhode Island, Montana and Hawaii although credit is usually available for attorneys who wish to apply individually. Additionally, the following states currently do not grant credit for Bloomberg BNA OnDemand programming: Arkansas, Ohio, Nebraska, and Delaware. All requests are subject to approval once the live webinar has taken place or the customer has viewed the OnDemand version. Please contact the Bloomberg BNA accreditations desk if you have specific questions that have not been addressed.

If you have further questions regarding a specific state or how to file for CLE credit, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the CLE Accreditation Coordinator.

Hardship Policy
Bloomberg BNA offers a hardship policy for attorneys earning less than $50,000 per year. If an attorney wishes to take advantage of this option, he or she must contact Bloomberg BNA directly. For attorneys who are unemployed or earning less than $35,000 per year, a full discount off the price of the program will be awarded upon written proof of hardship. Attorneys earning between $35,000 and $50,000 per year will receive a 50% discount off the price of the program. Any attorney working in the public service sector also qualifies for a special price. If you have further questions regarding the hardship policy or seek additional information, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the CLE Accreditations Coordinator, or email us at accreditations@bna.com.

Questions
For more information about Mandatory or Minimum Continuing Legal Education (MCLE) requirements, visit the American Bar Association website at http://www.abanet.org/cle/mandatory.html.

*Bloomberg BNA is an accredited provider in New York for experienced attorneys only.