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Conferences

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.

Registration Policies

Sessions Filters

Sessions

, 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
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      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 ÐÜèÊÓƵSelect 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 ÐÜèÊÓƵSelect 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 Trends & Business Insights

      Simplifying and Enhancing the Member Journey by Leveraging AI

      Presented by Sagility – An ÐÜèÊÓƵSelect 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 Trends & Business Insights

      Navigating the Future of Prior Authorization

      Presented by Optum – An ÐÜèÊÓƵSelect 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.