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TPA Speakers & Sessions

 


SPEAKER & SESSIONS as of 5/23/14

Wednesday, July 16, 2014


SESSION:
Help I Need Somebody, Help, Not Just Anybody
Legends Ballroom

As the brilliant Chinese military strategist Sun Tsu said: “every good warrior must learn to sharpen their own sword” or Abraham Lincoln once said; “If I had eight hours to chop down a tree, I would spend six hours sharpening my axe”. With all of the current mandates, compliance dictates and complex reporting requirements that TPA’s are now responsible for managing – how do we keep track of the ever changing rules so that our groups are/remain compliant?  What resources are available?  Please join us for an interactive session and hear what works from a small, medium and large TPA perspective – from punch lists, to process management processes, to eliciting tools for your compliance arsenal. We do need help and it cannot just be anybody….”


PANELISTS:
Carolyn Jarschke is a founder and co-owner of QVI Risk Solutions, Inc., a Third Party Administrator (TPA). QVI’s initial focus was providing administrative services to fully insured carriers. Under Carolyn’s leadership services quickly expanded to self-funded employer groups, FSA’s, HRA’s and BPO services. Carolyn’s customer focused business model as resulted in TPA’s selecting QVI as their health plan’s TPA. Prior to starting QVI in 2003, Carolyn was Vice President of Operations for LifeWise of Oregon. Her 30+ year carrier has included key positions at Pacific Health & Life, Western Benefits Administrators and Klamath Medical Service Bureau. She is the immediate past President of the Health Care Administrators Association, has taught at Central Oregon Community College and is a guest speaker for AHiMA. Carolyn began her health administration career following the completion of an AS degree from OIT in Health Information Technology and holds a BS in International Business from Linfield College. She enjoys the challenges of being a business owner and entrepreneur.

Linda Ludwick has extensive and varied experience as a leader in the health care industry. She has worked with Aetna Life & Casualty as a Regional Operations Manager where she was responsible for product development and implementation.  She spent close to three years with Blue Cross and Blue Shield managing projects with national scopes.  She has extensive experience in administration, budgets, staffing, business and product development, including over twenty years in the healthcare field.  
In February 2002 Ms. Ludwick was presented with an opportunity to join Mountain States as the Executive Director she worked with Mountain States through 2008.  In 2009 Ms. Ludwick joined Capitol Administrators in Rancho Cordova, CA as COO, she remains in that position.
She currently serves as the Immediate Past President of the Health Care Administrators Association (HCAA) chairing the Strategic Partners Committee, and sits on the Board of AAPPO (American Association of Preferred Providers Organization).


Todd Archer, a native of Tennessee, graduated from Jackson Central Merry High School, and then from the University of Tennessee with a Bachelor of Science Degree in Business Administration.  He then successfully completed a management training program with Integon Life Insurance Co. in Winston-Salem, North Carolina.  After completing the program, he was assigned a Group Representative position in Memphis, Tennessee.
In 1983, Todd accepted a position with Safeco Life Insurance Company where he held numerous positions culminating in his managing the marketing and underwriting of their Medical Excess Loss, Life and Disability products for the Regional Office in Dallas, Texas.  Todd joined MAA in 1990 as Vice President of Marketing.  In 1996, his responsibilities were expanded when he was named MAA’s Executive Vice President, and he served as MAA’s President from 2002-2013. 

With MAA, Todd served as a panelist for national conferences on Medical Stop-Loss and Self-Insurance; as a guest lecturer at the University of Central Oklahoma on the topic of employee benefits; on the Board of Advisors for the Oklahoma City Chamber of Commerce, and served on a TPA Advisory Council for the Oklahoma State Department of Insurance.  He is currently on the Board of the Health Care Administrators Association (HCAA) were he serves as Immediate Past President.  He is also involved in numerous community service activities including being a graduate of Leadership Oklahoma City, a member of the Downtown Oklahoma City Rotary Club, and is a member of the Rebuilding Together Board of Directors. 

MODERATOR:
Tim Callender serves as Corporate Counsel with AmeriBen in Boise, Idaho. Prior to joining AmeriBen Tim spent many years in private practice in the Boise area, preceded by positions with the Boise City Attorney’s Office and the Idaho Industrial Commission. Tim heads up AmeriBen’s legal and compliance efforts as well as overseeing AmeriBen’s Plan Document Department. Tim is also AmeriBen’s HIPAA Privacy Officer. Tim received his undergraduate degree from the College of Idaho and his Juris Doctor degree from the University of San Diego School of Law. Tim is licensed to practice law in the State of Idaho as well as before the 9th Circuit Court of Appeals. Tim currently sits on the Idaho Immunization Assessment Fund’s Board of Directors.

SESSION:
Internal Claim Audit - Is It Necessary?
Legends Ballroom

The importance of accurate claim processing cannot be over emphasized. It is the basis by which clients, reinsurers and external auditors evaluate a claims administrator's capabilities. The accuracy of claim processing is an overall reflection of the effectiveness of a claims administrator’s resources - personnel, training, policy and procedure documentation and system capabilities. Inaccuracy is expensive. In addition to the dollar value of overpaid claims, there are the administrative costs of processing voids and reissues, reimbursing underpayments and collecting overpayments, as well as the risk of incurring customer dissatisfaction. Additionally, a growing number of self-funded clients are requesting that performance standards be included as part of their administration contract, with penalties applied for failure to maintain these standards.

SPEAKER:
Kathy Smith is one of the founding principals of Trilogy Consulting Group, Inc. Trilogy specializes in the performance of excess loss claims audits, self funded employer audits and the publication of The Trilogy Claims Administrative Handbook. In addition to Ms. Martin-Smith's proficiency in the performance of claim audits, Ms. Martin-Smith performs TPA, MGU and HMO claim administration operational reviews.



SESSION:
You Can’t Checklist Yourself to Compliance
Legends Ballroom

The HITECH Act codified by the Omnibus Final Rule as significantly increased HIPAA enforcement activities, raised civil penalties and cast a much wider net over organizations that are newly statutorily obligated to comply with these regulations. Enforcement actions related to sensitive information have increased at the Federal (e.g., Office for Civil Rights, Federal Trade Commission) and State (e.g., State Attorneys General) levels This presentation presents practical, tangible, actionable information for TPAs and their customers, the self-insured plan sponsors. Operations staff will learn the areas of greatest focus, the sources of greatest risk and, importantly, preventative actions to take now to avoid causing a breach of their plan sponsors information.

SPEAKER:
Bob Chaput has worked as an educator, an executive and an entrepreneur. He has assisted businesses and individuals in developing highly secure information technology (IT) strategies that are tightly linked with their business strategies and goals. His workshops, seminars, writings and consultations reflect his knowledge, humor, enthusiasm and vision. Given world events, increasingly more stringent security and privacy regulations around safeguarding personal and healthcare information (PII and PHI) along with increased business dependency on technology, his passion and focus is in helping organizations become and remain compliant with HIPAA and HITECH regulations.


Thursday, July 14, 2014


KEYNOTE:
How to Get People On Board So You Can Make Things Happen Now
Legends Ballroom

Successful people are GREAT influencers. They know how to get consensus, ownership and buy-in from the people who count–without manipulation, intimidation, sacrificing relationships, or stepping on toes. Bottom line: Getting the job done the right way hinges on your ability to “sell” yourself and your ideas in such a trusting and positive way that people will CHOOSE to: Follow your lead. Cooperate with you. Learn from you. Buy from you. Partner with you. And…support you so you can make things happen! With a rare blend of laugh-out-loud humor, uncanny insight into human nature and killer persuasive strategies, Human Relations expert Connie Podesta, will take you right inside the minds of the people you need to influence and impress. You will learn how to negotiate differences, influence behaviors, change attitudes, overcome objections, and close the deal so you can create an amazing network of PEOPLE who have one common goal: to willingly help you GET THE JOB DONE NOW!

SPEAKERS
Connie Podesta is a game-changing, money-making, sales-generating, idea innovator whose rare blend of laugh-out-loud humor, out-of-the-box strategies and signature, tell-it-like-it-is delivery style has made her one of the most talked about entertaining business motivational speakers in the marketplace today.



SESSION: 
Buidling Customer Value Through Benefit Strategic Planning
Legends Ballroom

The Employee Benefits marketplace continues to challenge even the best benefits industry professionals. Cost containment, navigating ACA, and dealing with volatile economic conditions are major points of focus right now for all employers. A benefits strategic plan is one effective tool you can use to manage through uncertainty and change. By building a multi-year game plan, one that is rooted in the values and goals of your employer-client, you are better equipped to anticipate needs and provide solutions regardless of whether your clients are fully insured or self-insured. You also reposition yourself as a trusted advisor, elevating and strengthening your client relationships. This session will: delve into the basics of Benefit Strategic Planning; provide a roadmap for how to incorporate this approach into your practice; and provide attendees case studies of how Benefit Strategic Planning has been used in the marketplace.

SPEAKERS:
Jack Kwicien is Managing Partner of Daymark Advisors, a position he has held since co-founding the firm in 2001. He has over 30 years of executive management and entrepreneurial experience with specialization in strategic business development, negotiating strategic alliances, financing transactions and mergers and acquisitions. Mr. Kwicien has significant experience in insurance, benefits, financial services and workforce management market sectors.

Susanne Radek is a founding Partner of Daymark Advisors, LLC a Baltimore, MD-based merger /acquisition and consulting practice serving the insurance and benefits industries. She has over 20 years of experience in strategic marketing communications and interactive marketing as well as financial advisory services including equity capital raising and buy and sell side M&A engagements. Ms. Radek is a co-founder and co-developer of SMART practice enabling solutions for insurance professionals.



SESSION: 
Innovative Patient-Centered Engagement: High Dollar Risk Impact
Legends Ballroom

Impacting and controlling high risk dollars is critical in today's self-insured market. Self- insured employers are seeing high risk claims dollars sky rocket, especially in such areas as diabetes and coronary related issues, and they are looking for creative, real solutions NOW. There has been a tendency to chase the program "de jour" – that promise big results and then do not deliver! Today you will learn firsthand about the 180-degree shift in strategies needed to enable high risk and chronic people to be accountable and efficient consumers of the health care delivery system and what is required to motivate lifestyle choices leading to improved health and lower risk.

SPEAKERS:
Lindsay DeYoung has over 25 years of experience developing relationships in the TPA – Self Insured, PPO, Managed Care, Stop-Loss and Broker/Consultant market sectors. Currently, Lindsay is the Vice President of Sales for MCM Solutions for Better and responsible for developing new partnership and sales expansion throughout the U.S. by marketing MCM’s broad range of Population Health Management products, and provide customized, integrated health care solutions to clients. Prior to joining MCM, Lindsay has served in a variety of Senior Business Development and Management positions for Third Party Administrators and National/Regional PPO Networks. Lindsay attended the Ohio State University, holds a Health Insurance Associate (HIA) designation and has previously served on the membership committee for HCAA.


Jim Wicka is Co-Founder and Executive Vice President of Corporate Development at Novu. A lawyer and veteran sales executive, Jim is responsible for guiding the company’s strategic roadmap and identifying areas of growth for the business. Jim provides guidance on the nuances of the evolving health care landscape to both clients and the internal team. Prior to Novu, Jim served as National Director of Sales for IWCO Direct, defining and leading successful sales initiatives to the company’s stable of Fortune 500 companies across multiple vertical markets. He holds a JD from William Mitchell Law School and a BS from the University of Minnesota’s Carlson School of Management. Outside of Novu, Jim enjoys yoga, traveling and can often be found boating with his family.



SESSION: 
Your Don’t Get What You Don’t Ask For: Negotiating Corporate Contracts
Legends Ballroom

Few organizations subscribe to today's best practices in the sourcing of high technology goods and services, especially software. This oversight can cost the company money and result in less than ideal contract terms. Through a proven process by which you can control the flow of information, a formal software sourcing strategy can guarantee more value, a faster return on investment, and less risk to your organization. Speaker, Randy Roth, will discuss the current key trends and process in software strategic sourcing: selection criteria, negotiable and non-negotiable contract terms, aspects of contract and relationship management, control of information between the vendor and your company, gaining the most value from the transaction.

SPEAKERS:
Randy Roth is a managing partner at Corporate Contracts with responsibility for daily operations and has been with the firm since 2000. Randy is an expert in software licensing and specializes in the strategic sourcing of highly complex, enterprise-level applications and outsourced services. Randy has extensive experience with Enterprise Resource Planning software and implementation, HR/Payroll outsourcing, mainframe outsourcing, and comprehensive nationwide desktop services (including IMAC (Install, Move, Add, Change), tech refresh, break/fix, off premises support, etc.) Randy manages the most complex aspect of these negotiations by creating clear, quantifiable service levels, a manageable process for measuring failure and applying monetary credits or early termination rights. Randy has assisted several companies with the creation and implementation of strategic sourcing processes and policies. Randy manages some of Corporate Contracts’ key customer relationships and remains active in the IT sourcing community through industry sourcing groups. Randy has over 30 years of experience in IT and strategic sourcing including 13 years in mainframe, client server and object oriented development. He spent additional time in IT research and development before his permanent move to sourcing and procurement in an executive role. This role included the responsibility for all IT and non-IT procurement, Contract Management and IT Asset Management.



SESSION:
Capitalizing on Private Exchanges: The Case for TPAs in the Coming Industry Shift
Legends Ballroom

Make no mistake: by the end of the decade, we may not even recognize our industry. Accenture, the highly respected consulting firm, predicts that 85% of employers will be in private exchanges in the next 6-8 years. Considering virtually no TPAs are yet on an exchange and that network control and broker commissions discourage networks and brokers from including TPAs on their exchanges, our businesses are under credible threat. However, these large fully insured exchanges are not the cure-all they are purported to be, and there is a strong business case to be made for the continuance of traditional self-funding, or self-funding on a TPA-controlled private exchange. This must-attend session will make this business case. It is imperative that as TPAs we understand the drivers of this industry shift and how to sell our alternative convincingly to maintain and grow our businesses. By doing so, we can profit from, and not be threatened by, what may be the largest benefits industry shift in 50 years.

SPEAKERS:
Lee Lewis is an Executive at AmeriBen with a ten-year track record of business development, channel innovation, product creation, process improvement, human capital leadership and operational excellence in high-growth, high-innovation, and high-expectation environments.



SESSION:
Changing Culture-From Vision to Operations
Legends Ballroom

As TPAs we perform a number of fairly mundane administrative functions on a day to day basis. Our claims examiners, eligibility coordinators and CSRs come to work focused on turnaround times, accuracy rates, speed to answer and abandonment rates. But are these the metrics that really matter? Are these really the reasons why our people come to work each day motivated and driven to service our customers? Gallup research has directly connected the level of employee engagement with the respective performance of an organization.

Join Tom Partlow as he describes the process he and the EBMS leadership team went through to re-invigorate a work force so that each employee felt an integral part of something more important than simply processing a claim. Every organization strives to provide this “higher calling” to their staff in order to improve job-satisfaction and ultimately the customer experience. Tom will share how EBMS developed a new company Vision and how it was translated into everyday action by the line employees.

SPEAKERS:
Tom Partlow is the Chief Executive Officer at EBMS. For the past 25 years, Tom Partlow has had a highly successful career in the self-insurance/group health marketplace, earning a proven track record of achieving organizational goals for both growth and profitability.

Tom previously served as president of Delta Health Systems, a California-based leading service provider for self-funded health plan management where he was instrumental in the development of a suite of wellness and disease management programs. He also was instrumental in the development of an Accountable Care Organization-based network in the Southern California region, comprising over 4,000 physicians and 20 hospitals. During his presidency, Delta’s revenue grew to greater than $30 million, with robust margins.


Friday, July 18, 2014


OPERATIONAL ROUNDTABLES ROUND 1
Legends Ballroom

Stop Loss Claim Filing Best Practices

No one wants them, but we get them - high dollar catastrophic losses. And come submission time, every TPA strives to get every single dollar of shock loss claim recovery for their Plan Sponsor. There are ways to increase the likelihood that you will obtain a dollar for dollar (maximum) recovery. There are blue prints for success and conversely, tales of woe. In this informative session, a carrier and an MGU will give us the “answers to the test and tricks to the trade”. They will share with us examples of the most efficient processes for submission, what not to do, what carriers are looking for procedurally, forms for best submission practices, claim trends they are seeing in the industry, and best vendor partner list (i.e. tools in your claim constraint arsenal – retrospective review companies, cost containment, repricing organizations, medical peer review, etc.). Please join us and learn how to increase your chances of being successful with your submission process!

SPEAKERS:
Alice Arnold is Vice President of Claims for Risk Solution Resources (“RSR”). Her responsibilities are claim auditing and oversight on a diverse portfolio of products with the majority being Stop Loss. Prior to RSR she worked for an auditing firm which exposed her to a number of TPA’s and MGU’s and a variety of unique claim issues and claim filing and submission styles.

Donna Duncan is the Claims Manager for East Coast Underwriters (ECU). She is responsible for auditing stop loss claims for contracts written through ECU. Her duties also include appeals, reserve maintenance and risk analysis consultation for medical disclosures. She deals with numerous TPA’s on a daily basis that have varying claim submission processes, as well as working with carriers as needed for a variety of claim issues. Her past experience includes claims auditor for fully insured carriers and certified medical assistant for specialty medical practices.



Effective Budgeting and Operational Cost Management

Participants will engage in active discussion of Budgeting vs. Rolling Forecasts to identify the value and appropriateness of these tools for their business. Utilizing HCAA materials, Sherlock Expense Evaluation Report and other tools, participants will discuss what operating cost measures that are most critical for their business success. The session will wrap up with suggestions and ideas for effectively managing operation costs from the budgets, forecasts, measures and metrics utilized.

SPEAKER:
Marilyn Bartlett is a past president and much-loved member of the Montana Society of CPAs. She was the inaugural recipient of the Outstanding CPA in Business and Industry Award, which was presented to her because of the professionalism she has shown, as well as her many contributions to the profession. Very few CPAs are as respected or well-known by their peers as is Marilyn Bartlett. She is an inspiration to me and to many others, and has forged the way as a leader in a profession that, until recently, didn’t have many women leaders. She has made a difference for us all.



Exhibit A (Your ASA) – Are You Protected?

In the hustle and bustle of ensuring that we are exceeding our client's expectations and satisfying the numerous compliance and ACA requirements that are upon us, we need to take a moment to review our Administrative Service Agreements and determine if any amendments are necessary to clearly define the current respective rights, duties, and responsibilities of you and your client. In the event a dispute arises between you and your client the Administrative Service Agreement becomes Exhibit A and now is a good time to tidy up those terms and make sure you are minimizing your legal exposure.

SPEAKER:
Cori Cook, J.D. is a corporate strategist specializing in corporate, insurance, employment and health care law.  She graduated from Gonzaga School of Law and is a national speaker on topics related to health and benefits, and healthcare reform.

Ms. Cook serves on various industry committees including:  the Health Care Committee of the Self-Insurance Institute of America (SIIA); the Government Regulations and Regulatory Compliance Committee of the Health Care Administrator’s Association (HCAA), where she represents the legislative and regulatory interests of the industry; and recently served as a board member for the Society of Professional Benefit Administrators (SPBA).

Managing Remote Employees

Have you ever managed or been managed in a remote work environment? Remote Employee Management Skills are essential to today’s virtual work environment where technology is expanding and lack of skilled labor is a growing challenge. Managing in a virtual team environment has its advantages but also can come with its challenges if left without clear policies and oversight.

SPEAKER:
Melissa Lyon's ethical and loyal work character are significant assets to EBMS and its leadership team. Her compelling background of over 20 years in human resources has brought invaluable experience to EBMS, where she believes hiring, developing, and retaining top-quality employees are what give EBMS a superior competitive advantage.

Prior to joining EBMS, in March 2011, Melissa’s broad experience included managing retirement plans for businesses, supporting community banking for the State of Montana, and managing branch banks in Billings and the surrounding area.



OPERATIONAL ROUNDTABLES ROUND 2
Legends Ballroom

Stop Loss Claim Filing Best Practices

No one wants them, but we get them - high dollar catastrophic losses. And come submission time, every TPA strives to get every single dollar of shock loss claim recovery for their Plan Sponsor. There are ways to increase the likelihood that you will obtain a dollar for dollar (maximum) recovery. There are blue prints for success and conversely, tales of woe. In this informative session, a carrier and an MGU will give us the “answers to the test and tricks to the trade”. They will share with us examples of the most efficient processes for submission, what not to do, what carriers are looking for procedurally, forms for best submission practices, claim trends they are seeing in the industry, and best vendor partner list (i.e. tools in your claim constraint arsenal – retrospective review companies, cost containment, repricing organizations, medical peer review, etc.). Please join us and learn how to increase your chances of being successful with your submission process!


Questions regarding TPA University contact:
Phone: 888.637.1605
E-mail: hcaainfo@hcaa.org

5353 Wayzata Blvd. Suite 350
Minneapolis, MN 55416

Phone: 888.637.1605
Fax: 952.252.8096
Email: hcaainfo@hcaa.org

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