ABA National Managed Care Institute

Crowell & Moring Partners Kelly Hibbert and Jed Wulfekotte, and Senior Counsel Janet Walker, members of the firm's Health Care Practice Group, will be speaking at this year's ABA National Managed Care Institute, which will be taking place in person at Greenberg Traurig December 14-15th in Washington, D.C. (CLE offered for both presentations.)

Janet Walker's presentation, entitled "Managed Care Forecast 2023: Transforming the Modern Health Care Business & the Continuing Role of Value Based Care," will be taking place December 15th from 11:15 a.m. - 12:15 p.m. ET, and she will be joined by Marinan Williams (CEO & President, Seton Insurance Services at Ascension) and Brock Ingmire (Director of Health Policy, Centene Corporation). The pursuit of cost-efficiency in the health care industry is increasingly driven by the formation of collaborative arrangements among multiple health care providers who furnish services to patients at various points along the care continuum. This instance is becoming increasingly prevalent as federal and state governments continue to advocate for a shift from volume-based to value-based reimbursement schemes. To remain viable, health care industry stakeholders will need to adapt their business models to deliver higher quality care at lower cost.  This panel will cover the transformational shifts in the managed care space accelerated by the pandemic and the shift to value, including a discussion on recent tensions between payors and providers, increased implementation of alternative payment models, and an examination of the increased focus on social determinants of health.

Kelly Hibbert & Jed Wulfekotte's presentation, entitled "Affirmative Recovery: Opportunities for Medicare Plan Sponsors and Medicaid Managed Care Organizations," will also be taking place December 15th from 1:15-2:15 p.m. ET, and they will be joined by Jeremy Ches (Assistant General Counsel at Florida Blue). CMS requires payors to take an affirmative role in preventing, detecting, and correcting fraud, waste, and abuse.  But in addition to meeting CMS’s requirements, Medicare Plan Sponsors and MCOs – who can become the victim of fraud themselves – can realize significant monetary recoveries by pursuing affirmative claims in litigation or arbitration.  This session will explore how Plan Sponsors and MCOs can identify, develop, and pursue affirmative recovery matters.

The Managed Care Institute is an educational symposium for attorneys in private practice, in government service and in-house that work in the area of managed care and with risk based health care entities of all types. This includes traditional MCOs, provider operated health plans, ACOs, ICNs, MSOs, TPAs, PBMs, tribal health plans, self-funded ERISA plans, administrative support entities and all others involved in the reimbursement side of health care.