Each year, the Centers for Medicare & Medicaid Services (CMS) notifies health care industry stakeholders about proposed updates and changes to the current risk adjustment model and Star Ratings methodology for Medicare Advantage (MA) plan sponsors. CMS released Part 1 of its 2020 Advance Notice and Call Letter outlining methodological changes for calendar year (CY) 2020 for the MA CMS-HCC Risk Adjustment Model on Dec. 20, 2018. Part 2, which will outline changes to MA capitation rates, Part C and Part D payment policies and annual adjustments to the Medicare Part D benefit parameters, is anticipated for release on or before Jan. 31, 2019. For MA plans, an understanding of CMS’s 2020 Advance Notice and Call Letter is essential to developing and implementing effective operational improvement strategies for 2020 and beyond.
Industry experts will provide an in-depth look at CMS’ proposed payment, risk adjustment and quality-related policies for the 2020 CY. Attendees will gain actionable insight into the proposed changes and potential impact to health insurance providers as they consider, develop, and submit formal comments to CMS for consideration ahead of the 2020 Final Call Letter release, expected on April 1, 2019.
Sean Creighton is responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.
His extensive experience with claims data and application of Avalere’s modeling and analytics functions enable him to advise clients on their strategic goals.
Prior to Avalere, Sean was a senior vice president at Verscend Technologies, where he led the development and management of risk adjustment products. Prior to that, he spent 15 years at the Centers for Medicare & Medicaid Services, leading the policy development and implementation of major public programs.
Sean holds graduate degrees in sociology and statistics from the London School of Economics and Trinity College, Dublin, Ireland, and a BA from the University of Limerick, Ireland.
Senior Systems Solutions Engineer
Matt Caminiti is responsible for planning, operations, design, modeling, and coordination of the Inovalon solutions for Medicare, Medicaid, and commercial risk adjustment products.
His experience bringing risk adjustment and quality improvement solutions to health plans is invaluable and his mastery of the risk adjustment and quality improvement models across all lines of business is essential to effective program execution for health plans and health systems.
Matt has focused on public policy and its impact on businesses for more than one decade, including appearances as a subject matter expert at industry-leading healthcare conferences.
He has a Master of Business Administration in Finance and International Business from Loyola University, Maryland, and a Bachelor of Arts degree from Boston College.