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Medicare Advantage and the Cures Act:
Scaling to Meet Rising ESRD Enrollment

  • October 26, 2021
  • 1:00 PM – 2:00 PM ET
  • Online
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The 2022 open enrollment period begins in just a few weeks, kicking off the second year under the 21st Century Cures Act. Eligible end stage renal disease (ESRD) patients will once again have the opportunity to choose coverage under a Medicare Advantage (MA) plan. The Cures Act opened the door for over 400,000 previously ineligible ESRD patients to choose coverage under an MA plan for the very first time. The Center for Medicare and Medicaid Services more than doubled its projections for ESRD enrollment in MA plans for 2021-2022. In fact, 2021 MA plans have seen anywhere from a modest to up to 30% increase in ESRD member enrollment.

ESRD is complex to treat and costly to cover. Patients often have comorbid conditions, and many live with social determinants of health barriers that interrupt care and impede their ability to remain adherent to treatment plans. While only 1% of Medicare beneficiaries have ESRD, they represent 7% of Medicare spending and the average medical loss ratio (MLR) for an ESRD member is 112%.

This is just the tip of the iceberg. Currently 37 million people in the U.S. are living with chronic kidney disease (CKD) and 90% are unaware of their condition. Many learn only when their kidneys fail and they “crash” into dialysis. Early identification and intervention can disrupt the CKD to ESRD trajectory, helping people live healthier, longer.

A well-defined kidney care program and comprehensive kidney health management strategy can help MA plans improve care and outcomes for an enhanced member experience while also managing total medical expenses. By participating in this webinar, MA health plan leaders will learn how a well-defined Cures Act strategy can help them achieve their MA plan’s kidney care goals.

Attendees will learn about:

  • Key learning and insights from year one under the Cures Act
    o What to expect and how to prepare for year two
  • How to implement a Cures Act strategy that gets results now and preemptively disrupts the CKD to ESRD trajectory going forward by:
    o Focusing on early detection to slow disease progression and planned, clinically appropriate, and optimized care transitions
    o Empowering providers
    o Engaging, educating, and supporting members
  • How and why having a Cures Act strategy in place benefits members, providers and MA plans

Speakers


Eric Reimer
Chief Executive Officer and Co-chairman of the Board
Healthmap Solutions

Eric serves as a director of ELAP Services, and is the Co-chairman of the Board of Healthmap Solutions. He has more than 30 years of healthcare services experience and leadership, focused on growing payer service and provider companies. Prior to joining Healthmap, Eric was an operating partner at private equity firm Water Street.

As the former Chief Executive Officer of CareCentrix, Eric broadened the management team and introduced innovative product offerings leading to a tripling of company revenues. Previously at Magellan Health Services, he led the Health Plan West Behavioral division serving 15 Blues plans; was Chief Growth Officer responsible for sales, strategy, and acquisitions; and Chief Executive Officer of National Imaging Associates (NIA), where he led the division through 800% revenue growth over two years.

Eric received his bachelor’s degree from Washington University and a Master’s in Business Administration from the Wharton School of Business at the University of Pennsylvania.


Dr. Richard Popiel
Chief Medical Officer
Healthmap Solutions

Dr.  Popiel is a board-certified internal medicine physician and healthcare executive with more than 26 years of experience leading patient-centric healthcare organizations. Throughout his career, he has used his medical and business expertise to help individuals navigate the complexities of the healthcare system while ensuring the cost of healthcare remains affordable to consumers.

He is the Co-founder and Managing Partner at Xploration Health, LLC, and a Senior Advisor at McKinsey & Co. He is also the former Executive Vice President and Chief Medical Officer for Cambia Health Solutions, a Portland-based healthcare solutions company working to create a person-focused and economically sustainable healthcare system. Prior to joining Cambia, he served as President and Chief Operating Officer of Horizon Healthcare Innovations, a Horizon BlueCross BlueShield (BCBS) of New Jersey company.

Richard serves on the Advisory Boards of several trailblazing & influential healthcare organizations, including CareCentrix, Medecision, BioiQ, Tabula Rasa Healthcare, and Pager, and is a member of the Board of The George Washington University Medical Associates in Washington, DC.

Dr. Popiel is a graduate of The George Washington University Medical School and received his MBA from the Kellogg School of Management at Northwestern University.