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 2021 Advance Notice and Call Letter outlining methodological changes for calendar year (CY) 2021 for the MA CMS-HCC Risk Adjustment Model and Part C and Part D payment policies on Jan. 6, 2020. Part 2, which will outline changes to MA capitation rate methodology and other risk adjustment methodologies for CY 2021, along with annual adjustments to the Medicare Part D benefit parameters, is anticipated for release on or before Feb. 6, 2020. For MA plans, an understanding of CMS’s 2021 Advance Notice and Call Letter is essential to developing and implementing effective operational improvement strategies for 2021 and beyond.
Industry experts will provide an in-depth explanation of CMS’ proposed payment, risk adjustment, and quality-related policies for the 2021 CY. Attendees will gain actionable insight into the proposed changes that CMS plans to phase in and potential impact to health plans as they consider, develop, and submit formal comments to CMS for consideration ahead of the 2021 Final Call Letter release, expected on April 6, 2020.
Tom provides analytical support and strategic advice for clients on Medicare Advantage risk adjustment and payment, and on Part D issues. He has over 20 years of public and private sector experience in Medicare Advantage and Part D payment policy. Prior to joining Avalere, Mr. Kornfield served as a vice president of Medicare policy at America’s Health Insurance Plans (AHIP). During his tenure at AHIP, he led risk adjustment policy discussions with plan members and external stakeholders. Additionally, he oversaw research and analyses about the impacts of Medicare Advantage (MA) payment and risk adjustment policies. He also helped to lead work looking at the distribution of rebates among Part D plans, and contributed to analyses of the impacts of restructuring the Part D benefit.
Tom also spent 10 years working at the Centers for Medicare & Medicaid Services (CMS), where he held a variety of positions focused on MA and Part D payment policy. Specifically, Tom analyzed MA bids and payments and changes in MA payment rates, and he created a policy to allow for 5-star MA plans to market and enroll year-round. He has also worked for Coventry Health Care, the Alliance of Community Health Plans, and the Senate Finance Committee.
Tom holds a graduate degree from the University of Michigan’s School of Public Policy. His undergraduate degree is from Hamilton College.
Senior Systems Engineer
Mr. Caminiti is responsible for planning, operations, design, modeling, and coordination of the Inovalon risk adjustment solutions for Medicare, Medicaid, and commercial risk adjustment products. Mr. Caminiti’s experience bringing risk adjustment solutions to health plans is invaluable, and his mastery of the risk adjustment models across all lines of business is essential to execution of the risk adjustment process review. Mr. Caminiti has focused on public policy and its impact on businesses for more than a decade, including appearances as a subject matter expert at industry-leading healthcare conferences. In addition, Mr. Caminiti previously discussed policy issues on Bloomberg Television, Bloomberg.com, Federal News Radio, and in front of the Maryland State Legislature. He has a Master of Business Administration in Finance and International Business from Loyola University, Maryland, and a Bachelor of Arts from Boston College.