PROGRAM AGENDA

Wednesday, February 25th

3:00 p.m. – 6:30 p.m.

Registration Open

5:00 p.m. – 6:30 p.m.

Welcome Reception

Thursday, February 26th

7:30 a.m. – 6:00 p.m. 

Registration Open

7:30 a.m. – 8:30 a.m.

Networking Breakfast

8:30 a.m. – 8:35 a.m.  

Welcome Remarks

Mike Ferguson
President & Chief Executive Officer
SIIA

It's All About the MRFs ('Bout the MRFs) 
The Machine-Readable Files (MRFs) are the means through which pricing information must be publicly disclosed. To date, the MRFs have not lived up to expectations. They are way too large, and the information inputted into the MRFs is often times incorrect, inaccurate, and/or duplicative. The Trump Administration is trying to do something about it with the release of a new and improved 2.0 MRF Schema. In addition, recently released proposed Transparency in Coverage (TiC) regulations are endeavoring to increase the accuracy of the pricing information by requiring the CEO of an insurance carrier to "attest" that the pricing information included in the carrier's MRF is correct. If plan sponsors are going to be able to access, analyze, and evaluate the pricing information, it's all about the MRFs. 

MODERATORS:   

Chris Condeluci, Esq.
Washington Counsel
SIIA

Anthony Murrello
Government Relations Manager
SIIA

SPEAKERS:   

David Cardelle, R.Ph.
Chief Strategy Officer
Advanced Medical Strategies (AMS)

Chief Product Officer
Deerhold Ltd.

Matt Robben
Co-Founder & Chief Technology Officer
Serif Health

AI and APIs: Can Technology Help Purchasers and Patients Consume the Data? 
Technological advances are changing the workforce, revolutionizing industries, and juicing the economy. With respect to price transparency, can Artificial Intelligence (AI) more readily aggregate, interpret, and present the data, making it more usable and actionable relative to our current capabilities? With respect to health claims data, should AI be used to correlate pricing data with claims data to identify waste, errors, and fiduciary risk given the sheer size and complexity of both data sets? Can Application Program Interfaces (APIs) be used to transmit the pricing and claims data from insurance carriers and medical providers directly to purchasers and patients in real-time? Are there security concerns associated with leveraging these technologies? Or can we use AI and APIs to finally give purchasers and patients clear, clean, and understandable data?

MODERATOR:  

Chris Condeluci, Esq. 
Washington Counsel
SIIA

SPEAKERS:    

Stephen Carrabba
Co-Founder & Chief Executive Officer
ClaimInformatics

Deep Kapur
Co-Founder
Amera Health Solutions

Steve Miller
SVP, Client Executive - Employee Benefits
Kapnick Insurance

Co-Founder & Chief Executive Officer
Avant Health

10:45 a.m. – 11:00 a.m.

Networking Break

Fiduciary Alert: Service Providers Must Share the Data So Plan Sponsors Can Satisfy Their Fiduciary Duties
Self-insured plan sponsors have an ERISA fiduciary duty to access, analyze, and evaluate pricing and claims data. However, plan service providers are either refusing to share the data or they are purposefully or negligently making available incorrect and inaccurate data. The result is that plan sponsors cannot do their job and satisfy their ERISA fiduciary duties, thus being exposed to potential employee-participant lawsuits claiming fiduciary breach. To resolve these issues, should plan service providers be considered ERISA fiduciaries for purposes of sharing pricing and claims data? Can this be resolved through the courts or should the Department of Labor and Congress get involved?

MODERATOR:  

Chris Condeluci, Esq.
Washington Counsel
SIIA

SPEAKERS:    

Alden Bianchi, Esq.
Counsel
McDermott, Will & Schulte

Assistant General Counsel
AMWINS

Senior Advisory for Policy
Peterson Center on Healthcare

Julie Selesnick, Esq.
Founder & Principal
Health Plan Legal Counsel

12:15 p.m. – 1:15 p.m.

Hosted Luncheon

Mental Health Parity: Can the Data Increase Access & Compliance?
Back in October 2024, the Biden Administration endeavored to increase access to mental health and substance use disorder (MH/SUD) through final regulations governing the use of Non-Quantitative Treatment Limitations (NQTLs). But, the employer-sponsored health plan community signaled that these regulations are unworkable, and in response, the Trump Administration halted the regulations. Meanwhile, the DOL continues to audit self-insured health plans for compliance with the existing NQTL Analysis requirements. Can the publicly disclosed pricing information help increase access to MH/SUD benefits, and also, compliance with the NQTL Analysis requirements? 

MODERATOR:  

Chris Condeluci, Esq.
Washington Counsel
SIIA

SPEAKERS:    

Partner
Groom Law Group

Cheryl Matochik
Managing Director
Third Horizon

Jordan Smith
Chief Compliance Officer
Self Insured Reporting

2:15 p.m. – 2:30 p.m.

Networking Break

FINALLY, a Unique & Separate Rx Drug MRF
The original TiC Rule (issued back in 2020) required the public disclosure of prescription drugs and other prescription drug-related information through a unique Rx Drug MRF (Machine-Readable File) that is separate and apart from the Hospital MRF and TiC MRF. But, this Rx Drug MRF was effectively halted due to a lawsuit. The Trump Administration's Transparency 2.0 efforts resurrected the Rx Drug MRF and we now have proposed regulations governing the type of information that must be included in the Rx Drug MRF so payers, providers, researchers, and entrepreneurs can more accurately compare and audit prescription drug costs. What impact is this unique and separate Rx Drug MRF having on the industry?

MODERATOR:  

Chris Condeluci, Esq. 
Washington Counsel
SIIA

SPEAKERS:    

Senior Consultant, Pharmacy Benefit and Self-Funded Strategy
IMA Financial Group, Inc.

Vice President, Strategic & Federal Relationships
Brown & Brown

Chief Executive Officer
Innovu

Co-Founder & Chief Operating Officer
Handl Health

3:30 p.m. – 3:45 p.m.

Networking Break

Transparency 3.0: Will We See It & What Should We Expect?
The Trump Administration is doubling down on requiring hospitals and health care payers to publicly disclose medical and prescription drug prices through a "Transparency 2.0" exercise. Coming soon: "Transparency 3.0," which will likely involve developing new ideas like delivering pricing information through APIs and other innovative ways of increasing transparency, including through the use of AI, and also developing strategies for direct contracting and ideas for creating and promoting the use of value-based insurance designs. Come hear what the future holds!!

MODERATORS:

Chris Condeluci, Esq. 
Washington Counsel
SIIA

Anthony Murrello
Government Relations Manager
SIIA

SPEAKERS:

Principal
XO Health, Inc.

Andrew Bremberg
Former Director of the Domestic Policy Counsel
Trump Administration 2016 to 2020

Taylor Hittle
Senior Manager, Washington Counsel
Ernst & Young LLP (EY)