Health insurance exchanges: The new competitive landscape


December 07, 2012 17:00 GMT

December 07, 2012 18:00 GMT

Duration: 01:00

Broadcast live fromNew York

This webcast is being prepared for on-demand viewing and will be available on this website soon.

The US health care landscape is changing for both payers and providers. The introduction of government-sponsored health insurance exchanges and the resulting consumer-oriented marketplace may transform the individual and small-group market.

With the potential to introduce tens of millions of new customers, payers need to consider now the capabilities required to qualify for participation and compete effectively.

In this webcast, hear from health care thought leaders about how to best prepare your organizations to be both profitable and sustainable in this new environment.

Are you up to these critical tasks?

Join our panel, led by Jim Costanzo, Ernst & Young LLP Advisory Health care sector leader, for this interactive discussion.Whether federal, state-based or privately operated, health insurance exchanges are on their way with impact on payers and providers. Those that choose to be leaders open themselves up to a world of opportunity in the form of increased membership, market share and growth.

Register today.

"Very insightful thoughts on the impact of providers and their infrastructure."

- CFO, Health Care


Jim Costanzo

Ernst & Young LLP

Jim Costanzo is the Sector Leader for EY’s Health Care Advisory Services practice in the Americas. He has over 28 years of experience in the health care/health insurance industry, ranging from full life-cycle systems development through capacity planning, implementation, maintenance, and operations. He has extensive experience managing the design, development, and installation of the industry’s leading Managed Health Care packages.

Jim has lead efforts at some of the industry’s largest and most complex clients. His experience includes large scale business transformation for all aspects of health plan organizations including claim adjudication, membership, billing, ID cards, coordination of benefits, provider, capitation, dental, explanation of benefits, EDI, provider payments, risk pools, new product definition, benefit plans, accounts payable, general ledger, eligibility, enrollment, claims inquiry, retail sales, and pharmacy.

Jim earned a BS in Computer Science and Business Administration from Mount Union College.

Bill Fera M.D.

Ernst & Young LLP

Bill is a principal in EY’s Health Care Advisory Services practice and serves as the Clinical Transformation leader for health care clients. He has provided over a decade of clinical and information technology leadership at academic, community and ambulatory medical centers and has consistently worked to redefine the model of health care delivery through deployment of state-of-the-art information technologies to produce superb clinical and financial outcomes.

Bill’s area of focus is on electronic medical record systems and information technologies that support quality efforts in health care as well as payer-provider integration. He has deployed multiple inpatient and outpatient electronic medical record systems and oversaw one of the earliest community hospital CPOE deployments in the country.

His professional background includes serving as a member of the UPMC Quality Patient Care Board, as well as the Clinical Quality Improvement committee for the UPMC Health Plan. Through these efforts, Dr. Fera has gained a unique understanding of the challenges facing health care organizations from a payer and provider system level and endeavors to find and promote technologies to further the mission of patient care.

Dr. Fera is a graduate of the Medical College of Pennsylvania with Alpha Omega Alpha honors and served as chief resident at University of Pittsburgh Medical Center, St. Margaret Hospital. Dr. Fera has bachelor degrees from the University of Pennsylvania and Wharton School of Business.

Debbi Fitzgerald

Ernst & Young LLP

Debbi, a partner with EY’s Advisory Services, has over 20 years of experience in executing strategic teaming and reengineering engagements with a focus on health care payers and providers enterprise risk management, internal audit, compliance and project management office (PMO) functions. She has assisted Fortune 500 health care payers and large multi- system health care providers with implementing major business process changes to meet new or changing regulatory requirements, to improve efficiency and effectiveness and to enhance risk mitigation and identification.

  • Currently teams with several Compliance Departments to perform ongoing auditing and monitoring activities for compliance with the Office of Inspector General (OIG) annual work plan. Projects have included, Medicare Secondary payer, Hospital Same Day Re- Admissions, Drug Rebate programs for Medicaid MCO enrollees, System Security Controls over Protected health information, Observation Services during Outpatient Visits, Eligibility and Enrollment, Web Portal Security Assessments, Special Needs Plans, Oversight of Contractors, Fraud Waste and Abuse.
  • Established a Project management office or advised Project Management Offices (PMO’s) for major business process changes, including ICD- 10 readiness, claim system conversion, new marketing and advertising campaigns, and outsourcing of : 1) Revenue Cycle processes (billing, coding, collections), 2) Health care payer Special Investigation Units, and 3) IT application software development.
  • Engaged by senior management and board to perform Risk function assessments for the Internal Audit, Compliance, and Quality Assurance departments.
  • Designed and implemented a combined corporate compliance and internal audit function which increased overall risk coverage, eliminated redundancies/ gaps and reduced third party regulatory audits.
  • Define, drive and provide scorecard assessments of hospital clinical departments, new product or service launches, and third party arrangements (PBM’s, brokers/ agents, call centers, business offices).

Debbi graduated from Northern Arizona University and is a Certified Public Accountant and Certified internal Auditor.

Craig A. Kappel

Ernst & Young LLP

Craig is partner in EY’s Health Care Advisory Services practice and has 30 years of health care experience. He serves as a practice leader for EY’s New England region and is the leader for EY’s ICD10 National Service Line and Revenue Management Service Line. He has directed and led a wide range of finance, revenue management and operational consulting engagements, with a particular emphasis on all aspects of revenue and receivables management. His diverse background includes operations management, finance, marketing, revenue management, reimbursement, organizational redesign, and process redesign.

  • Led ICD10 Assessment / Implementation engagements for several clients including a three hospital system, an eight hospital system, a twelve hospital system, a forty two hospital system. Included in these health systems are a variety of physician organizations, health plans and other ambulatory companies.
  • Directed the creation of an integrated (hospital and physician) revenue management operation for a major, 1,000–bed teaching hospital and a 700+–member practice plan. Prior to and in connection with the creation of this new revenue management organization, led an organization-wide cash acceleration initiative that netted more than $42 million of additional cash over a period of six months.
  • Led the design, development and implementation of a revenue management focused intranet-based key performance indicator (KPI) dashboard and benchmarking system for a twenty hospital system on the east coast of the United States. Upon completion the KPI system will allow each hospital and the corporate revenue management function to readily determine specific areas of opportunity to improve revenue performance across the health system.
  • Directed a comprehensive assessment and redesign of the revenue process for a six hospital system that included a centralized business office. Significant outcomes included the creation of a centralized pre-registration function and a dedicated denial management program, reduced DNFB, increased cash of approximately $25 million over six months, and a standardized methodology for charge master maintenance, as well as standardized processes for patient access, case management, utilization review, and medical records in each of the six hospitals.
  • Led the revenue management process transformation for a 12–hospital system over a four-year period. Centralized services were also installed to achieve economies of scale for patient follow-up on behalf of all 12 hospitals. Receivable days were reduced by 20%, and significant bad debt reductions were also achieved and have been sustained for the past six years.

Craig received a Bachelor of Science degree from Valparaiso University. He is a member of the Healthcare Financial Management Association.

"There are so many questions on implementing the new health care law. It was a good discussion and I like to see the polling results showing many others had my same concerns."

- Senior Manager, Health Care


Dan Sernett

Ernst & Young LLP

Dan is a partner in EY’s Health Care Advisory Services practice. He has over 25 years of experience in serving health care organizations as both a professional service advisor as well as a former member of executive management within a Fortune 250 healthcare company.

Through a variety of roles, he provides leadership in defining performance improvement opportunities in financial, operational, and compliance components of health plan and provider organizations. His areas of focus in serving health care clients include ACA regulatory matters with an emphasis on insurance exchange readiness and preparation. He has broad executive experiences leading engagement teams in managed care (payer and provider perspectives) with focus on finance, operations, corporate governance, audit/compliance and enterprise risk functions.

  • Led the implementation of a PMO engagement for identifying, documenting and coordinating workstream activities for the post-merger integration of a Fortune 500 financial services company.
  • Led the implementation of a PMO for identifying, documenting and coordinating workstream activities for the post-merger integration of a Fortune 250 managed care organization.
  • Led numerous professional client service engagements with multiple schedule variables, large teams and complex milestone schedules.
  • Served as the engagement quality executive on various firm engagements with provider and payer clients.
  • Specific advisory focus within health plan operating environments has involved performance improvement initiatives aimed at organizational change in a variety of business areas such as: claims/encounter processing; membership accounting; product design and benefits administration; customer contact center strategy and technology enablement; financial planning/forecasting; financial reporting and internal control management; IT security strategy, structure and management; provider network management strategy and administration; underwriting and actuarial pricing and data management; and sales incentive structuring and administration.
  • Dan has a bachelor’s degree in business administration from the University of Notre Dame’s Mendoza School of Business and is a member of the American Institute of Certified Public Accountants.

    "Up to date information in this erratic environment."

    - CFO, Government