Summit: NG Payers US 9

Transcription

1 Summit: NG Payers US 9 Day One 13:00 17:00 Summit registration & onsite app activation 16: :25 Welcome & your itinerary explained 16:25 16:35 Solution Providers Briefing 16:30 18:00 Roundtable Track 1: Healthcare as a Digital Business A move towards better engagement Moderator: Adam Fenech, Director, Information Services - Priority Health / Spectrum Health Roundtable Track 2: From Care Management to Population Health Management Moderator: Jennifer Mazzuca, Independent Senior Analyst Partner Roundtable Track 3: Increasing Value with Healthcare Analytics 18:00 19:00 Cocktail Reception 19:00 22:00 Gala Dinner & Keynote Speech Eric Alexander, Adventurer, Guide of First Blind Everest Ascent - Executive Speaker's Bureau Day Two 7:00 8:00 Breakfast Breakfast Title: Payers and Providers Driving Value and Quality Through Collaboration Keynote Speaker: Eric Zerneke, Director of Enterprise Sales - AthenaHealth 8:05 8:45 Synopsis: As reimbursement increasingly shifts from fee-for-service to more value- and risk-based models, and as the data is emerging to actually support these models, the traditional perceptions of the zero-sum game between providers and payers is making way for opportunities for true collaboration. As both groups share increasing incentives to achieve better health outcomes at lower costs, the question now becomes how will they effectively work together? 1. The friction preventing collaboration between payers and providers is increasingly due to an inability to effectively share trustworthy, complete information within the provider workflows rather than a significant misalignment of incentives. 2. Overworked providers are struggling to make sense of quality and care gap data received from regional and national payers in a multitude of different formats and frequencies. 3. Moving to risk requires that providers invest capital they don t have in staff, technology, and services. Although they largely prefer to remain independent, this dynamic is further contributing to physicians choosing hospital employment to survive the transition. Workshop 1 8:50 9:30 Workshop 2 9:35 10:15 Title: What do major pronouncements by large national payers mean to the marketplace and to the provider industry? Speaker: Jeffrey Gold, Healthcare Associate of NY Synopsis: Aetna and United continue to talk about leaving the exchanges and whether the exchanges and aspects of the ACA are viable Aetna and Humana and Cigna and Anthem are attempting to merge, what does this do to local markets? Aetna and United are poised to leave AHIP, the national health plan association Title: Integrating Behavioral Healthcare: Moving Beyond the Talking Points Speaker: Mark Heit, SVP, National Strategy & Development and Dr. Emma Stanton, Associate Chief Medical Officer Beacon Health

2 Synopsis: Integration of behavioral and medical care is among the most prominent topics in today s healthcare discourse, yet the narrative often fails to identify or address the fundamental clinical and operational barriers to integrated care. Further, the discussion fails to acknowledge that integration takes many forms based on a variety of factors within any market, including geography, provider community norms, and severity of mental health burden. Successfully navigating these challenges and design decisions is not as simple as integrating funding sources, collocating clinical activities, or insourcing administrative functions. In actuality, achieving integrated care requires specialized expertise in the presentation of various forms of behavioral health conditions and tireless attention and effort to ensure that services are integrated and coordinated across the continuum. With nearly 20 years of experience integrating behavioral health management into health plan operations and 30 years experience managing systems of care to treat mental illness and addiction, Beacon has developed a range of programs and capabilities to deliver integrated care across various payer system models. This workshop will provide key insights on the tools necessary to promote evidence-based practices for integrated primary care and models for advancing other integrated and coordinated practices that ensure whole-person care is available to those whose behavioral health or other impairments do not fit within traditional primary care models. 1. Understand how concepts of integrated care must adapt across the continuum of behavioral health needs. 2. Delineate the roles of payer and provider in driving adoption of integrated care models. 3. Define the manner in which a behavioral health specialty organization can improve integration of care partner does not mean carve-out. Workshop 3 10:20 11:00 Workshop 4 11:05 11:45 Title: PATIENTS, PROVIDERS, AND PAYERS: MAKING THE QUADRUPLE AIM POSSIBLE Speaker: Dr. Peter Aran, Blue Cross Blue Shield Oklahoma Synopsis: We are all aware that a basic tenet of population health initiatives is that of team based care. In this discussion, we will see how to marry theory with practice in that regard. We will discuss how to operationalize that concept with payers being integral team members of real-life ongoing initiatives. Learn how three CMS initiatives currently underway leverage patients, providers, and payers to improve health care delivery. Understand why the "quadruple aim" is needed in order to accomplish healthcare transformation efforts. Discuss the challenges related to manpower issues needed to implement population health initiatives in our own organizations. Title: The Value of Home Care in a Value-Based World Speaker: Scott Vasey, VNSNY Synopsis: Traditional home care represents 3-4% of medical spend, but has the potential to prevent 5-10% of avoidable re-admissions, as well as ED visits and admissions, with appropriate and timely interventions. Progressive home care agencies are partnering with sub-acute and other community-based providers to manage post-acute bundles, as well as population risk, ultimately driving improved quality, decreased cost, and improved overall patient experience. How does home care impact the Triple Aim? What are the capabilities you should look for in a home care agency partner? How do you partner? Keynote 11:50 12:30 Title: The Unfortunate Reality of Evidence-Based Medicine Speaker: WiserTogether

3 Synopsis: Data-driven medicine will revolutionize shared decision-making and improve patient outcomes. When facing treatment decisions for yourself and loved ones, you want reliable guidance. You want to get better, faster. Your members do too. Imagine a time when you were making tough treatment decisions. You faced mountains of information, varying expert opinions and input from family and friends. Data-driven medicine helps illuminate optimal treatment paths and shows the unfortunate reality of some commonly-recommended treatments. We have access to more information than ever before, but information without guidance is noise. It doesn't answer the fundamental - often heart-wrenching - question "what should I do"? 1. Evidence-based medicine is no longer enough. We have the data and technology to provide data-driven medicine and better support shared decision making. 2. We ve focused on cost and quality as the keys to good decisions, but those factors alone aren t getting the job done. Learn about the 22 preference criteria consumers use to make decisions. 3. We can exponentially impact value and bend trend by creating transparency around time - treatment duration - to help consumers get better, faster. 12:35 13:35 Lunch & Networking Workshop 5 13:40 14:20 Title: The Movement of an Enterprise Data Warehouse to Big Data Platforms Leader: Joe Fisne, Geisinger Health Synopsis: This workshop will be a discussion on the transition to moving to the use of big data and the journey to do so. Our goal would be to achieve unified data architecture, the steps to move in that direction, how this can be used to begin plan for working with population health, and the use of technology to do so. 1. Assessing your current IT environment 2. Developing a transition plan 3. The use of big data in the healthcare environment Workshop 6 14:25 15:05 Title: Lowering Cost and Improved Consumer Engagement through Care Engine and Patient Connect Speaker: Amit Mody, Global Head, Healthcare Solutions Health Plans & Provider HCL America, Inc. Synopsis: Our analysis shows that patients who are non-adherent (e.g. Epilepsy, Diabetic) to therapy and or medications are 30% more likely to have negative outcomes like falls and incur 5 times more medical spend as a group. Also it was found that improper use of medications in patients resulted in an increase in ED visits. Knowledge of such facts about your member population can help you take preventive actions and take control of members behavior. 1. Having Information (Big Data Lake) is the key: Data sources including EMR, Claims, hospital discharge, pharmacy, lab, and social media data to create a holistic view of the patient 2. Generating Intelligence: Calculate patient health risk scores, provide predictive models for identification and segmentation of patient groups based on cost, utilization and health events, identifying patients who are high cost and high risk (non-adherent to medication and therapy) 3. Digital is the New Face of the Customer: Healthcare Consumers are engaging through multiple channels web, , social media, IVR, call center. Payers must improve Consumer Engagement by providing all channels with the context specific information to the right person at the right time. Continuous one on one personalized engagement with Members through their preferred communication channel involving administration of care protocols, counseling programs, physician coordination, and Patient self-management help Workshop 7 Title: The Transition of Medical Management to Health Population Management

4 15:10 15:50 Speaker: Dr. Victor Collymore, Community Health Plan of Washington Synopsis: Traditionally, there have been six major strategies to foster appropriate stewardship of resources, but in the age of health care reform with an emphasis on value based care, this needs to evolve into a different paradigm. Namely, a model of care that focuses on population health that will incorporate social determinants of health and education on coding and documentation that provides evidence of the burden of illness for appropriate reimbursement. Learn about the six traditional strategies used in medical management and how they need to evolve. Understand an approach to health population management that stratifies a population by risk and links interventions based on that risk. Understand an approach to improving coding and documentation with the use of data to foster education and training. Workshop 8 15:55 16:35 Title: New Interventions in Medicaid: It Isn t Just $1000 Pills anymore. Leader: Mohit Ghose with Molina Healthcare and Jeff Myers with Medicaid Health Plans of America Roundtable Session 2 16:40 17:20 Synopsis: Synopsis: Cost pressures and quality concerns have strongly encouraged states to move toward capitated, coordinated care for their Medicaid enrollees. Because of the growth of Medicaid under the ACA, and as states move non-traditional populations in managed care, health plans now provide care to new types of patients that require access to new interventions. Most plans now are responsible for the outpatient drug benefit of Medicaid enrollees in the states; how do plans manage excessive new costs for dramatic improvements in health? With the growth of coordinated care management, and all of the services necessary for this design to work, how do the plans pay for traditionally non-health related expenses? This session will look at both the policy and the operational details surrounding medical technology and other interventions in the Medicaid space and the support services that modern CM requires to be successful. 19:00 20:00 Cocktail Reception Roundtable Track 1: Healthcare as a Digital Business A move towards better engagement Moderator: Adam Fenech, Director, Information Services - Priority Health / Spectrum Health Roundtable Track 2: From Care Management to Population Health Management Moderator: Jennifer Mazzuca, Independent Senior Analyst Partner Roundtable Track 3: Increasing Value with Healthcare Analytics Moderator: 20:00 22:30 Second Night Experience Day Three 7:00 8:25 Breakfast Workshop 9 Title: Building Healthcare Consumer Trust and Loyalty Through Transparency 8:30 9:10 Speaker: Carl McGowan, United Healthcare Synopsis: Many consumers don t know what an emergency department visit or Medical procedure costs until a letter from their health insurance plan and bill from a healthcare provider arrive in the mail. With employers increasingly turning to healthcare cost sharing, unexpected Medical debt has become an issue for individuals, companies, providers, and insurers. But new technology, tools, and tactics are allowing consumers To better understand, predict, and prepare for their healthcare costs, and the organizations that best equip these consumers will be most likely to capture and retain more of them. Join us as we discuss tactics from successful organizations as well as open Dialogue on the next wave of transparency and engagement. New transparency tools and initiatives intended to make healthcare prices more clear Tactics employers & organizations are using to drive consumer engagement What stakeholders are measuring and how they know if it works or not Workshop 10 9:15 9:55 Title: Healthpath: A Payer Provider Collaboration to Achieve The Triple Aim for Commercial SMI Population.

5 Leader: Dr. Matthew Collins, Blue Cross Blue Shield Rhode Island Synopsis: Provider Payer collaborations can ignite development and adoption. Partnerships can accelerate innovation and program enhancements Describe an intervention that can return commercial SMI population to functional level, even return to work. Workshop 11 10:00 10:40 Title: Motivating physicians to change; success and failure Speaker: Dr. Robert Kritzler, Family Health Network Synopsis: Physicians do not like to change. In the current value based environment they are being asked to change on many fronts. What works, what doesn t; that is the question. We will discuss lessons learned, in group practice, in an academic setting, as well as in networks. This is meant to be an interactive discussion. Physicians can change if properly motivated. If you stop motivating they stop changing. Physicians are competitive Physicians always question the data; especially from plans Workshop 12 10:45 11:25 Meetings & Networking Meetings & Networking Workshop 13 11:30 12:10 Title: Employers Want More Bang for Their Buck Speakers: Chris Fey and Dr. Despina Walsworth, Big Bang Health Plan Synopsis: Brokers/Consultants Are Screaming for Something New Wellness alone does not deliver results Big Data is chasing the wrong horse Self-Funding and Reference Based Pricing are Keys to the Future Telemedicine is anchor to digital transformation Re-examine your entire business Focus on what the customer is demanding Challenge conventional wisdom even if it means major course correction. Workshop 14 12:15 12:55 Title: Engaging Physicians as Stakeholders to Improve Population Health Management Speaker: Dr. Jatin Dave, Tufts Health Plan Synopsis: Physician engagement is essential for successful transitionto population health. Physician engagement strategies include actionable data with acceptable comparative data, clearly defined best practices with user-friendly yet evidence-based tools. This talk will also address drivers of physician motivation and impact of recent changes on physician engagement. The presenter will describe the health plan s approach in engaging physicians.

6 13:00 13:15 Summit wrap-up & next steps 13:15 14:15 Lunch & Networking