Agenda Links: Preconference | Day III
DAY II
TUESDAY, JUNE 18, 2019
7:00 am
Registration Open; Networking Breakfast
BREAKFAST ROUNDTABLES
Grab you breakfast and join the discussion. Seating limited
7:00 am
Breakfast Roundtable I: APG Expert Angle: Now What? Operating Under Tomorrow’s Value-Based Care Payment Models
Donald H. Crane, JD
President and Chief Executive Officer, America’s Physician Groups (APG), Los Angeles, CA
President and Chief Executive Officer, America’s Physician Groups (APG), Los Angeles, CA
Don Crane is the President and CEO of America’s Physician Groups, the nation’s leading professional association representing medical groups and independent practice associations practicing coordinated care. With offices in Los Angeles, Sacramento and Washington, America’s Physician Groups has become a leading voice for the value-based healthcare movement at the state and federal levels. America’s Physician Groups’ are at the forefront of national healthcare reform and represent the care model and payment methodologies adopted by federal legislation for the entire nation. Mr. Crane serves on the Board of Directors of the National Coalition on Health Care. In 2016, he received the prestigious Mathies Award for Vision and Excellence in Healthcare Leadership.
Gaurov Dayal, MD
President, New Markets and Chief Growth Officer, ChenMed
President, New Markets and Chief Growth Officer, ChenMed
Dr. Gaurov Dayal is ChenMed President, New Markets and Chief Growth Officer. Responsible for ChenMed’s national expansion and new market operations, Gaurov has broad experience in population health, physician group, health plan and hospital operations. Previously, Gaurov was a Lumeris SVP, implementing operational solutions for large health care systems and provider groups; CMO and Interim CEO for SSM Wisconsin Hospitals; CMO for Adventist Health Care; President Adventist Medical Group; and a McKinsey and Co. consultant.
Niyum Gandhi
Executive Vice President and Chief Population Health Officer, Mount Sinai Health System, Los Angeles, CA
Executive Vice President and Chief Population Health Officer, Mount Sinai Health System, Los Angeles, CA
Niyum Gandhi is the Executive Vice President and Chief Population Health Officer of the Mount Sinai Health System. In this role, he oversees Mount Sinai’s transition from a primarily fee-for-service model of care to one that is also inclusive of value and risk-based population health.
Mr. Gandhi’s role involves aligning the Health System’s clinical and economic transformations in support of Mount Sinai’s vision to be the leading population health manager in the competitive New York market, as well as the best possible partner to the Health System’s broad physician community.
Prior to his position at Mount Sinai, Mr. Gandhi served as a partner in the Health and Life Sciences consulting practice of Oliver Wyman in Chicago where, among other things, he worked with a variety of Accountable Care Organizations and other population health management companies, helping them design and implement value-based clinical models, develop value-based contracts and integrated product distribution strategies.
Mr. Gandhi’s role involves aligning the Health System’s clinical and economic transformations in support of Mount Sinai’s vision to be the leading population health manager in the competitive New York market, as well as the best possible partner to the Health System’s broad physician community.
Prior to his position at Mount Sinai, Mr. Gandhi served as a partner in the Health and Life Sciences consulting practice of Oliver Wyman in Chicago where, among other things, he worked with a variety of Accountable Care Organizations and other population health management companies, helping them design and implement value-based clinical models, develop value-based contracts and integrated product distribution strategies.
Valinda Rutledge, MBA
Vice President of Federal Affairs, APG, VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health, Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC
Vice President of Federal Affairs, APG, VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health, Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC
Valinda Rutledge is currently the Vice President of Federal Affairs at America’s Physician Groups. She is responsible for analyzing and advocating for APG’s positions on government initiatives such as bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs.
7:00 am
Breakfast Roundtable II: Clinical Success Metrics in Commercial Episode of Care Programs
Sage Nakagawa, MBA, MHA
Senior Director, Clinical Operations, Remedy Partners, New York, NY
Senior Director, Clinical Operations, Remedy Partners, New York, NY
Serving as Senior Director at Remedy Partners, Sage Nakagawa is responsible for the creation of educational materials and physician tools for the company’s commercial partners. She has held positions in the government sector, health plan consulting, and pharmaceutical space before transitioning to value based care.
Amita Rastogi, MD, MHA, FACHE
Medical Director, Vice President, Commercial Business Lines, Remedy Partners, Former Chief Medical Officer, HCI3, Prometheus Payment Inc., Chicago, IL
Medical Director, Vice President, Commercial Business Lines, Remedy Partners, Former Chief Medical Officer, HCI3, Prometheus Payment Inc., Chicago, IL
Dr. Rastogi is Medical Director, VP Commercial Business Lines at Remedy Partners. She is an experienced physician leader who has been fondly called “The Episode-Queen” by her sponsor Steve Wiggins. Dr. Rastogi has been involved in the development and enhancement of several groupers during her career including the original Health Market Grouper, adding Procedure Event Grouper (PEGs) to ETGs (episode treatment grouper) at Optum, Prometheus® evidence informed case rates at HCI3, and the CMS sponsored open source Episode Grouper for Medicare (EGM) partnering with Brandeis University. Amita is adept in the use of statistical models and risk-adjustment methodologies and has extensive experience in the use of episodes-of-care to foster high quality, efficient medical care. Dr. Rastogi is a Mayo-trained cardiac surgeon.
Andrew Wilson, MPH, PhD
Director, Episode Development Analytics at Remedy Partners, Grand Rapids, MI
Director, Episode Development Analytics at Remedy Partners, Grand Rapids, MI
Andrew Wilson is a health services researcher with an expertise in episodes of care analytics and bundled payments. He is currently Director of Episode Analytics at Remedy Partners where he supports Remedy’s commercial analytics infrastructure, including target pricing, risk adjustment, and performance assessment. Previously, Mr. Wilson was Research Leader at the Health Care Incentives Improvement Institute (HCI3) (now Altarum) where he contributed to the development of Prometheus Analytics. Mr. Wilson is completing his graduate degree at the Heller School for Social Policy and Management at Brandeis University and was the recipient of an AHRQ health services research training fellowship.
DAY 2: JOINT ACO/BUNDLED/MACRA OPENING PLENARY SESSION
8:00 am
Welcome and Comments on the Policy and Politics of Value-based Care
Susan Dentzer
Visiting Fellow, Duke-Margolis Center for Health Policy, Former Editor in Chief, Health Affairs, Former Health Correspondent, PBS NewsHour, Washington, DC (Chair)
Visiting Fellow, Duke-Margolis Center for Health Policy, Former Editor in Chief, Health Affairs, Former Health Correspondent, PBS NewsHour, Washington, DC (Chair)
Susan Dentzer is one of the nation’s most respected health and health policy thought leaders and a frequent speaker and commentator on television and radio, including PBS and NPR, and an author of commentaries and analyses in print publications such as Modern Healthcare, the Annals of Internal Medicine, and the New England Journal of Medicine and NEJM Catalyst. Susan is an elected member of the National Academy of Medicine. She is also the editor and lead author of the book Health Care Without Walls: A Roadmap for Reinventing U.S. Health Care, available on Amazon.com.
8:15 am
HHS/CMS/CMMI Keynote Address
Adam Boehler
Senior Advisor to the Secretary, US Department of Health and Human Services; Deputy Administrator and Director, Center for Medicare and Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services, Washington, DC
Senior Advisor to the Secretary, US Department of Health and Human Services; Deputy Administrator and Director, Center for Medicare and Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services, Washington, DC
Adam Boehler is the Senior Advisor to the Secretary, CMS Deputy Administrator and Director of the Innovation Center. Adam is widely regarded as an innovative leader in the private sector and has designed and implemented new, patient-focused approaches to healthcare delivery. Before coming to CMS, Adam was founder and CEO of Landmark Health, a company that provides home-based medical care. Additionally, before joining CMS, Adam was an Operating Partner at Francisco Partners, and the founder and Chairman of Avalon Health Solutions, the leading provider of laboratory benefit management services. Previously, Adam was Founder and CEO of Accumen, a Principal at Accretive, LLC, where he was responsible for healthcare investments and, Executive Vice President and General Manager at MedeAnalytics. Adam started his career at Battery Ventures, a leading technology venture capital firm with over $2 billion under management, focusing on investments in software and emerging technologies.
8:45 am
Getting to Affordability
Ezekiel J. Emanuel, MD
Vice Provost for Global Initiatives, Diane V.S. Levy and Robert M. Levy University Professor and Chair, Department of Medical Ethics and Health Policy, University of Pennsylvania; Senior Fellow, Center for American Progress; Former Special Advisor, Health Policy to the Director, Office of Management and Budget, National Economic Council, Philadelphia, PA
Vice Provost for Global Initiatives, Diane V.S. Levy and Robert M. Levy University Professor and Chair, Department of Medical Ethics and Health Policy, University of Pennsylvania; Senior Fellow, Center for American Progress; Former Special Advisor, Health Policy to the Director, Office of Management and Budget, National Economic Council, Philadelphia, PA
Ezekiel J. Emanuel is Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He previously served as special advisor for health policy to the director of the White House Office of Management and Budget. Since 1997 he was chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist. After completing his internship and residency in internal medicine at Boston’s Beth Israel Hospital and his oncology fellowship at the Dana-Farber Cancer Institute, he joined the faculty at the Dana-Farber Cancer Institute. He has since been a visiting professor at the University of Pittsburgh School of Medicine, UCLA, the Brin Professor at Johns Hopkins Medical School, and the Kovitz Professor at Stanford Medical School and visiting professor at New York University Law School. He is currently a columnist for the New York Times.
9:15 am
Integrating the Social Determinants of Health into Value-based Care
Peter Long, PhD
President and CEO, Blue Shield of California Foundation; Former Senior Vice President, Henry J. Kaiser Family Foundation; Former Director of Research and Planning, The California Endowment, San Francisco, CA
President and CEO, Blue Shield of California Foundation; Former Senior Vice President, Henry J. Kaiser Family Foundation; Former Director of Research and Planning, The California Endowment, San Francisco, CA
Peter Long is the SVP Healthcare and Community Health Transformation. Prior to joining Blue Shield of California, Peter was the president and CEO of Blue Shield of California Foundation. In addition to his philanthropic background, Dr. Long has extensive experience working on health policy issues at the state and national levels. Previously, Dr. Long was executive director of the Indian Health Center of Santa Clara Valley, and earlier, a legislative analyst for the Progressive Primary Health Care Network in Cape Town, South Africa during the country’s transition to democracy. Outside of his role as CEO, Peter serves on the Board of Directors for Grantmakers in Health, Grantmakers for Effective Organizations, and Southern California Grantmakers, as cochair of the National Academy of Medicine’s Workshop on High-need Patients and co-chair of the National Academy of Medicine’s Health Data. In addition, Peter practices as an adjunct professor at the University of California, Los Angeles Fielding School of Public Health.
9:45 am
The Future of Delivery System Reform: What Might we be Missing?
Elliott S. Fisher, MD, MPH
Professor of Health Policy and Clinical Practice, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
Professor of Health Policy and Clinical Practice, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
Dr. Fisher is Professor of Health Policy, Medicine and Community and Family Medicine at the Dartmouth Institute for Health Policy and Clinical Practice. His research has focused on exploring the causes and consequences of regional and provider-specific differences in spending and quality and, more recently, on developing policy approaches to slowing the growth of spending while improving quality. He was one of the originators of the concept of “accountable care organizations” (ACOs) and worked with colleagues to carry out the research that led to their inclusion in the Affordable Care Act. His current research is focused on exploring the policy and organizational determinants of health system performance in the United States and on the drivers of rising health care costs. He is a member of the National Academy of Medicine.
10:15 am
Break
ACO SUMMIT PLENARY SESSION AND BUNDLED PAYMENT & MACRA MINI SUMMITS
ACO SUMMIT PLENARY SESSION
11:00 am
CMS/CMMI Accountable Care, Primary Care, CPC-Plus and Other Primary Care Models Keynote Address
Pauline Lapin, MHS
Director, Seamless Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD
Director, Seamless Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD
Pauline Lapin is the Director for the Seamless Care Models Group (SCMG) in the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Pauline oversees and provides guidance in the development and implementation of innovative payment and delivery models related to advanced primary care and accountable care organizations, namely the Comprehensive Primary Care (CPC) and CPC Plus initiatives, the Pioneer ACO and Next Generation ACO Models, and the Comprehensive ESRD Care initiative. Her group also manages Health Care Innovation Awards related to primary care redesign, “hot-spotting,” and ACO-like models. Pauline has been in federal service at CMS for over 24 years, previously serving as Deputy Director of SCMG, and as a Division Director in the Office of Research, Development and Information, where she oversaw the design and implementation of a variety of demonstrations, including those related to medical home/advanced primary care practice and prevention.
11:30 am
Keynote: Update on Private Sector ACO Initiatives
Hoangmai H. Pham, MD
Vice President, Provider Alignment Solutions, Anthem; Former Chief Innovation Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, DC
Vice President, Provider Alignment Solutions, Anthem; Former Chief Innovation Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, DC
Mai Pham is the Vice President Provider Alignment Solutions for Anthem, Inc. Mai is responsible for developing and refining Anthem’s provider payment models that reduce the cost of care while rewarding improvements in quality and access. Additionally, she is focused on developing new products and networks built on a foundation of value-based care, and overseeing Anthem’s Enhanced Personal Health Care initiative, a program that focuses on patient-centered care and reimburses doctors for value-based, rather than volume-based, performance. Prior to joining Anthem in 2017, Mai was a founding official at the Center for Medicare & Medicaid Innovation (CMMI), where she served as Chief Innovation Officer. Previously, she was senior health researcher and co-director of research at the Center for Studying Health System Change and Mathematica. A general internist, Mai has practiced for several years at safety net clinics in the Washington D.C. area.
12:00 pm
Co-chair Keynote Roundtable: A Lightning Round on the Hot Accountable Care Issues of Today
Emily DuHamel Brower, MBA
Senior Vice President, Clinical Integration, Trinity Health; Former Vice President, Population Health, Atrius Health; Former Senior Director, Clinical Improvement Ventures, Harvard Vanguard Medical Associates, Livonia, MI (Co-chair)
Senior Vice President, Clinical Integration, Trinity Health; Former Vice President, Population Health, Atrius Health; Former Senior Director, Clinical Improvement Ventures, Harvard Vanguard Medical Associates, Livonia, MI (Co-chair)
Emily DuHamel Brower is Senior Vice President & Physician Services at Trinity Health. In this role, she provides leadership and strategic direction within the evolving accountable healthcare environment, with an emphasis on clinical integration and transformation under alternative payment models. Previously, she was Vice President of Population Health for Atrius Health where she developed opportunities to support transformational work that measurably improved healthcare for Atrius Health patients, including leading Atrius Health’s implementation of the Pioneer ACO model, an initiative of CMS’ Center for Medicare and Medicaid Innovation.
David B. Muhlestein, PhD, JD
Chief Research Officer, Leavitt Partners, LLC; Adjunct Assistant Professor, the Dartmouth Institute, Geisel School of Medicine, Dartmouth College; Visiting Policy Fellow, Duke-Margolis Center for Health Policy, Duke University; Visiting Fellow, Accountable Care Learning Collaborative, Washington, DC (Co-chair)
Chief Research Officer, Leavitt Partners, LLC; Adjunct Assistant Professor, the Dartmouth Institute, Geisel School of Medicine, Dartmouth College; Visiting Policy Fellow, Duke-Margolis Center for Health Policy, Duke University; Visiting Fellow, Accountable Care Learning Collaborative, Washington, DC (Co-chair)
David Muhlestein is Chief Research Officer for Leavitt Partners, LLC, based in Washington, DC. He directs the study of accountable care organizations through the LP Center for Accountable Care Intelligence and leads the firm’s quantitative evaluation of health care markets. He is an expert in using policy analysis, predictive modeling, and applied analytics to understand the evolving health care landscape. David also serves as Adjunct Assistant Professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College, is a Visiting Policy Fellow at the Margolis Center for Health Policy at Duke University, and is a Visiting Fellow at the Accountable Care Learning Collaborative. In these roles he conducts research to translate learnings of high-performing organizations for the benefit of the broader health care system.
Hoangmai H. Pham, MD
Vice President, Provider Alignment Solutions, Anthem; Former Chief Innovation Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair)
Vice President, Provider Alignment Solutions, Anthem; Former Chief Innovation Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair)
Mai Pham is the Vice President Provider Alignment Solutions for Anthem, Inc. Mai is responsible for developing and refining Anthem’s provider payment models that reduce the cost of care while rewarding improvements in quality and access. Additionally, she is focused on developing new products and networks built on a foundation of value-based care, and overseeing Anthem’s Enhanced Personal Health Care initiative, a program that focuses on patient-centered care and reimburses doctors for value-based, rather than volume-based, performance. Prior to joining Anthem in 2017, Mai was a founding official at the Center for Medicare & Medicaid Innovation (CMMI), where she served as Chief Innovation Officer. Previously, she was senior health researcher and co-director of research at the Center for Studying Health System Change and Mathematica. A general internist, Mai has practiced for several years at safety net clinics in the Washington D.C. area.
S. Lawrence Kocot, JD, LLM, MPA
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair and Moderator)
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair and Moderator)
Larry Kocot is a Principal at KPMG, LLP and National Leader of KPMG’s Center for Healthcare Regulatory Insight. Prior to joining KPMG, Mr. Kocot practiced law at Epstein Becker Green, PC, and Dentons, US LLP; he also served as Deputy Director of the Engelberg Center for Health Care Reform at Brookings and was a visiting fellow in the Economic Studies Program at the Brookings Institution. Previously, he was Senior Advisor to the Administrator of the Centers for Medicare and Medicaid Services (CMS) at the U.S. Department of Health and Human Services. Mr. Kocot also served as Senior Vice President and General Counsel at the National Association of Chain Drug Stores, a Fellow in International Security Studies at the Center for Strategic and International Studies (CSIS) and an adjunct fellow at CSIS. Mr. Kocot serves on the board of the Partnership for a Healthier America, ICF International, Inc. and the Commonwealth Health Research Board.
12:30 pm
Networking Luncheon
BUNDLED & MACRA MINI SUMMITS I: 11:00 am – 12:30 pm
(Choose one Mini Summit only)
Special LAN Mini Summit I: The Health Care Payment and Learning Action Network’s (LAN) Roadmap for Driving High Performance in Alternative Payment Models
11:00 am
Introductions, Presentations and Q&A
Lili Brillstein, MPH
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealth Care, Newark, NJ
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealth Care, Newark, NJ
Lili Brillstein is a nationally recognized thought leader in the advancement of Episodes of Care as a value-based approach for specialty care. She is the Director of Episodes of Care for the Market Innovations team of Horizon Blue Cross Blue Shield of New Jersey.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Aparna Higgins
President and CEO, Ananya Health Innovations Inc.; Policy Fellow, The Duke-Margolis Center for Health Policy; Visiting Scholar at The Heller School of Social Policy and Management, Brandeis University, Dunn Loring, VA
President and CEO, Ananya Health Innovations Inc.; Policy Fellow, The Duke-Margolis Center for Health Policy; Visiting Scholar at The Heller School of Social Policy and Management, Brandeis University, Dunn Loring, VA
Aparna Higgins is Founder and CEO of Ananya Health Innovations Inc., and a Policy Fellow at the Duke-Margolis Center for Health Policy. She is a recognized leader and strategic thinker in payment and delivery system reform, quality measurement, and healthcare analytics with experience in both public and private sector healthcare programs. Previously, she was Senior Vice President, Private Market Innovations and Center for Policy and Research at America’s Health Insurance Plans (AHIP). At AHIP she led her organizational efforts in healthcare analytics, payment and delivery system reform, and performance measurement. She led and established in collaboration with the Centers for Medicare and Medicaid Services (CMS) a national multi-stakeholder initiative called the Core Quality Measures Collaborative to align measures across public and private sector programs.
Katie Martin, MPA
Vice President, Health Policy and Programs, National Partnership for Women and Families; Former Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
Vice President, Health Policy and Programs, National Partnership for Women and Families; Former Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
Katie Martin leads the National Partnership for Women & Families’ policy and advocacy efforts to support a health care system with universal access to high-quality, affordable, and patient/family-centered care. Most recently, Katie served as Acting Assistant Secretary for Planning and Evaluation (ASPE) at HHS, where she oversaw policy development, analysis, evaluation and strategic planning for issues across the Department. Prior to ASPE, Katie was the Counselor to the Secretary for Health Policy at HHS, where she advised the Secretary on programs administered by CMS, AHRQ, ONC, and OCR. Katie also worked at OMB for 11 years under two administrations serving as a policy analyst in the Health Financing Branch and as Branch Chief for Health Insurance Data and Analysis.
Thomas Buckingham, BSN, MBA
Executive Vice President, Select Medical; President, Allevant Solutions; Member, Guiding Committee, Health Care Payment Learning and Action Network, Mechanicsburg, PA (Moderator)
Executive Vice President, Select Medical; President, Allevant Solutions; Member, Guiding Committee, Health Care Payment Learning and Action Network, Mechanicsburg, PA (Moderator)
Tom Buckingham serves as the Executive Vice President for Select Medical, a healthcare provider with approximately 48,000 employees throughout the United States. Select Medical owns and operates long-term acute care and inpatient rehabilitation hospitals as well as occupational and physical therapy clinics. Tom also serves as the President of Allevant, a 50-50 joint venture with Mayo Clinic. Allevant’s mission is to provide consultative services and clinical education to rural and Critical Access Hospitals. Tom’s advisory roles include participation on the Health Care Payment – Learning Action Network Guiding Committee, the naviHealth Scientific Advisory Board and the American Hospital Association Post-Acute Care Strategy Steering Committee.
Presentation Material (Acrobat)
Reference Material (Acrobat)
12:30 pm
Networking Luncheon
Bundled Payment Mini Summit II: Oncology Care & Radiation Therapy Bundles
11:00 am
Lessons Learned from the Oncology Care Model and Version 2.0 Cancer Care Payment Models
Alice G. Gosfield, JD
Founding Partner, Alice G. Gosfield & Associates; Past Chair, American Health Lawyers Association, HCI3 and National Committee for Quality Assurance, Philadelphia, PA
Founding Partner, Alice G. Gosfield & Associates; Past Chair, American Health Lawyers Association, HCI3 and National Committee for Quality Assurance, Philadelphia, PA
Alice Gosfield of Philadelphia’s Alice G. Gosfield and Associates, PC, has a national practice devoted to health law and healthcare regulation with a special emphasis on physician representation, managed care, quality, clinical integration, fraud and abuse, and medical staff issues. She served as Chairman of the Board of Directors of the National Committee for Quality Assurance for five terms and was President of the National Health Lawyers Association (now the American Health Lawyers Association) from 1992-93. She was the founding Chairman of the Board of PROMETHEUS Payment? Inc., and a member of the original Design Team. She was the first Chairman of the Board of the Healthcare Incentives Improvement Institute, Inc, (HCI3) the merger of PROMETHEUS Payment Inc and Bridges to Excellence, Inc.
Barbara L. McAneny, MD, FASCO, MACP
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd., Albuquerque, NM
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd., Albuquerque, NM
Barbara L. McAneny is a board-certified medical oncologist/hematologist. She is president of the American Medical Association, served on the AMA Board of Trustees, has been a member of the American Society of Clinical Oncology (ASCO) Board of Directors, and president of the New Mexico Medical Society (NMMS), the Greater Albuquerque Medical Association, and the New Mexico Chapter of the American College of Physicians. Currently Dr. McAneny chairs the board of the National Cancer Care Alliance.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
Randall A. Oyer, MD
Medical Director, Ann B. Barshinger Cancer Institute, Lancaster General Hospital, Lancaster, PA
Medical Director, Ann B. Barshinger Cancer Institute, Lancaster General Hospital, Lancaster, PA
Randall Oyer is a Medical Oncologist and serves as Medical Director of the Ann B. Barshinger Cancer Institute of Penn Medicine Lancaster General in Lancaster, Pa. Dr. Oyer is a co-leader of the organization’s Oncology Care Model (OCM) participation. In addition, Dr. Oyer is Penn Medicine Lancaster General’s Medical Director of Oncology and Cancer Risk Evaluation. Dr. Oyer is currently President-Elect of the Association of Community Cancer Centers. He is a Commissioner of the American College of Surgeons Commission on Cancer and a Member of the National Cancer Policy Forum, representing the ACCC.
Jay Sultan
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA (Moderator)
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA (Moderator)
Jay Sultan has been working on the intersection of payment reform policy and enabling technology for twenty years. He is a software executive that has been a pioneering voice on both the policy of payment reform and the reality of its execution at scale. He is now serves as the VP Healthcare Strategy at Cognizant, creating new solutions to enable value based care through engagement. Jay has previously authored two patents on payment bundling methods and has been engaged by payers, providers, and governments on the best ways to implement new VBR and VBID programs.
11:45 am
Radiation Therapy Bundles and Strategies for Success
Anne Hubbard, MBA
Director of Health Policy, American Society for Radiation Oncology; Former Director of Governmental Affairs, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Director of Health Policy, American Society for Radiation Oncology; Former Director of Governmental Affairs, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Anne Hubbard is the Director of Health Policy for the American Society for Radiation Oncology. As Director of Health Policy, Ms. Hubbard leads efforts to inform Medicare and private payers of policies that impact the practice of radiation oncology. This includes over site of the CPT and RUC process, coding and coverage policies, as well as the development of an alternative payment model for radiation oncology. Prior to joining ASTRO, she spent four years with the Maryland Hospital Association where she was involved in the renewal of Maryland’s All Payer Model. Ms.
Constantine A. Mantz, MD
Radiation Oncologist and Chief Policy Officer, Former Chief Medical Officer, 21st Century Oncology, Fort Myers, FL
Radiation Oncologist and Chief Policy Officer, Former Chief Medical Officer, 21st Century Oncology, Fort Myers, FL
Dr. Constantine Mantz is a practicing radiation oncologist who led his company’s efforts to execute the first comprehensive radiation therapy bundled payment agreement with a national commercial payer in 2012. He has since helped execute a number of similar agreements with smaller regional payers. He is a member of ASTRO’s Health Policy team and has consulted with CMS and CMMI regarding bundled payment design for a Medicare APM.
Sheila Rege, MD
Regional Medical Director, Northwest Cancer Clinic, Former Radiation Oncologist, Kadlec Providers, Vice President, American College of Radiation Oncology, Kennewick, WA
Regional Medical Director, Northwest Cancer Clinic, Former Radiation Oncologist, Kadlec Providers, Vice President, American College of Radiation Oncology, Kennewick, WA
Dr. Rege is a UCLA trained radiation oncology physician. She founded and then led her Washington based clinic into a joint venture with a national healthcare entity in 2015. Sheila’s insight into medical practice is honed through professional experiences in multiple practice settings (single, specialty, multi-specialty, academic). Sheila as held teaching positions at LSU Shreveport, UCLA, and the UW school of medicine. She is currently Clinical Associate Professor at WSU. She is the Vice Chair of the independent HCA HTCC Committee within Washington State for technology assessment. She moderated a symposium on physician led medial homes in 2006. She has hosted a regional radio program, “Cancer Chat with Dr. Rege” and founded “Rise Above Cancer” fundraising effort. She currently serves as President of the American College of Radiation Oncology, is a member of the AMA Council on Medical service, and is the specialty advisor to the MA RUC and CPT committees.
Francois de Brantes, MBA
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT (Moderator)
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT (Moderator)
François de Brantes serves as Senior Vice President of Commercial Business Development at Remedy Partners. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions. Prior to joining Remedy Partners, he served as Vice President of Altarum, a national nonprofit, he was Executive Director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of healthcare delivery. The organization, which merged with Altarum in December 2017, was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs. Prior to HCI3, François was Chief Operating Officer of the eHealth Initiative (eHI), which promotes adoption of health information technology in the U.S.
12:30 pm
Networking Luncheon
Bundled Payment Mini Summit III: Gainsharing in Bundled Payment Projects & Effective Use of Waivers
11:00 am
The Use of Gainsharing in Bundled Payment Arrangements
Kyle A. Gotchy, JD
Senior Associate, King & Spalding, LLP, Sacramento, CA
Senior Associate, King & Spalding, LLP, Sacramento, CA
Kyle Gotchy works with hospitals, health systems, medical groups, and related businesses in connection with regulatory matters, operational issues, complex contracting, investigations, and enforcement proceedings. He works closely with in-house counsel, leadership, and other business, clinical, and compliance stakeholders on matters related to the state and federal laws governing providers and suppliers, the physician self-referral (Stark) and anti-kickback laws, and the development of value-based payment arrangements. From 2016-2018, Kyle served as Senior Counsel at Seattle Children’s Hospital and worked closely with the organization’s affiliated pediatric clinically integrated network.
Kristin Oberfeld
Associate Principal, Sg2, A Vizient Company, Cleveland, OH
Associate Principal, Sg2, A Vizient Company, Cleveland, OH
Kristin Oberfeld specializes in projects across the spectrum of physician alignment, paying particular attention to bundled payments and other value-based care services. She is a continuous innovator, a mentor to consultants, and an industry presenter. Kristin maintains twelve years of health care experience in both finance and consulting. Prior to joining Sg2, Kristin spent seven years with TRG Healthcare Solutions. She has unparalleled experience and extensive knowledge of bundled payments, having worked with over 40 hospitals and 60 medical groups in Medicare bundled payment programs. Her consulting focuses on creating strategies for success under episodic payment models, developing gainsharing programs to align providers, producing actionable data analytics solutions, and assisting with care redesign initiatives that will improve both cost and quality. In addition to bundled payments, Kristin’s value-based care work includes organizational readiness and feasibility analyses, supporting organizations that are participating in shared savings models, and assisting providers with MACRA.
11:45 am
Effective Use of Waivers in Bundled Payment Initiatives
Nick Bluhm, MA, JD
Senior Director, Strategy and Government Policy, Remedy Partners; Former Litigation Attorney/Health Insurance Specialist, US Department of Health and Human Services, Washington, DC
Senior Director, Strategy and Government Policy, Remedy Partners; Former Litigation Attorney/Health Insurance Specialist, US Department of Health and Human Services, Washington, DC
Nick Bluhm is Senior Director, Strategy and Government Policy with Remedy Partners. Previously, he was a Litigation Attorney/Health Insurance Specialist with the U.S. Department of Health and Human Services where he served in the Office of the General Counsel (Litigation Attorney) and the Centers for Medicare and Medicare & Medicaid Innovation (Health Insurance Specialist). He began his career as a Research Associate with the Committee on Capital Markets Regulation.
Jay Sultan
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA
Jay Sultan has been working on the intersection of payment reform policy and enabling technology for twenty years. He is a software executive that has been a pioneering voice on both the policy of payment reform and the reality of its execution at scale. He is now serves as the VP Healthcare Strategy at Cognizant, creating new solutions to enable value based care through engagement. Jay has previously authored two patents on payment bundling methods and has been engaged by payers, providers, and governments on the best ways to implement new VBR and VBID programs.
Diwen Chen, MPH
Executive Director, Payment Innovation and Accountable Care, Dignity Health, Los Angeles, CA (Moderator)
Executive Director, Payment Innovation and Accountable Care, Dignity Health, Los Angeles, CA (Moderator)
Diwen Chen is the Executive Director of Payment Innovation & Accountable Care for Dignity Health. She is responsible for system oversight of value-based payment initiatives, such as bundled payments and accountable care. Focused on the creation of future-ready delivery models, Diwen leads cross-disciplinary teams to implement physician alignment initiatives, pilot payment reform, and expand care delivery across the continuum. Diwen serves as the Implementing Value Models Co-Chair of the Health Care Transformation Task Force.
12:30 pm
Networking Luncheon
MACRA Mini Summit IV: MIPS Basics and Myths & The Role of Medicare Advantage in Achieving Advance APM Status
11:00 am
MIPS Basics and Myths
Joshua M. Liao, MD, MSc, FACP
Associate Medical Director, Contracting and Value-Based Care, Assistant Professor, University of Washington, Seattle, WA
Associate Medical Director, Contracting and Value-Based Care, Assistant Professor, University of Washington, Seattle, WA
Dr. Liao is a board-certified internal medicine physician and the Associate Medical Director for Contracting and Value Based Care at UW Medicine, where he is also the Director of the UW Medicine Value and Systems Science Lab, a unit embedded within the health system and applies scholarship to drive change that impacts patients and populations. Dr. Liao’s expertise includes policy analysis related to value-based payment and care reforms, with scholarly work focusing on evaluating and testing the impact of value-based payment and delivery reforms on patients, physicians, and health care organizations. He is also an Associate Editor for Healthcare: The Journal of Delivery Science and Innovation. He was also a Clinical Fellow in Medicine at Harvard Medical School. He is an Adjunct Senior Fellow at the Leonard Davis Institute of Health Economics located at the University of Pennsylvania, where he received his training in health policy research.
11:45 am
The Role of Medicare Advantage in Achieving Advance APM Status
Sanjay Doddamani, MD
Senior Advisor and Medical Officer, Center for Medicare and Medicaid Innovation; Former Senior Director in Population Health, Geisinger Health System, Chief Medical Officer, Keystone ACO, Washington, DC
Senior Advisor and Medical Officer, Center for Medicare and Medicaid Innovation; Former Senior Director in Population Health, Geisinger Health System, Chief Medical Officer, Keystone ACO, Washington, DC
Dr. Sanjay Doddamani is the Senior Advisor and Medical Officer for the Center for Medicare and Medicaid Innovation. Dr. Doddamani joined public service to help advance value based care transformation through development and implementation of innovative care models and payment for Medicare and Medicaid beneficiaries. He was previously the Chief Medical Officer of Geisinger at Home, a home-based model of care for Geisinger’s population of medically complex patients. He also served as Chief Medical Officer of the Keystone ACO and was a Senior Director in Population Health. His clinical background as a practicing heart failure cardiologist has helped provide deep insights into chronic conditions and the struggles faced by patients and their caregivers. He has served on numerous panels and committees and presented on diverse topics both nationally and abroad.
Alefiyah Mesiwala, MD, MPH
Senior Medical Director for Value-based Care and Innovation at UPMC Health Plan; Former Senior Advisor in Healthcare at the White House under President Obama; Former Senior Advisor and Medical Officer at the Centers for Medicare and Medicaid Innovation, Washington, DC
Senior Medical Director for Value-based Care and Innovation at UPMC Health Plan; Former Senior Advisor in Healthcare at the White House under President Obama; Former Senior Advisor and Medical Officer at the Centers for Medicare and Medicaid Innovation, Washington, DC
Simon Moody, FIA, FSA
Principal and Consulting Actuary, Milliman, Brookfield, WI
Principal and Consulting Actuary, Milliman, Brookfield, WI
Simon Moody is a Principal and Consulting Actuary in Milliman’s Milwaukee office. He has more than 20 years of experience working with health provider organizations, insurers, governmental agencies, and a variety of other organizations. Simon’s core area of expertise is working with providers, and sometimes also payers, in the design, evaluation, negotiation, audit, and performance monitoring of various types of population-based reimbursement agreements. He also works with a number of health systems and ACOs to design and implement internal distribution models. Simon has extensive Medicare Advantage expertise from assisting several health plans with Medicare Advantage bid development and certification. He has developed Medicare Advantage feasibility studies for health providers considering starting up their own MA plan or forming joint ventures with existing MA organizations.
Valinda Rutledge, MBA
Vice President of Federal Affairs, APG; VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC (Moderator)
Vice President of Federal Affairs, APG; VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC (Moderator)
Valinda Rutledge is currently the Vice President of Federal Affairs at America’s Physician Groups. She is responsible for analyzing and advocating for APG’s positions on government initiatives such as bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs.
12:30 pm
Networking Luncheon
MACRA Mini Summit V: Rural and Safety Net APMs
11:00 am
Designing and Implementing APMs for Rural Providers
Bill Finerfrock
President, Capitol Associates (CAI); Executive Director, National Association of Rural Health Clinics; Former Director of Federal Affairs, American Academy of Physicians Assistants, Alexandria, VA
President, Capitol Associates (CAI); Executive Director, National Association of Rural Health Clinics; Former Director of Federal Affairs, American Academy of Physicians Assistants, Alexandria, VA
On January 1, 2014, Mr. Finerfrock became the President and owner of Capitol Associates, a government relations/health policy consulting firm. Prior to assuming ownership of CAI, Finerfrock was a Senior Vice President in the company for more than 20 years. Finerfrock has worked in and with the U.S. Congress and federal agencies on health policy for 40 years. He spent nearly eight years working for two United States Senators – Edward W. Brooke (R-MA) and Roger Jepsen (R-IA). Finerfrock specializes in health care financing, health system reform, health workforce and rural health. Finerfrock co-founded the National Association of Rural Health Clinics and serves as the organization’s Executive Director. Finerfrock also served as the first federal lobbyist for the Physician Assistant Professions serving as Director of Federal Affairs for the association for eight years.
Timothy McBride, PhD
Bernard Becker Professor, Brown School; Co-director, Center for Health Economics and Policy, Washington University in St. Louis, St. Louis, MO
Bernard Becker Professor, Brown School; Co-director, Center for Health Economics and Policy, Washington University in St. Louis, St. Louis, MO
Timothy McBride is a health economist and health policy analyst who focuses on health reform, rural health, Medicaid and Medicare policy, and is the author on several dozen articles and books in these areas. McBride has been active in testifying before Congress and consulting with state government policymakers. He is a member of the Rural Policy Institute’s Rural Health Panel and chairs the Medicaid Oversight Committee for Missouri.
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Moderator)
Chief Executive Officer, Envision Genomics; Member, Physician-focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Moderator)
Dr. Grace E. Terrell is CEO of Envision Genomics, a company dedicated to helping clinicians diagnose rare disease through the integration of genomic data into clinical care. As a leader in health care delivery system reform, Dr. Terrell speaks to health systems, provider groups and professional organizations about the importance of improving population health through patient care model redesign, clinical and information integration, and value-based compensation. In 2013, Dr. Terrell launched CHESS, a population health management company dedicated to helping health systems and other medical groups make the transition to value-based medicine. For over 16 years, Dr. Terrell served as the president and chief executive officer of Cornerstone Health Care, P.A. a 370-provider independent multispecialty medical group that won the AMGA’s prestigious Acclaim Award in 2015.
11:45 am
Safety Net APMs for the Uninsured, Medicaid and FQHCS
Julian D. Bobbitt, Jr.
Of Counsel, Smith Anderson, Raleigh, NC
Of Counsel, Smith Anderson, Raleigh, NC
Bo Bobbitt’s practice focuses on providing strategic general counsel and regulatory guidance for health care organizations. He is involved in business planning, resolution of complex legal and health policy questions, and advanced negotiations for these clients. His practice is concentrated in the area of representing clinically-integrated hospital and physician organizations, physician-owned Health Information Technology companies, accountable care organizations, patient-centered medical homes, health information exchanges, and nonprofit and professional associations, to achieve process, outcomes and cost improvements in health care delivery. He has extensive experience in developing and drafting accountable care shared savings and other pay-for-performance contracts. Bo has spoken nationally to both legal and medical audiences and written in both legal and medical journals concerning health law and policy issues.
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Moderator)
Chief Executive Officer, Envision Genomics; Member, Physician-focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Moderator)
Dr. Grace E. Terrell is CEO of Envision Genomics, a company dedicated to helping clinicians diagnose rare disease through the integration of genomic data into clinical care. As a leader in health care delivery system reform, Dr. Terrell speaks to health systems, provider groups and professional organizations about the importance of improving population health through patient care model redesign, clinical and information integration, and value-based compensation. In 2013, Dr. Terrell launched CHESS, a population health management company dedicated to helping health systems and other medical groups make the transition to value-based medicine. For over 16 years, Dr. Terrell served as the president and chief executive officer of Cornerstone Health Care, P.A. a 370-provider independent multispecialty medical group that won the AMGA’s prestigious Acclaim Award in 2015.
12:30 pm
Networking Luncheon
MACRA Mini Summit VI: Improving Risk Adjustment in MIPS and APMs & Creating Better Quality Measures in MIPS and APMs
11:00 am
Improving Risk Adjustment in MIPS and APMs
Richard L. Fuller, MS
Economist, Clinical and Economic Research, 3M Health Information Systems, Silver Spring, MD
Economist, Clinical and Economic Research, 3M Health Information Systems, Silver Spring, MD
Rich Fuller is an economist for the Clinical and Economic Research Group of 3M Health Information Systems. In his time with 3M he has worked under direct and indirect contract to CMS, MedPAC, state Medicaid programs, commercial payers, and hospitals. Prior to joining 3M, he worked for Johns Hopkins Hospital, Carefirst Blue Cross Blue Shield of Maryland and as an economist for the U.K. government. He has published numerous articles on risk adjustment, payment system design and the related issue of providing incentives to obtain value from health care spending.
Eric T. Roberts, PhD
Assistant Professor, Health Policy and Management, Pitt Public Health, University of Pittsburgh; Visiting Faculty, Department of Health Care Policy, Harvard Medical School, Pittsburgh, PA
Assistant Professor, Health Policy and Management, Pitt Public Health, University of Pittsburgh; Visiting Faculty, Department of Health Care Policy, Harvard Medical School, Pittsburgh, PA
Eric Roberts is an Assistant Professor of Health Policy and Management at the University of Pittsburgh. His research examines the provision and financing of health care in low-income populations, including the implementation of alternative payment models and their financial implications for providers serving socially disadvantaged patients. Dr. Roberts’ work has appeared in Health Affairs, JAMA Internal Medicine, Annals of Internal Medicine, Health Services Research, and other health policy journals. He is the recipient of a career development award from the Agency for Healthcare Research and Quality to examine the effects of Medicaid payment policies on dual Medicare-Medicaid beneficiaries’ access to care and health outcomes.
John H. Wasson, MD
Active Emeritus Professor of Community and Family Medicine, Active Emeritus Professor of Medicine, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
Active Emeritus Professor of Community and Family Medicine, Active Emeritus Professor of Medicine, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
John Wasson is Emeritus Professor of Community and Family Medicine at the Geisel School of Medicine, Dartmouth College. He received an award as “pioneer for practice-based research” from the Agency for HealthCare Quality and Research. His HowsYourHealth.org family of web-tools is used nationwide to improve communication and health care quality by patients, doctors’ offices, and communities. Based on years of use and suggestions by health professionals and patients, these tools are intended to be a public good.
Harold D. Miller
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
Harold Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that facilitates improvements in healthcare payment and delivery systems. Miller also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Miller is a nationally-recognized expert and author of over a dozen widely-used reports on health care payment and delivery reform. He has twice given invited testimony to Congress on how to reform healthcare payment, and he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is one of the eleven members of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress to advise the Secretary of Health and Human Services on the creation of alternative payment models.
11:45 am
Creating Better Quality Measures in MIPS and APMs
Catherine MacLean, MD, PhD
Chief Value Medical Officer, Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery; New York, NY
Chief Value Medical Officer, Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery; New York, NY
Catherine MacLean is the Chief Value Medical Officer at Hospital for Special Surgery, where she leads the development and execution of strategies to measure, report and improve health care value. Dr. MacLean is a nationally recognized expert on healthcare quality and value. She has previously served as the executive leader of quality and care management programs at Anthem/WellPoint; principal investigator on numerous quality research projects; and as a director, chair or participant on numerous national committees and panels related to health care quality and value.
Frank Opelka, MD
Medical Director, Quality and Health Policy, American College of Surgeons; Former Vice Chancellor for Clinical Affairs, LSU Health Science Center, New Orleans, LA
Medical Director, Quality and Health Policy, American College of Surgeons; Former Vice Chancellor for Clinical Affairs, LSU Health Science Center, New Orleans, LA
Frank Opelka is a physician executive and surgeon with over two decades of experience in quality and health policy. He has served in executive roles in large, multispecialty academic practices for over 30 years. Dr. Opelka’s current work includes moving to value based care models with aligned payment and compensation models. He works collaboratively with several universities to establish a value expression for surgical care aligned with Michael Porter’s work at Harvard in establishing value = Quality/Cost. Dr. Opelka also works with several health systems to develop interoperability solutions using a unified patient medical record in an open standard environment. These systems will allow for scaled interoperability with digital apps. Dr. Opelka has published extensively in peer reviewed journals, textbooks and serves on several editorial boards.
John H. Wasson, MD
Active Emeritus Professor of Community and Family Medicine, Active Emeritus Professor of Medicine, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
Active Emeritus Professor of Community and Family Medicine, Active Emeritus Professor of Medicine, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
John Wasson is Emeritus Professor of Community and Family Medicine at the Geisel School of Medicine, Dartmouth College. He received an award as “pioneer for practice-based research” from the Agency for HealthCare Quality and Research. His HowsYourHealth.org family of web-tools is used nationwide to improve communication and health care quality by patients, doctors’ offices, and communities. Based on years of use and suggestions by health professionals and patients, these tools are intended to be a public good.
Harold D. Miller
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
Harold Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that facilitates improvements in healthcare payment and delivery systems. Miller also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Miller is a nationally-recognized expert and author of over a dozen widely-used reports on health care payment and delivery reform. He has twice given invited testimony to Congress on how to reform healthcare payment, and he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is one of the eleven members of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress to advise the Secretary of Health and Human Services on the creation of alternative payment models.
12:30 pm
Networking Luncheon
JOINT ACO/BUNDLED/MACRA NETWORKING LUNCHEON AND PRESENTATIONS
12:30 pm
Networking Luncheon
1:00 pm
Luncheon Keynote Roundtable on the Future of Value-based Care
Marc Berg, MD, PhD
Partner, Healthcare Innovation, McKinsey, Washington, DC
Partner, Healthcare Innovation, McKinsey, Washington, DC
Marc Berg is a Partner with McKinsey and a leader in our Health Care Innovation Center, focusing on improving the value of care through policy, incentives and delivery reform. Based in Washington, DC, he has more than 20 years worldwide experience helping healthcare organizations and governments to improve the value of care. He is a recognized innovative leader in value-based contracting, outcomes measurement and payment reform. In addition, he has pioneered several data & analytical services to support organizations and governments achieving these aims. He has led a wide range of private and public sector engagements including the full redesign and implementation of New York State’s Medicaid delivery and payment systems.
Francois de Brantes, MBA
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT
François de Brantes serves as Senior Vice President of Commercial Business Development at Remedy Partners. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions. Prior to joining Remedy Partners, he served as Vice President of Altarum, a national nonprofit, he was Executive Director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of healthcare delivery. The organization, which merged with Altarum in December 2017, was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs. Prior to HCI3, François was Chief Operating Officer of the eHealth Initiative (eHI), which promotes adoption of health information technology in the U.S.
Barbara L. McAneny, MD, FASCO, MACP
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd., Albuquerque, NM
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd., Albuquerque, NM
Barbara L. McAneny is a board-certified medical oncologist/hematologist. She is president of the American Medical Association, served on the AMA Board of Trustees, has been a member of the American Society of Clinical Oncology (ASCO) Board of Directors, and president of the New Mexico Medical Society (NMMS), the Greater Albuquerque Medical Association, and the New Mexico Chapter of the American College of Physicians. Currently Dr. McAneny chairs the board of the National Cancer Care Alliance.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
Michael Thompson
President and Chief Executive Officer, National Alliance of Healthcare Purchaser Coalitions; Former Principal, Health Care, PricewaterhouseCoopers, Washington, DC
President and Chief Executive Officer, National Alliance of Healthcare Purchaser Coalitions; Former Principal, Health Care, PricewaterhouseCoopers, Washington, DC
Michael Thompson is the President and CEO of the National Alliance of Healthcare Purchaser Coalitions, the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value for companies and communities across the country. Our members represent more than 12,000 employers/purchasers, 45 million Americans, and $300 billion in annual healthcare spend. Michael is a nationally recognized thought leader for business health strategies and health system reform.
Susan Dentzer
Visiting Fellow, Duke-Margolis Center for Health Policy, Former Editor in Chief, Health Affairs, Former Health Correspondent, PBS NewsHour, Washington, DC (Moderator)
Visiting Fellow, Duke-Margolis Center for Health Policy, Former Editor in Chief, Health Affairs, Former Health Correspondent, PBS NewsHour, Washington, DC (Moderator)
Susan Dentzer is one of the nation’s most respected health and health policy thought leaders and a frequent speaker and commentator on television and radio, including PBS and NPR, and an author of commentaries and analyses in print publications such as Modern Healthcare, the Annals of Internal Medicine, and the New England Journal of Medicine and NEJM Catalyst. Susan is an elected member of the National Academy of Medicine. She is also the editor and lead author of the book Health Care Without Walls: A Roadmap for Reinventing U.S. Health Care, available on Amazon.com.
BUNDLED PAYMENT SUMMIT PLENARY SESSION & ACO/MACRA MINI SUMMITS
BUNDLED PAYMENT SUMMIT PLENARY SESSION
2:00 pm
CMS/CMMI Keynote Address on Bundled Payment Policy
Christina S. Ritter, PhD
Director, Patient Care Models Group (PCMG); Former Deputy Director, Hospital and Ambulatory Policy Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MA
Director, Patient Care Models Group (PCMG); Former Deputy Director, Hospital and Ambulatory Policy Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MA
Chris Smith Ritter is the Director of the Patient Care Models Group (PCMG) at the Innovation Center. In this role, Chris manages specialty models for the Innovation Center, including bundled and episode payment models such as OCM, CJR, and BPCI Advanced. Chris has worked in many capacities at CMS in her 20+ year career including managing hospital and physician FFS payment systems, and payments for Part B drugs and biologicals, and payments to clinical laboratories among others. In addition to fee-for-service payment policy, Chris also has spent time working on coverage, Medicare Advantage, quality measures, and drug payment policy broadly.
2:30 pm
Keynote Update on Private Sector Bundled Payment Initiatives
Francois de Brantes, MBA
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT
Senior Vice President, Commercial Business Lines, Remedy Partners; Former Program Leader, Health Care Initiatives, GE Corporate Health Care, Newtown, CT
François de Brantes serves as Senior Vice President of Commercial Business Development at Remedy Partners. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions. Prior to joining Remedy Partners, he served as Vice President of Altarum, a national nonprofit, he was Executive Director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of healthcare delivery. The organization, which merged with Altarum in December 2017, was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs. Prior to HCI3, François was Chief Operating Officer of the eHealth Initiative (eHI), which promotes adoption of health information technology in the U.S.
3:00 pm
Co-chair Keynote Roundtable: A Lightning Round on the Hot Bundled Payment Issues of Today
Lili Brillstein, MPH
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ (Co-chair)
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ (Co-chair)
Lili Brillstein is a nationally recognized thought leader in the advancement of Episodes of Care as a value-based approach for specialty care. She is the Director of Episodes of Care for the Market Innovations team of Horizon Blue Cross Blue Shield of New Jersey.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Diwen Chen, MPH
Executive Director, Payment Innovation and Accountable Care, Dignity Health, Los Angeles, CA (Co-chair)
Executive Director, Payment Innovation and Accountable Care, Dignity Health, Los Angeles, CA (Co-chair)
Diwen Chen is the Executive Director of Payment Innovation & Accountable Care for Dignity Health. She is responsible for system oversight of value-based payment initiatives, such as bundled payments and accountable care. Focused on the creation of future-ready delivery models, Diwen leads cross-disciplinary teams to implement physician alignment initiatives, pilot payment reform, and expand care delivery across the continuum. Diwen serves as the Implementing Value Models Co-Chair of the Health Care Transformation Task Force.
Pamela M. Pelizzari, MPH
Principal and Senior Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY (Co-chair)
Principal and Senior Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY (Co-chair)
Pamela Pelizzari is a nationally recognized expert on the development and implementation of bundled payment methodologies. She is a Principal in the New York Health Practice at Milliman, working with payers, providers, and other stakeholders on developing functional and effective value-based payment methodologies. Prior to joining Milliman, Pamela was a senior technical advisor at the Centers for Medicare and Medicaid Services, leading development and implementation of their Bundled Payments for Care Improvement models, the Oncology Care Model, and other episode-based models.
Valinda Rutledge, MBA
Vice President of Federal Affairs, APG; VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair and Moderator)
Vice President of Federal Affairs, APG; VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC (Co-chair and Moderator)
Valinda Rutledge is currently the Vice President of Federal Affairs at America’s Physician Groups. She is responsible for analyzing and advocating for APG’s positions on government initiatives such as bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs.
3:30 pm
Break
ACO & MACRA MINI SUMMITS II: 2:00 pm – 3:30 pm
(Choose one Mini Summit only)
ACO Mini Summit VII: Accountable Care Case Studies: Aledade & NY ACOs
2:00 pm
Case Study: Aledade’s Accountable Care Organizations (ACOs)
Sean Cavanaugh
Chief Administrative Officer, Aledade, Former Deputy Administrator and Director, Center for Medicare, Centers for Medicare & Medicaid Services, Washington, DC
Chief Administrative Officer, Aledade, Former Deputy Administrator and Director, Center for Medicare, Centers for Medicare & Medicaid Services, Washington, DC
Sean Cavanaugh is the Chief Administrative and Performance Officer of Aledade, which partners with independent physicians to succeed in value-based payment models. He previously was the Deputy Administrator and Director of the Center for Medicare at the Centers for Medicare & Medicaid Services and Deputy Director at the Center for Medicare and Medicaid Innovation.
James P. Sharp, MPH, JD
Director, Health Care Strategy and Transformation, BlueCross BlueShield of North Carolina; Former Policy and Strategy Advisor, Office of the Director, Center for Medicare and Medicaid Innovation, Washington, DC
Director, Health Care Strategy and Transformation, BlueCross BlueShield of North Carolina; Former Policy and Strategy Advisor, Office of the Director, Center for Medicare and Medicaid Innovation, Washington, DC
JP Sharp is the Director of Healthcare Strategy and Transformation at Blue Cross and Blue Shield of North Carolina where he leads the design of new payment models and strategic healthcare initiatives to transform care delivery, which includes the launch of the Blue Premier program. JP previously worked at the CMS Innovation Center, where he led the development of the Next Generation ACO Model, the Quality Payment Program under MACRA, and strategic planning in the Office of the Director.
2:45 pm
Case Study: New York’s ACOs — Turning a Corner?
Gregory C. Burke, MPA
Director, Innovation Strategies, United Hospital Fund; Former Vice President for Planning, Montefiore Medical Center, New York, NY
Director, Innovation Strategies, United Hospital Fund; Former Vice President for Planning, Montefiore Medical Center, New York, NY
Greg Burke works with the United Hospital Fund as Director, Innovation Strategies, focusing on three broad areas: advanced primary care, behavioral health integration and accountable care. His recent focus has been on the challenges facing small primary care practices, and social determinants of health. He has published a number of reports tracking the trajectory of Medicare ACOs in New York State. Following graduation with an MPA from NYU’s Wagner School, he spent seven years in Hartford, CT serving as associate Director of the Capital Area Health Consortium, and Assistant Dean at the University of Ct School of Medicine. From 1982 to 2010 Greg served as VP, Planning at Montefiore Medical Center in The Bronx.
Presentation Material (Acrobat)
Reference Material (Website)
3:30 pm
Transition Break
ACO Mini Summit VIII: Social Determinants of Health into ACO/Risk Bearing Models & Integrating a Substance Abuse (Opioids Plus) Program into Value-based Arrangements
2:00 pm
Integrating Social Determinants of Health into ACO/Risk Bearing Models
Anna Yevseevna Bavykina, MD
Hospitalist, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
Hospitalist, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
Anna Yevseevna Bavykina is Kaiser Permanente Northern California Medical Director of Complex Needs and Continuum. Her areas of oversight include design and implementation of optimal management of complex medical patients who may also have unmanaged psycho-social needs as well as operational oversight of chronic conditions programs, care delivery in skilled nursing facilities, home health and hospice. Dr Bavykina is Board certified in Internal Medicine and Palliative care / Hospice.
Eric Cragun, MBA
Partner, Population Health, Intermountain Healthcare, Senior Director, The Advisory Board Company, Salt Lake City, UT
Partner, Population Health, Intermountain Healthcare, Senior Director, The Advisory Board Company, Salt Lake City, UT
Eric Cragun is a Partner in Intermountain Healthcare’s Population Health department. In his role, Eric leads Intermountain’s efforts to improve performance in risk-based contracts with government payers. Relevant payment models include a Track 1+ MSSP ACO, bundled payments (BPCIA and CJR), an owned Medicare Advantage plan, and a Medicaid ACO. In addition, Eric contributes to Intermountain’s thought leadership in national and state health policy discussions. Prior to joining Intermountain, Eric spent a decade working at Advisory Board in Washington, DC. At Advisory Board, Eric led the firm’s health policy work, advising health care executives and policymakers on the strategic and operational impact of policy changes. Eric’s previous roles at Advisory Board included supporting health care executives on service line strategy and information technology adoption. Before joining Advisory Board, Eric worked as a research assistant for the Council of Economic Advisers in Washington, DC.
Katie Martin, MPA
Vice President for Health Policy and Programs, National Partnership for Women & Families; Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
Vice President for Health Policy and Programs, National Partnership for Women & Families; Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
Katie Martin leads the National Partnership for Women & Families’ policy and advocacy efforts to support a health care system with universal access to high-quality, affordable, and patient/family-centered care. Most recently, Katie served as Acting Assistant Secretary for Planning and Evaluation (ASPE) at HHS, where she oversaw policy development, analysis, evaluation and strategic planning for issues across the Department. Prior to ASPE, Katie was the Counselor to the Secretary for Health Policy at HHS, where she advised the Secretary on programs administered by CMS, AHRQ, ONC, and OCR. Katie also worked at OMB for 11 years under two administrations serving as a policy analyst in the Health Financing Branch and as Branch Chief for Health Insurance Data and Analysis.
Kristen Mucitelli-Heath
Administrator, Regional Health Initiatives, St. Joseph’s Health; Former Interim Executive Director, Central New York Care Collaborative; Former Vice President, Strategy and Planning, Empire State Development, Syracuse, NY
Administrator, Regional Health Initiatives, St. Joseph’s Health; Former Interim Executive Director, Central New York Care Collaborative; Former Vice President, Strategy and Planning, Empire State Development, Syracuse, NY
Kristen Mucitelli-Heath is currently Administrator of Regional Health Initiatives at St. Joseph’s Health in Syracuse, N.Y. with a portfolio overseeing development of a statewide SuperCIN, Medicaid VBP and Innovation, population health management system development, operations of SJH’s Medicaid Care Coordination Network, facilitation of regional system development and affiliations and leading government relations strategy and advocacy in NYS on behalf of Trinity Health, St. Joseph’s national system parent. Additional roles included 10 months as an executive on loan to start up and develop the regional Performing Provider System under the NYS Delivery System Reform Incentive Payment (DSRIP) program. Prior to St. Joseph’s, Ms. Mucitelli-Heath led a policy caucus in the NYS Senate, served as Chief of Staff at Empire State Development Corporation, and served two NYS Governors in various roles for the Executive Chamber.
Mara McDermott, JD
Vice President, McDermott+Consulting; Former Vice President of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Vice President, McDermott+Consulting; Former Vice President of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Mara McDermott is an accomplished health care executive with a deep understand of federal health care law and policy, including delivery system reform, physician payment and Medicare models. Prior to McDermottPlus, Mara served as the senior vice president of federal affairs at America’s Physician Groups (formerly the California Association of Physician Groups, CAPG). As head of the Washington, DC office, Mara worked to advance policies that promoted coordinated care. Her work covered a number of issue areas including Medicare Advantage, MACRA, ACOs and the physician fee schedule. Previously, Mara was counsel in the health industry practice at a law firm in Washington, DC.
2:45 pm
Value-based Arrangements for Addiction Care & Recovery Including Opioids
Amita Rastogi, MD, MHA, FACHE
Medical Director, Vice President, Commercial Business Lines, Remedy Partners, Former Chief Medical Officer, HCI3, Prometheus Payment Inc., Chicago, IL
Medical Director, Vice President, Commercial Business Lines, Remedy Partners, Former Chief Medical Officer, HCI3, Prometheus Payment Inc., Chicago, IL
Dr. Rastogi is Medical Director, VP Commercial Business Lines at Remedy Partners. She is an experienced physician leader who has been fondly called “The Episode-Queen” by her sponsor Steve Wiggins. Dr. Rastogi has been involved in the development and enhancement of several groupers during her career including the original Health Market Grouper, adding Procedure Event Grouper (PEGs) to ETGs (episode treatment grouper) at Optum, Prometheus® evidence informed case rates at HCI3, and the CMS sponsored open source Episode Grouper for Medicare (EGM) partnering with Brandeis University. Amita is adept in the use of statistical models and risk-adjustment methodologies and has extensive experience in the use of episodes-of-care to foster high quality, efficient medical care. Dr. Rastogi is a Mayo-trained cardiac surgeon.
Greg Williams, MA
Managing Director, Third Horizon Strategies; Filmmaker, The Anonymous People and Generation Found; Campaign Director and Executive Producer, Unite to Face Addiction Rally on the National Mall, New York, NY
Managing Director, Third Horizon Strategies; Filmmaker, The Anonymous People and Generation Found; Campaign Director and Executive Producer, Unite to Face Addiction Rally on the National Mall, New York, NY
Gregory Williams is a strategic health policy consultant and communications specialist. As person in long-term recovery from addiction, Greg’s career has been dedicated towards creating positive changes in access to quality health care and recovery supports for the over 20 million American’s still struggling with addiction. He is the award-winning filmmaker of feature length documentaries, The Anonymous People and Generation Found. Greg has a master’s degree in addiction public policy from New York University, and over a decade of experience working with organizations and government agencies on solving addiction issues. His work has been featured in the New York Times, Washington Post, ABC World News, LA Times, and several other news outlets.
Presentation Material (Acrobat)
Reference Material (Website)
3:30 pm
Transition Break
ACO Mini Summit IX: Enhancing Patient Engagement and Experience in Accountable Care & Lessons Learned and Best Practices in Value-based Contracting
2:00 pm
Enhancing Patient Engagement and Experience in Accountable Care
Angelo Aiello, MS
Senior Director, Clinical Integration, MHN ACO; Former Director, Care Coordination, Access Community Health Network, Chicago, IL
Senior Director, Clinical Integration, MHN ACO; Former Director, Care Coordination, Access Community Health Network, Chicago, IL
Angelo Aiello is the Senior Director of Clinical Integration at Medical Home Network ACO- a fourth year Medicaid ACO serving 113,000 members in Cook County Illinois. In his role, Mr. Aiello oversees the integration of care management into the primary care setting. Additionally, he is responsible for the development of educational initiatives and manages the day-to-day training operations for the ACO. Mr. Aiello is a highly skilled leader and educator with over 26 years of healthcare experience across the continuum. Angelo has held both inpatient and outpatient clinical leadership positions and has most recently been responsible for the development and implementation of care management/care coordination programs for Medicaid and Medicare.
Joel James, MA
Director of Public and Government Affairs, Signature Medical Group; Former Assistant Vice President, Federal Reserve Bank of St. Louis, Saint Louis, MO
Director of Public and Government Affairs, Signature Medical Group; Former Assistant Vice President, Federal Reserve Bank of St. Louis, Saint Louis, MO
Joel James is Director of Public Policy and Government Affairs for Signature Medical Group, Inc., an independent multi-specialty physician organization based in St. Louis, Missouri. He previously headed external and government relations for the Federal Reserve Bank of St. Louis and managed legislative affairs for the Resolution Trust Corporation in Dallas and Washington, D.C. Joel’s military service includes graduating from the Clinical Specialist School at William Beaumont Army Medical Center and working as a pediatric nurse and administrator of the Allergy, Immunology and Dermatology Clinic at the Fort Carson military hospital in Colorado Springs. He chairs the Advocacy Council for the American Association of Orthopaedic Executives, is a member of the Advocacy Committee for the OrthoForum, and member of the Affinia Healthcare foundation’s board of directors.
Tiffany E. Wandy, MBA, MPH
Executive Director, Clinically Integrated Network, LifeBridge Health, Baltimore, MD
Executive Director, Clinically Integrated Network, LifeBridge Health, Baltimore, MD
Tiffany Wandy is the Executive Director of the Clinically Integrated Network and Operational Director of the MSSP ACO for LifeBridge Health, a regional health care organization. LifeBridge Health consists of Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, LifeBridge Health & Fitness, hundreds of primary care and specialty physicians throughout the region, and many affiliated health-related partners.
Prior to joining LifeBridge, Tiffany was a Senior Data Analyst and Lead Program Consultant for the CareFirst Patient-Centered Medical (PCMH) Program. Tiffany has both payor and provider experience and leverages this knowledge to drive increased use of analytics, business development, and practice transformation for rural, suburban, and urban organizations. Tiffany started her career in China, first working in crisis counseling and suicide prevention for LifeLine Shanghai and then later as a Community Marketing Manager for Parkway Health, a Singapore-based hospital system with eight clinics across China.
Prior to joining LifeBridge, Tiffany was a Senior Data Analyst and Lead Program Consultant for the CareFirst Patient-Centered Medical (PCMH) Program. Tiffany has both payor and provider experience and leverages this knowledge to drive increased use of analytics, business development, and practice transformation for rural, suburban, and urban organizations. Tiffany started her career in China, first working in crisis counseling and suicide prevention for LifeLine Shanghai and then later as a Community Marketing Manager for Parkway Health, a Singapore-based hospital system with eight clinics across China.
Thomas Merrill
Committee Director & Strategic Advisor, Accountable Care Learning Collaborative, Senior Analyst, The CARIN Alliance, Salt Lake City, UT (Moderator)
Committee Director & Strategic Advisor, Accountable Care Learning Collaborative, Senior Analyst, The CARIN Alliance, Salt Lake City, UT (Moderator)
Tom Merrill is an experienced researcher and speaker on the nation’s ongoing efforts to shift to a value-based system. His work has included managing research teams that surveils the vast number of secondary sources on the movement but also building research relationships with standout operational leaders of the value-based movement for unique primary insights. His contributions include front-line informed resources for leaders of the value-based movement, including the landmark resource, The Accountable Care Atlas.
2:45 pm
Lessons Learned and Best Practices in Value-based Contracting
Mark Cronin, MBA
Chief Operating Officer, Accountable Health Partners; Former CEO, University Cardiovascular Associates; Former VP, Corporate and Systems Initiatives, American Cancer Society, Henrietta, NY
Chief Operating Officer, Accountable Health Partners; Former CEO, University Cardiovascular Associates; Former VP, Corporate and Systems Initiatives, American Cancer Society, Henrietta, NY
Mark Cronin was appointed Chief Operating Officer of Accountable Health Partners (AHP), the integrated delivery network affiliated with the University of Rochester Medical Center, in June 2013. Prior to joining AHP, Mark served as Chief Executive Officer of University Cardiovascular Associates (UCVA), Regional Vice President for the American Cancer Society, and also served for 11 years at Rochester Individual Practice Association (RIPA). Mark currently serves as board chair of UR Medicine HomeCare and also serves on the boards of directors of St. Ann’s Community, Flower City Habitat for Humanity, and Common Ground Health.
Oraida Roman, MHA
Vice President of Value Based Strategies, Humana; Former Market President, Colorado, DaVita Medical Group, Louisville, KY
Vice President of Value Based Strategies, Humana; Former Market President, Colorado, DaVita Medical Group, Louisville, KY
Oraida Roman is Vice President of Value Based Strategies for Humana, leading the organizational advancement of innovative payment models that enable Humana to support providers as population health managers in value-based care relationships. The Value Based Strategies organization develops, supports and deploys the best programs, practices and capabilities that assist Humana’s provider partners and internal customers to successfully achieve enterprise value based goals. Roman’s career with Humana spans more than 18 years, holding various management roles, including Regional President, Director of Operations, and Director of Provider Contracting. Prior to being Vice President for Humana, Roman worked for several years with DaVita Medical Group as the Chief Operating Officer of Florida and Market President of Colorado.
Kate de Lisle
ACO Research Manager, Accountable Care Learning Collaborative; Senior Analyst, Leavitt Partners; Former Senior Associate, Accountable Care Work Group Health Care Transformation Task Force, Salt Lake City, UT (Moderator)
Presentation Material (Acrobat)
ACO Research Manager, Accountable Care Learning Collaborative; Senior Analyst, Leavitt Partners; Former Senior Associate, Accountable Care Work Group Health Care Transformation Task Force, Salt Lake City, UT (Moderator)
Presentation Material (Acrobat)
3:30 pm
Transition Break
MACRA Mini Summit X: Primary Care First & Direct Contracting
2:00 pm
Assessment of Primary Care First
Jean M. Antonucci, MD
Board Certified Family Physician, Farmington, ME
Board Certified Family Physician, Farmington, ME
Jean Antonucci is a solo family physician who runs a high functioning innovative practice in rural Maine. A graduate of Bard College, Temple University School of Medicine (from where she graduated AOA), and the Maine Dartmouth Family Practice residency, she also completed a fellowship in Academic Family medicine at UNC Chapel Hill. A cofounder of the non-profit Ideal Medical Practices, she just completed a stint as chair of the primary care service at Franklin Memorial hospital. She practices in Farmington, Maine and lives where it is quiet and beautiful. Her interests involve sustainability of both patients and doctors in what is currently a failing and nonfunctioning health care environment.
R. Shawn Martin
Senior Vice President – Advocacy, Practice Advancement & Policy, American Academy of Family Physicians, Former Director of Government Relations, American Osteopathic Association, Washington, DC
Senior Vice President – Advocacy, Practice Advancement & Policy, American Academy of Family Physicians, Former Director of Government Relations, American Osteopathic Association, Washington, DC
Shawn Martin is Senior Vice President, Advocacy, Practice Advancement and Policy at the American Academy of Family Physicians. In this role, he provides strategic leadership to the AAFP leadership and directs the public and private sector advocacy efforts of the nation’s largest primary care organization. Martin is responsible for overseeing the AAFP’s Division of Government Relations and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, as well as the Division of Practice Advancement. While his portfolio includes numerous issues, he is nationally known for his work on the development and implementation of primary care delivery and payment models. He has served in leadership roles of several coalitions and partnerships during his career, including a six-year period as chair of the Health Coalition on Liability and Access. He currently serves on the board of the National Coalition on Health Care and the Coalition for Sustainable RX Pricing.
Harold D. Miller
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Moderator)
Harold Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that facilitates improvements in healthcare payment and delivery systems. Miller also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Miller is a nationally-recognized expert and author of over a dozen widely-used reports on health care payment and delivery reform. He has twice given invited testimony to Congress on how to reform healthcare payment, and he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is one of the eleven members of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress to advise the Secretary of Health and Human Services on the creation of alternative payment models.
2:45 pm
Direct Contracting Update
Kavita Patel, MD
Vice President Payer Provider Integration, Johns Hopkins Health System; Nonresident Senior Fellow Brookings Institution; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former Director of Policy, The White House (Obama); Former Senior Advisor, Senator Edward Kennedy, Washington, DC
Vice President Payer Provider Integration, Johns Hopkins Health System; Nonresident Senior Fellow Brookings Institution; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former Director of Policy, The White House (Obama); Former Senior Advisor, Senator Edward Kennedy, Washington, DC
Kavita Patel is vice president of provider/payer transformation for the Johns Hopkins Health System. In this role, Dr. Patel collaborates with health system leadership and the provider community to facilitate strategic responses to matters related to the payer market.
Her prior roles include four years as a member of the clinical faculty at the University of California, Los Angeles, and two years as an associate natural scientist for RAND Health Care. She was the deputy staff director for health for Sen. Edward Kennedy and in 2009, she became a senior aide to Valerie Jarrett, who was a senior adviser to President Barack Obama. Previously she was a managing director and fellow at the Center for Health Policy at the Brookings Institution. Most recently, at Johns Hopkins she served as associate chief medical officer and medical director for Sibley Primary Care.
In 2016, after being nominated by Sens. Dianne Feinstein and Committee on Finance Chair Orrin Hatch, the Government Accountability Office appointed her to one of 11 positions on the Physician-Focused Payment Model Technical Advisory Committee. She is currently serving a three-year appointment on the committee, the responsibilities of which include development of criteria for national alternative payer models.
Her prior roles include four years as a member of the clinical faculty at the University of California, Los Angeles, and two years as an associate natural scientist for RAND Health Care. She was the deputy staff director for health for Sen. Edward Kennedy and in 2009, she became a senior aide to Valerie Jarrett, who was a senior adviser to President Barack Obama. Previously she was a managing director and fellow at the Center for Health Policy at the Brookings Institution. Most recently, at Johns Hopkins she served as associate chief medical officer and medical director for Sibley Primary Care.
In 2016, after being nominated by Sens. Dianne Feinstein and Committee on Finance Chair Orrin Hatch, the Government Accountability Office appointed her to one of 11 positions on the Physician-Focused Payment Model Technical Advisory Committee. She is currently serving a three-year appointment on the committee, the responsibilities of which include development of criteria for national alternative payer models.
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL
Dr. Grace E. Terrell is CEO of Envision Genomics, a company dedicated to helping clinicians diagnose rare disease through the integration of genomic data into clinical care. As a leader in health care delivery system reform, Dr. Terrell speaks to health systems, provider groups and professional organizations about the importance of improving population health through patient care model redesign, clinical and information integration, and value-based compensation. In 2013, Dr. Terrell launched CHESS, a population health management company dedicated to helping health systems and other medical groups make the transition to value-based medicine. For over 16 years, Dr. Terrell served as the president and chief executive officer of Cornerstone Health Care, P.A. a 370-provider independent multispecialty medical group that won the AMGA’s prestigious Acclaim Award in 2015.
3:30 pm
Transition Break
MACRA Mini Summit XI: Lessons Learned for Specialty APMs & Engaging Specialists in Value-based Payments through Specialty Payment Chassis Design
2:00 pm
Lessons Learned for Specialty APMs
Lili Brillstein, MPH
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ
Director, Episodes of Care, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield New Jersey; Member, CMS Advisory Panel on Oncology Bundles; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ
Lili Brillstein is a nationally recognized thought leader in the advancement of Episodes of Care as a value-based approach for specialty care. She is the Director of Episodes of Care for the Market Innovations team of Horizon Blue Cross Blue Shield of New Jersey.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, and oncology.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that reward providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Lawrence R. Kosinski, MD, MBA, AGAF, FACG
Chief Medical Officer, SonarMD; Managing Partner, Illinois Gastroenterology Group, LLC, Chicago, IL
Chief Medical Officer, SonarMD; Managing Partner, Illinois Gastroenterology Group, LLC, Chicago, IL
Lawrence Kosinski has been in the practice of Gastroenterology since 1984 and is one of the managing partners of the Illinois Gastroenterology Group (IGG), the largest Gastroenterology practice in Illinois. Dr. Kosinski is the founder of SonarMD, a care management company and serves as its Chief Medical Officer. SonarMD is a technology-enabled care coordination and targeted care management solution for patients with High-Beta chronic disease. Dr. Kosinski has held numerous national leadership positions and recently completed a three-year term on the governing board of the American Gastroenterological Association. He is currently on the Advocate Sherman Hospital Board of Directors.
Barbara L. McAneny, MD, FASCO, MACP
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd. Albuquerque, NM
President, American Medical Association; Board-Certified Medical Oncologist/Hematologist; Co-founder and Managing Partner, New Mexico Oncology Hematology Consultants Ltd. Albuquerque, NM
Barbara L. McAneny is a board-certified medical oncologist/hematologist. She is president of the American Medical Association, served on the AMA Board of Trustees, has been a member of the American Society of Clinical Oncology (ASCO) Board of Directors, and president of the New Mexico Medical Society (NMMS), the Greater Albuquerque Medical Association, and the New Mexico Chapter of the American College of Physicians. Currently Dr. McAneny chairs the board of the National Cancer Care Alliance.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
In 2012 Dr. McAneny received a $19.8 million award from the Centers for Medicare & Medicaid Innovation to test how oncology private practices could provide cancer patients better care at a lower cost. This award, called COME HOME (for Community Oncology Medical Home), later helped form Medicare’s Oncology Care Model. Innovative Oncology Business Solutions Inc., the company she created to manage the award, is now assisting physician practices, in collaboration with ASCO, in developing the process changes needed for MACRA.
S. Lawrence Kocot, JD, LLM, MPA
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC (Moderator)
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC (Moderator)
Larry Kocot is a Principal at KPMG, LLP and National Leader of KPMG’s Center for Healthcare Regulatory Insight. Prior to joining KPMG, Mr. Kocot practiced law at Epstein Becker Green, PC, and Dentons, US LLP; he also served as Deputy Director of the Engelberg Center for Health Care Reform at Brookings and was a visiting fellow in the Economic Studies Program at the Brookings Institution. Previously, he was Senior Advisor to the Administrator of the Centers for Medicare and Medicaid Services (CMS) at the U.S. Department of Health and Human Services. Mr. Kocot also served as Senior Vice President and General Counsel at the National Association of Chain Drug Stores, a Fellow in International Security Studies at the Center for Strategic and International Studies (CSIS) and an adjunct fellow at CSIS. Mr. Kocot serves on the board of the Partnership for a Healthier America, ICF International, Inc. and the Commonwealth Health Research Board.
2:45 pm
Holistically Engaging Specialists in Value-based Payments through Specialty Payment Chassis Design
Robert Krebbs
Staff Vice President, Payment Innovation, Anthem, Inc., Richmond, VA
Staff Vice President, Payment Innovation, Anthem, Inc., Richmond, VA
Robert Krebbs is Staff Vice President, Payment Innovation at Anthem where he is responsible for the design and execution of payment innovations related to hospitals, specialists, ancillary service providers, and special populations. Mr. Krebbs works with network physicians and facilities on innovative programs aimed at delivering healthcare value by promoting high quality, affordable care. He was a member of the leadership and development team at Anthem recognized with the John M. Eisenberg Patient Safety and Quality Award (Joint Commission & National Quality Forum) for the Q-HIP and Quality Physician Performance Program value-based reimbursement programs.
Mr. Krebbs’ interest in advancing high value care solutions extends to participation in multi-stakeholder efforts, including serving on the Board of Directors (now the Steering Committee) of the American Joint Replacement Registry, the Center to Advance Palliative Care (CAPC) Multi-Payer Workgroup and the Advisory Committee for the National Committee for Quality Assurance’s (NCQA) Patient Centered Specialty Practice (PCSP) program.
Mr. Krebbs’ interest in advancing high value care solutions extends to participation in multi-stakeholder efforts, including serving on the Board of Directors (now the Steering Committee) of the American Joint Replacement Registry, the Center to Advance Palliative Care (CAPC) Multi-Payer Workgroup and the Advisory Committee for the National Committee for Quality Assurance’s (NCQA) Patient Centered Specialty Practice (PCSP) program.
3:30 pm
Transition Break
MACRA Mini Summit XII: Using Quality as a Service & Methods for Managing Post Acute Care
2:00 pm
MACRA: Using Quality as a Service
2:45 pm
Methods for Managing Post Acute Care
Karen Chambers, RN, CCM, CDMS, CTC
Vice President, Clinical Outcomes, naviHealth; Former VP Operations, athenahealth, Nashville, TN
Vice President, Clinical Outcomes, naviHealth; Former VP Operations, athenahealth, Nashville, TN
Karen Chambers is VP of Clinical Outcomes at naviHealth, one of the nation’s largest conveners in the CMS Bundle Payment program and a leader in Post-Acute Care Management. Her role at naviHealth includes creation, fidelity and outcome measurement of naviHealth’s Clinical Model. Ms. Chambers has over 30 years of healthcare experience in case management and managed care. Prior to joining naviHealth, she was on the ground floor of numerous successful health care startups utilizing both her clinical and technological skills. Ms. Chambers was named Case Manager of the Year by the Case Management Society of America (CMSA) in 1995 and served as the organization’s National President in 2002-03. She has presented at both a national and international level and has been published in Case Management journals.
Dawn Rakiey, MPT, MHA
Director Clinical Integration Network and ACO, University Medical Center, Lubbock, TX
Director Clinical Integration Network and ACO, University Medical Center, Lubbock, TX
Dawn Rakiey is the Director Clinical Integration Network and ACO at University Medical Center in Lubbock, TX. She has practiced as a therapist for 13 years with experience in acute care, home health, and outpatient settings. Since October 2016, she was the CJR and Post-Acute Care Coordinator and was just recently promoted to Director of Clinical Integration Network and ACO at UMC which includes the mandated CJR program. Ms. Rakiey currently oversees the post-acute care network as well as implementing our preferred provider network.
Jay Sultan
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA (Moderator)
Vice President, Healthcare Strategy, Cognizant, Watkinsville, GA (Moderator)
Jay Sultan has been working on the intersection of payment reform policy and enabling technology for twenty years. He is a software executive that has been a pioneering voice on both the policy of payment reform and the reality of its execution at scale. He is now serves as the VP Healthcare Strategy at Cognizant, creating new solutions to enable value based care through engagement. Jay has previously authored two patents on payment bundling methods and has been engaged by payers, providers, and governments on the best ways to implement new VBR and VBID programs.
3:30 pm
Transition Break
MACRA SUMMIT PLENARY SESSION AND
ACO & BUNDLED PAYMENT MINI SUMMITS
MACRA SUMMIT PLENARY SESSION
4:00 pm
CMS/CMMI Keynote Address on MACRA Policies
Sanjay Doddamani, MD
Senior Advisor and Medical Officer, Center for Medicare and Medicaid Innovation; Former Senior Director in Population Health, Geisinger Health System, Chief Medical Officer, Keystone ACO, Washington, DC
Senior Advisor and Medical Officer, Center for Medicare and Medicaid Innovation; Former Senior Director in Population Health, Geisinger Health System, Chief Medical Officer, Keystone ACO, Washington, DC
Dr. Sanjay Doddamani is the Senior Advisor and Medical Officer for the Center for Medicare and Medicaid Innovation. Dr. Doddamani joined public service to help advance value based care transformation through development and implementation of innovative care models and payment for Medicare and Medicaid beneficiaries. He was previously the Chief Medical Officer of Geisinger at Home, a home-based model of care for Geisinger’s population of medically complex patients. He also served as Chief Medical Officer of the Keystone ACO and was a Senior Director in Population Health. His clinical background as a practicing heart failure cardiologist has helped provide deep insights into chronic conditions and the struggles faced by patients and their caregivers. He has served on numerous panels and committees and presented on diverse topics both nationally and abroad.
4:30 pm
MACRA Keynote Address: Are Alternative Payment Models Better than Fee for Service?
Harold D. Miller
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Co-chair)
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA (Co-chair)
Harold Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that facilitates improvements in healthcare payment and delivery systems. Miller also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Miller is a nationally-recognized expert and author of over a dozen widely-used reports on health care payment and delivery reform. He has twice given invited testimony to Congress on how to reform healthcare payment, and he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is one of the eleven members of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress to advise the Secretary of Health and Human Services on the creation of alternative payment models.
5:00 pm
A Lightning Round on the Hot MACRA Issues of Today
Valinda Rutledge, MBA
Vice President of Federal Affairs, APG, VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health, Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC
Vice President of Federal Affairs, APG, VP Public Payor Health Strategy, Care Coordination Institute, Prisma Health, Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, Washington, DC
Valinda Rutledge is currently the Vice President of Federal Affairs at America’s Physician Groups. She is responsible for analyzing and advocating for APG’s positions on government initiatives such as bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs.
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Co-chair)
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and CEO, Cornerstone Health Care, Huntsville, AL (Co-chair)
Dr. Grace E. Terrell is CEO of Envision Genomics, a company dedicated to helping clinicians diagnose rare disease through the integration of genomic data into clinical care. As a leader in health care delivery system reform, Dr. Terrell speaks to health systems, provider groups and professional organizations about the importance of improving population health through patient care model redesign, clinical and information integration, and value-based compensation. In 2013, Dr. Terrell launched CHESS, a population health management company dedicated to helping health systems and other medical groups make the transition to value-based medicine. For over 16 years, Dr. Terrell served as the president and chief executive officer of Cornerstone Health Care, P.A. a 370-provider independent multispecialty medical group that won the AMGA’s prestigious Acclaim Award in 2015.
5:30 pm
Adjournment and Networking Reception
ACO & BUNDLED PAYMENT MINI SUMMITS III: 4:00 pm – 5:30 pm
(Choose one Mini Summit only)
ACO Mini Summit XIII: Accountable Care Organizational Resources: NAACOS, ACLC and APG
4:00 pm
National Association of ACOs (NAACOS)
Brian A. Hammer, MS, MBA, FACHE
Vice President, Membership and Business Services, National Association of ACOs (NAACOS); Former Manager, Physician and Business Development, Meridian Health (Ocean Medical Center) Brick, NJ; Visiting Adjunct Professor, Monmouth University, Washington, DC
Vice President, Membership and Business Services, National Association of ACOs (NAACOS); Former Manager, Physician and Business Development, Meridian Health (Ocean Medical Center) Brick, NJ; Visiting Adjunct Professor, Monmouth University, Washington, DC
Brian Hammer is the Vice President of Membership and Business Services for the National Association of ACOs and leads all recruitment and retention activities with new and existing ACOs contracting with CMS and commercial payers. Brian oversees strategic business partnerships benefiting ACOs. Before NAACOS, Brian’s considerable experience in the hospital arena and out-patient ambulatory setting proved beneficial to Meridian Health as he strategized physician alignment through practice acquisitions and recruitment initiatives. Most notably, he delivered a successful ACO recruitment campaign yielding over 10,000 beneficiary lives. Prior to Meridian, Brian won multiple national awards for Johnson & Johnson and Takeda Pharmaceuticals. He is a visiting professor at Monmouth University and a Fellow of the American College of Healthcare Executives.
4:30 pm
Accountable Care Learning Collaborative (ACLC)
Thomas Merrill
Committee Director & Strategic Advisor, Accountable Care Learning Collaborative, Senior Analyst, The CARIN Alliance, Salt Lake City, UT
Committee Director & Strategic Advisor, Accountable Care Learning Collaborative, Senior Analyst, The CARIN Alliance, Salt Lake City, UT
Tom Merrill is an experienced researcher and speaker on the nation’s ongoing efforts to shift to a value-based system. His work has included managing research teams that surveils the vast number of secondary sources on the movement but also building research relationships with standout operational leaders of the value-based movement for unique primary insights. His contributions include front-line informed resources for leaders of the value-based movement, including the landmark resource, The Accountable Care Atlas.
5:00 pm
APG Risk Evolution Task Force Provides Benchmarking and Learning Collaboratives for ACO Members
Melanie Matthews, MA
CEO, NW Momentum Health Partners ACO; CEO, Physicians of Southwest Washington; Former Operations, Prestige Care, Olympia, WA
CEO, NW Momentum Health Partners ACO; CEO, Physicians of Southwest Washington; Former Operations, Prestige Care, Olympia, WA
Melanie Matthews is the dynamic, creative and innovative CEO at Physicians of Southwest Washington (PSW) bringing more than 20 years of operations, financial, human resources and product marketing experience in health care services for specialty populations. Since she joined the company in 2016, she has maintained the core principals in which PSW was founded on and expanded business lines to include MSO services including credentialing, coding and compliance and the implementation of CMMI innovation models such as the Next Generation ACO. Melanie’s extensive knowledge in post-acute care provides strategic focus in reducing overall cost of care as well as provider and beneficiary engagement. Prior to PSW, Melanie served for three years as Vice President of Operations for Prestige Care, Inc. Among her other accomplishments, Melanie serves as the chair of the Washington Health Care Association and was selected by the American Health Care Association as a “National Political Ambassador” in 2013.
5:30 pm
Adjournment and Joint Networking Reception
ACO Mini Summit XIV: Integrating Behavioral Health and Primary Care & Shared Decision Making and Personalized Care into Value-based Arrangements
4:00 pm
Integrating Behavioral Health and Primary Care into Value-based Arrangements
Katherine Hobbs Knutson, MPH, MD
Chief of Behavioral Health, Blue Cross North Carolina; Physician, Duke University Health System; Adjunct Assistant Professor, Duke University School of Medicine, Durham, NC
Chief of Behavioral Health, Blue Cross North Carolina; Physician, Duke University Health System; Adjunct Assistant Professor, Duke University School of Medicine, Durham, NC
Katherine Hobbs Knutson is the Chief of Behavioral Health at Blue Cross North Carolina (BCNC). She is an Adult and Child Psychiatrist and adjunct Assistant Professor at the Duke University School of Medicine. At BCNC, Katherine is leading the strategy for value transformation for behavioral health, focusing on alternative payment methods, outcome measurement, and innovative service delivery models. Clinically, she has practiced in integrated care settings treating individuals with serious mental illness and substance use disorders. Prior to joining BCNC, Katherine was the Chief Medical Officer at Alliance Behavioral Healthcare, Director of Community Psychiatry at the Children’s National Health System, and Associate Medical Director for Psychiatry for the Massachusetts Medicaid program. She has conducted health services research on psychiatry telephone consultation programs, behavioral health predictive modeling, and care management interventions that incorporate peer and family support.
David Wennberg, MD, MPH
Chief Executive Officer, Quartet Health; Former CEO, Northern New England Accountable Care Collaborative; Former CEO, High Value Health Collaborative, The Dartmouth Institute, New York, NY
Chief Executive Officer, Quartet Health; Former CEO, Northern New England Accountable Care Collaborative; Former CEO, High Value Health Collaborative, The Dartmouth Institute, New York, NY
David Wennberg serves as Quartet’s Chief Executive Officer. Prior to becoming CEO, David was Quartet’s Chief Data Scientist and led the Business Development team. David previously served as the Chief Executive Officer of the Northern New England Accountable Care Collaborative (NNEACC), and as the Chief Executive Officer of the High Value Health Collaborative at The Dartmouth Institute. A co-founder of Health Dialog Analytic Solutions, the analytic division of Health Dialog, David served as Health Dialog’s Chief Science Officer. David is a member of the Dartmouth Institute for Health Policy and Clinical Practice faculty.
4:45 pm
Integrating Shared Decision Making and Personalized Care into Value-based Arrangements
David Wennberg, MD, MPH
Chief Executive Officer, Quartet Health; Former CEO, Northern New England Accountable Care Collaborative; Former CEO, High Value Health Collaborative, The Dartmouth Institute, New York, NY
Chief Executive Officer, Quartet Health; Former CEO, Northern New England Accountable Care Collaborative; Former CEO, High Value Health Collaborative, The Dartmouth Institute, New York, NY
David Wennberg serves as Quartet’s Chief Executive Officer. Prior to becoming CEO, David was Quartet’s Chief Data Scientist and led the Business Development team. David previously served as the Chief Executive Officer of the Northern New England Accountable Care Collaborative (NNEACC), and as the Chief Executive Officer of the High Value Health Collaborative at The Dartmouth Institute. A co-founder of Health Dialog Analytic Solutions, the analytic division of Health Dialog, David served as Health Dialog’s Chief Science Officer. David is a member of the Dartmouth Institute for Health Policy and Clinical Practice faculty.
5:30 pm
Adjournment and Joint Networking Reception
ACO Mini Summit XV: What’s Next for Next Gen ACOs? Applying OCM Strategies to Boost Value-based Contract Opportunities
4:00 pm
What’s Next for Next Gen ACOs?
Jonathan Chines, MPP
Vice President, Payer Contracting and Network Strategy, Reliant Medical Group; Former Vice President of Network Contracting, Senior Products, Tufts Health Plan, Boston, MA
Vice President, Payer Contracting and Network Strategy, Reliant Medical Group; Former Vice President of Network Contracting, Senior Products, Tufts Health Plan, Boston, MA
Jonathan Chines serves as Vice President of Payer Contracting and Network Strategy at Reliant Medical Group. In this role, he is responsible for the strategy, negotiation, and management of Reliant’s relationships with commercial payers, and for leading Reliant’s Accountable Care Organization (ACO) initiatives with Medicare and the Massachusetts Medicaid program. In addition, Jonathan leads the development of Reliant’s preferred referral network, supporting the efficient delivery of high-quality care for Reliant’s patients. An experienced health care executive with expertise in population health management, network development, and accountable care readiness, Jonathan joined Reliant in 2017. Prior to joining Reliant, Jonathan spent 11 years at Tufts Health Plan in a variety of roles in corporate strategy, product development, business performance, and network contracting.
Peter J. Kelly, MBA
Executive Director, CareMount ACO LLC, Senior Director of Development, CareMount Medical PC, Former Executive Director of Market Operations, Universal American Corp., New York, NY
Executive Director, CareMount ACO LLC, Senior Director of Development, CareMount Medical PC, Former Executive Director of Market Operations, Universal American Corp., New York, NY
Peter Kelly is the Executive Director at CareMount ACO and Senior Director of Business Development at CareMount Medical. CareMount Medical is the largest independent multi-specialty medical group in New York State with over 550 clinicians across 45 office locations. Peter is responsible for the Government Programs division of CareMount, covering approximately 40,000 seniors across a Next Generation ACO and three risk-based Medicare Advantage contracts. Prior to joining CMM, Peter served as Executive Director of Market Operations at Universal American (NYSE: UAM), a Medicare Advantage and ACO company. Peter also spent 6 years at Avalere Health as a healthcare strategy consultant.
Elissa Langley, MHA
Vice President and Chief Operating Officer, Triad HealthCare Network; Former Chief Operations Officer, BuyMD; Former Network Manager, Aetna, Greensboro, NC
Vice President and Chief Operating Officer, Triad HealthCare Network; Former Chief Operations Officer, BuyMD; Former Network Manager, Aetna, Greensboro, NC
An accomplished health care professional with thirty plus years of payor, provider, and consulting experience, Ms. Elissa Langley is the Vice President, Chief Operating Officer for Triad HealthCare Network (“THN”) of the Cone Health System. Her responsibilities include assisting with the development, implementation, and operation of THN, an Accountable Care Organization (“ACO”) in the Piedmont Triad area of North Carolina. She is currently responsible for THN’s operations, which includes managing over 204,000 covered lives. She oversees contracting with all Payers for THN’s shared savings/risk arrangements, including the Next Generation ACO Program. Additionally, she managed the implementation of a Medicare Advantage Risk Agreement with Humana and North Texas Specialty Physicians and was instrumental in the development of Cone’s Medicare Advantage Plan called HealthTeam Advantage. Previously, Ms. Langley has worked for managed care plans such as Humana and Aetna as a Network Manager.
Michael Reiche, MS, MBA
Executive Director, Medicare Accountable Care, Steward Health, Boston, MA
Executive Director, Medicare Accountable Care, Steward Health, Boston, MA
Michail Reiche is the Executive Director of the Medicare ACO business unit at the Steward Health Care Network. In this role, he is responsible for Steward’s entire portfolio of industry-leading Medicare risk programs: Next Generation ACO, MSSP ACO and Bundled Payments. Through effective programmatic planning, analytics, care redesign, physician engagement and partnership development, the Medicare ACO team ensures that Medicare beneficiaries receive the top-quality care they deserve. Michail formerly served as the Director of Bundled Payments at Steward, where he led one of the nation’s largest and most successful Medicare bundled payments programs. Prior to joining Steward, he held roles in management consulting with Deloitte and The Monitor Group.
James P. Sharp, MPH, JD
Director, Health Care Strategy and Transformation, BlueCross BlueShield of North Carolina; Former Policy and Strategy Advisor, Office of the Director, Center for Medicare and Medicaid Innovation, Washington, DC
Director, Health Care Strategy and Transformation, BlueCross BlueShield of North Carolina; Former Policy and Strategy Advisor, Office of the Director, Center for Medicare and Medicaid Innovation, Washington, DC
JP Sharp is the Director of Healthcare Strategy and Transformation at Blue Cross and Blue Shield of North Carolina where he leads the design of new payment models and strategic healthcare initiatives to transform care delivery, which includes the launch of the Blue Premier program. JP previously worked at the CMS Innovation Center, where he led the development of the Next Generation ACO Model, the Quality Payment Program under MACRA, and strategic planning in the Office of the Director.
Mara McDermott, JD
Vice President, McDermott+Consulting; Former Vice President of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Vice President, McDermott+Consulting; Former Vice President of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Mara McDermott is an accomplished health care executive with a deep understand of federal health care law and policy, including delivery system reform, physician payment and Medicare models. Prior to McDermottPlus, Mara served as the senior vice president of federal affairs at America’s Physician Groups (formerly the California Association of Physician Groups, CAPG). As head of the Washington, DC office, Mara worked to advance policies that promoted coordinated care. Her work covered a number of issue areas including Medicare Advantage, MACRA, ACOs and the physician fee schedule. Previously, Mara was counsel in the health industry practice at a law firm in Washington, DC.
4:45 pm
Applying OCM Strategies to Boost Value-based Contract Opportunities
Wendy Rossi
Principal, Premier, Inc., Former Contract Manager, Katz Brunner Healthcare, Former Business and Strategic Planning Project Manager, Charlotte, NC
Principal, Premier, Inc., Former Contract Manager, Katz Brunner Healthcare, Former Business and Strategic Planning Project Manager, Charlotte, NC
Wendy Rossi is a Principal with Premier Performance Partners. She is a leader within the Premier Bundled Payment Collaborative and manages the Oncology Care Model cohort. Through the Collaborative she provides education and guidance in performance improvement efforts around care re-design, quality measurement, cost reduction, and physician engagement. Ms. Rossi’s expertise enables the successful transition from volume- to value-based care for her clients. Prior to joining Premier, she was the Strategic Planning Manager at New Hanover Regional Medical Center in Wilmington, NC. Her responsibilities included strategic planning in oncology, cardiology and women’s and children’s service lines. Ms. Rossi worked closely with senior leadership on major initiatives such as opening the Betty Cameron Women’s and Children’s Hospital and expanding outpatient clinic services. Ms. Rossi began her career as a medical technologist. She received Lean Healthcare Certification from North Carolina State University.
Kristina Stoeppler-Biege, MS, RN, OCN
Director, Clinical Operations, Bon Secours St. Francis Cancer Center, Greenville, SC
Director, Clinical Operations, Bon Secours St. Francis Cancer Center, Greenville, SC
Kristina Stoeppler-Biege is the Director of Operations for the Hematology and Oncology service line at Bon Secours Mercy Health (Greenville, SC). She provides executive leadership and strategic oversight for various oncology care model platforms that encompass a wide range of services. These include cellular therapies and bone marrow transplant unit, a robust clinical trial portfolio, physician clinics, radiation oncology, gynecologic oncology, patient navigation, financial navigation and psychosocial departments. The program has successfully received performance-based payments from both government and commercial payors.
Chris Murphy, MBA
Principal, Premier Performance Partners, Premier, Inc., Former Director, Reimbursement Innovations, Highmark, Pittsburgh, PA (Moderator)
Principal, Premier Performance Partners, Premier, Inc., Former Director, Reimbursement Innovations, Highmark, Pittsburgh, PA (Moderator)
Chris Murphy is the Principal Healthcare Consultant for Premier’s Payer Partnerships with more than 20 years of diverse industry management experience, consulting expertise, and a strong hybrid skill-set encompassing leadership of fiscal, sales, and marketing operations and product management. Being a leader and innovator of technology, healthcare trends, and the movement of pay-for-volume to pay-for-performance, he has extensive knowledge in the reimbursement space with a focus on bundled payments, episode performance programs, gainsharing, capitation, and many other areas of the payment spectrum. Chris brings knowledge in behavioral health, care management, provider relations and network management, practice and physician recruitment and management, revenue cycle offerings including credentialing and enrollment and electronic billing, NCQA accreditation, HEDIS measures, clearinghouse and TPA capabilities, contract negotiations and management. In his Principal role, Chris leads members to positive outcomes and confidence in the relationship built with all areas within the Premier landscape.
5:30 pm
Adjournment and Joint Networking Reception
Bundled Payment Mini Summit XVI: Understanding and Overcoming Barriers to Bundled Payment Adoption: Experience from the Field
4:00 pm
Understanding and Managing Risk in Bundled Payment Arrangements
Pamela M. Pelizzari, MPH
Principal and Senior Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY
Principal and Senior Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY
Pamela Pelizzari is a nationally recognized expert on the development and implementation of bundled payment methodologies. She is a Principal in the New York Health Practice at Milliman, working with payers, providers, and other stakeholders on developing functional and effective value-based payment methodologies. Prior to joining Milliman, Pamela was a senior technical advisor at the Centers for Medicare and Medicaid Services, leading development and implementation of their Bundled Payments for Care Improvement models, the Oncology Care Model, and other episode-based models.
4:30 pm
How a Health Insurer and a Provider are Well-Positioned to Overcome the Barriers to Bundled Payment Adoption
Monica Deadwiler, MBA
Senior Director, Payment Innovation, Cleveland Clinic, Cleveland, OH
Senior Director, Payment Innovation, Cleveland Clinic, Cleveland, OH
Monica Deadwiler is the Senior Director for Payment Innovation within Cleveland Clinic’s Finance division. Monica’s primary focus is alternative payment model strategy development and implementation; such as, Bundled Payments, Centers of Excellence, Accountable Care Organizations and other value based contracts. Monica has been with the Cleveland Clinic for 10 years. Prior to that, Monica spent 14 years delivering innovative strategies in other industries undergoing structural changes (energy and airlines). She is a Lean Six Sigma Master Black Belt and Project Management Professional.
David Mauzey
General Manager, Bundle Pay Manager, Optum, Dallas, TX
General Manager, Bundle Pay Manager, Optum, Dallas, TX
David Mauzey is the Vice President and General Manager the Optum Network Payment Innovation focused on enabling organizations to administer their alternative payment programs including bundle based programs and population centric value based programs for some of the top health systems and payers in the country. Network Payment Innovation acts as a payment exchange service enabling the move from volume to value based arrangements. Prior to joining Optum, David spent 17 years with ppoONE, a claim pricing and provider data management solution for preferred provider networks. Serving as both COO and CIO, David gained a great appreciation for finding the right operational and technical balance that align to organizational vision.
Jeff Meyerhofer, MBA
President, UnitedHealthcare Bundled Payment Solutions, Minneapolis, MN
President, UnitedHealthcare Bundled Payment Solutions, Minneapolis, MN
Jordan Reigel, MBA
Vice President, Medicare Payment Strategy, United HealthCare; Former Network Management, Kaiser Permanente, Parker, CO
Vice President, Medicare Payment Strategy, United HealthCare; Former Network Management, Kaiser Permanente, Parker, CO
Jordan Reigel is the Vice President of Payment Strategy & Innovation at UnitedH-ealthcare. In this role, he is responsible for designing and implementing value-based payment strategies in collaboration with health care providers and developing strategic relationships to drive improved health outcomes and make care more accessible and affordable for all consumers.
During his more than 10 years at UnitedHealthcare, Mr. Reigel has held various leadership positions spanning strategy and network management, including Vice President of Network Management for the Mountain States Region. Prior to joining UnitedHealthcare, he worked in network design and management roles at regional and national health plans. In all these positions, he has developed new ways to bring care providers and health plans together to collaborate toward achieving the triple aim of improving the patient experience, improving health outcomes and reducing the cost of care.
During his more than 10 years at UnitedHealthcare, Mr. Reigel has held various leadership positions spanning strategy and network management, including Vice President of Network Management for the Mountain States Region. Prior to joining UnitedHealthcare, he worked in network design and management roles at regional and national health plans. In all these positions, he has developed new ways to bring care providers and health plans together to collaborate toward achieving the triple aim of improving the patient experience, improving health outcomes and reducing the cost of care.
5:30 pm
Adjournment and Joint Networking Reception
Bundled Payment Mini Summit XVII: AI, Analytics, Big Data and Blockchain Technologies to Drive Bundled Payment Success
4:00 pm
AI, Analytics and Big Data Strategies to Drive Bundled Payment Success
Basit Chaudhry, MD, PhD
Founder, Tuple Health; Former Medical Scientist, IBM; Former Researcher, The Rand Corporation, Washington, DC
Founder, Tuple Health; Former Medical Scientist, IBM; Former Researcher, The Rand Corporation, Washington, DC
Dr. Chaudhry is an internal medicine physician and medical technologist whose expertise focuses on healthcare payment, clinical service redesign, and the use of data analytics to improve clinical and financial performance in healthcare. Prior to starting Tuple Health Dr. Chaudhry was a medical scientist at IBM Research where his work focused on using data analytics and information technology to drive innovation in healthcare. His work focused on improving healthcare productivity, ACO & PCMH implementation, optimizing workforce utilization, and improving the quality and efficiency of care. In addition to technology development, Dr. Chaudhry worked on developing IBM’s private and public sector business strategies for the healthcare industry.
4:45 pm
Technology Specific to Payment Bundling, including Blockchain Technology
Jennifer Mann
Senior Product Manager TriZetto, A Cognizant Company, Chicago, IL
Senior Product Manager TriZetto, A Cognizant Company, Chicago, IL
Jennifer Mann is a Sr. Product Manager, with Cognizant Technology Services and specializes in bundled payment technology solutions within the NetworX product suite. She has over 25 years in the healthcare industry with regional and national payers. Operational/management experience includes customer service, enrollment/billing, compliance, appeals/ grievances, marketing, start-ups, and Medicare Advantage plans. In her current role, Jennifer has conducted over 250 discussions with payers and hospital systems throughout the U.S. over the last 4 years regarding value-based reimbursement and bundled payment programs.
5:30 pm
Adjournment and Joint Networking Reception
Bundled Payment Mini Summit XVIII: Risk/Bundle Selection, Performance Monitoring, and Clinical Management & Getting “Bundle Ready”: How Provider Organizations Can Design Clinical Pathways
4:00 pm
Trends and Tactics in National Bundled Payment Programs: Risk/Bundle Selection, Performance Monitoring, and Clinical Management
Chris Birkmeyer, MS
Executive Vice President, Analytics, ArborMetrix; Former EVP, Analytics and Products, SCIO Health Analytics; Former Director of Informatics, Health Dialog, Ann Arbor, MI
Executive Vice President, Analytics, ArborMetrix; Former EVP, Analytics and Products, SCIO Health Analytics; Former Director of Informatics, Health Dialog, Ann Arbor, MI
Chris Birkmeyer, M.S. is the Executive Vice President, Analytic Solutions where he leads the design, development, implementation, and refinement of clinical algorithms and reports within the ArborMetrix platform, as well as the preparation of bespoke research and analysis for individual clients. Chris has 20 years of experience in health services research, outcomes analysis, and software development. Prior to joining ArborMetrix, Chris was Executive Vice President at SCIO Health Analytics responsible for software development, delivery and sales, and practice lead for analytics and actuarial services. Previously, he directed the informatics department at Health Dialog, managed the Data Center for the Department of Surgery at Dartmouth-Hitchcock Medical Center, and consulted for The Leapfrog Group.
John Dickey
Vice President, Population Health, Sound Physicians, Bakersfield, CA
Vice President, Population Health, Sound Physicians, Bakersfield, CA
John Dickey is Sound Physician’s National Vice President of Population Health. He joined Sound in 2014 as a Hospitalist and continues to practice in the Southwestern region even as he works to server patients and providers across Sound. His innovative care models and management processes have contributed to Sound-leading improvements in the use of post-acute care and high-quality networks. John is passionate about working together as a team to make care better for our patients, and excited that Sound has embraced Population Health as essential to patient care. He believes that the journey to redesign care is an enormous opportunity to drive truly patient-centered outcomes and improvements in quality for our patients. Sound has developed strategic solutions with significant patient outcomes in BPCI(A), ACOs, and other at risk populations. A lifelong educator, he once taught science and math prior to a life in medical field.
4:45 pm
Getting “Bundle Ready”: How Provider Organizations Can Design Clinical Pathways in the Context of Bundled Payments
Joshua M. Liao, MD, MSc, FACP
Associate Medical Director, Contracting and Value-based Care, Assistant Professor, University of Washington, Seattle, WA
Associate Medical Director, Contracting and Value-based Care, Assistant Professor, University of Washington, Seattle, WA
Dr. Liao is a board-certified internal medicine physician and the Associate Medical Director for Contracting and Value Based Care at UW Medicine, where he is also the Director of the UW Medicine Value and Systems Science Lab, a unit embedded within the health system and applies scholarship to drive change that impacts patients and populations. Dr. Liao’s expertise includes policy analysis related to value-based payment and care reforms, with scholarly work focusing on evaluating and testing the impact of value-based payment and delivery reforms on patients, physicians, and health care organizations. He is also an Associate Editor for Healthcare: The Journal of Delivery Science and Innovation. He was also a Clinical Fellow in Medicine at Harvard Medical School. He is an Adjunct Senior Fellow at the Leonard Davis Institute of Health Economics located at the University of Pennsylvania, where he received his training in health policy research.
5:30 pm
Adjournment and Joint Networking Reception
Agenda Links: Preconference | Day III