Agenda: Pay for Performance Summit: Day III
Wednesday, March 4, 2015
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7:30 a.m. |
Registration
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MORNING PLENARY SESSION
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8:00 a.m. |
The Future of Quality Measurement and Improvement
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From the first quality measures developed in the early 90's and the landmark reports To Err is Human and Crossing the Quality Chasm that highlighted the need for sound quality and performance measurement science to improve healthcare delivery, to the development of the National Quality Strategy, healthcare quality measurement has evolved greatly over the past two decades. How much value is in all this activity? What are the information needs of patients, payers and providers in the world of innovation in healthcare delivery? Dr. Christine Cassel, president and Chief Executive Officer of the National Quality Forum, will address these questions and explore the challenges and opportunities ahead for improving health and healthcare through data and measurement.
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Christine Cassel, MD
President and Chief Executive Officer, National Quality Forum, Washington, DC
Speaker Bio
Dr. Cassel is president and CEO of The National Quality Forum (NQF) in Washington, DC, and formerly served for a decade as president and CEO of the American Board of Internal Medicine and the ABIM Foundation. She is a leading expert in geriatric medicine, medical ethics and health care quality and safety. Dr. Cassel, board certified in both internal medicine and geriatric medicine, has achieved a number of firsts for women in medicine -- she was the first female board chair of the American Board of Internal Medicine (1995 to 1996), the first female President of the American College of Physicians (1996 to 1997), and the first female dean of Oregon Health & Science University, Portland, Oregon (2002 to 2003).
Presentation Material (Acrobat)
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8:45 a.m. |
From ACOs to Joint Ventures: Emerging Plan-Provider Collaborations in California's Market
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This session will highlight innovation in plan-provider relationships, payments, and Accountable Care Organization initiatives in the California health care market. James Robinson, Leonard D. Schaeffer Professor of Health Economics at UC Berkeley will chair the session and present results from the IHA study of differences in total cost of care for physician-owned and hospital-owned medical groups. Pam Kehaly, President of Anthem Blue Cross for the western region, and David Feinberg, Chief Executive Officer of UCLA Medical Center, will discuss the new Vivity relationship between the insurer and its major hospital/physician partners in Southern California. Richard Fish, Chief Executive Officer of Brown and Toland Physicians, will describe the challenges and opportunities facing a physician-owned medical group that is pursuing ACO relationships with Medicare and with commercial PPOs as well as HMOs.
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David Feinberg, MD, MBA
President, UCLA Health System; Chief Executive Officer, UCLA Hospital System; Associate Vice Chancellor, UCLA Health Sciences, Los Angeles, CA
Speaker Bio
Dr. David T. Feinberg has been CEO of UCLA's hospitals and associate vice chancellor of UCLA Health Sciences since 2007. In July 2011, he assumed the position of president of UCLA Health System, overseeing all aspects of UCLA Health, its four hospitals ? Ronald Reagan UCLA Medical Center, Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA and Mattel Children's Hospital UCLA and UCLA Medical Center, Santa Monica -- and the UCLA Faculty Practice Group. Each year, UCLA's hospitals treat more than 45,000 patients, and 2 million patients are seen in UCLA's 150 community offices. Ronald Reagan UCLA Medical Center and UCLA Medical Center, Santa Monica, are ranked No. 5 in the nation by U.S. News & World Report, and Ronald Reagan UCLA Medical Center has been ranked "Best in the West" for 25 consecutive years.
Modern Healthcare named him among the "50 Most Influential Physician Executives and Leaders" in the United States for 2014. Dr. Feinberg is a clinical professor of psychiatry in the David Geffen School of Medicine at UCLA.
Along with his dedication to upholding the highest clinical standards for patient care and safety, Dr. Feinberg is committed to enhancing the patient experience. Under his leadership, patient-satisfaction scores have reached the 99th percentile in many areas.
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Richard Fish, MBA
Chief Executive Officer, Brown & Toland Physicians, San Francisco, CA
Speaker Bio
A healthcare expert with 25 years of industry experience, Richard became CEO of Brown & Toland Physicians in 2011. Before becoming CEO, he was senior vice president of New Business Development for Brown & Toland. Fish also has served in senior management roles for Talbert Medical Group, Pacific Cardiovascular Associates/Pacific Hospitalist Associates, Heritage Development Organization, and FHP International. He holds a Bachelor of Science degree from the University of California at Davis and an MBA from the University of Washington.
Founded in 1992, Brown & Toland Physicians is a leading network of independent doctors focused on delivering personalized, high quality, and affordable healthcare to the San Francisco Bay Area. Brown & Toland's 1,500 physicians, who care for more than 300,000 HMO and PPO patients, are dedicated to improving care through a number of patient-centered programs and use electronic tools to coordinate and deliver care. The group is leading the way forward in healthcare by participating in multiple accountable care projects, such as the Pioneer Accountable Care Organization (ACO) model, and other ACOs for both HMO and PPO patients.
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Pam Kehaly
President, Anthem West Region & Specialty Businesses, Anthem Blue Cross, Thousand Oaks, CA
Speaker Bio
Pam Kehaly is President of Anthem's West Region and Specialty Businesses. In Pam's role as President of Anthem West Region, she oversees services for approximately 9 million members delivered through Anthem Blue Cross of California, Anthem Blue Cross Blue Shield of Colorado and Anthem Blue Cross Blue Shield of Nevada. She also leads Anthems Specialty Business including Dental, Vision, Disability, Life, and Workers' Compensation business for the nation.
Pam previously served as President of Anthem Blue Cross, where she oversaw Anthem's commercial business in California. Prior to that, Pam was President of National Accounts at Aetna, with responsibility for 9 million members and the associated profit and loss performance.
Presentation Material (Acrobat)
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James C. Robinson PhD, MPH
Leonard D. Schaeffer Professor of Health Economics, UC Berkeley School of Public Health; Chair, Berkeley Center for Health Technology, Berkeley, CA (Moderator)
Speaker Bio
James Robinson is Leonard D. Schaeffer Professor of Health Economics and Director of the Berkeley Center for Health Technology (BCHT) at the University of California at Berkeley. His professional activities include his roles as Senior Director for Medical Technology at the Integrated Healthcare Association (IHA), Contributing Editor for Health Affairs journal, and as keynote speaker for conferences, policy roundtables, and board meetings. At the Integrated Healthcare Association, Dr. Robinson is a member of the Board of Directors.
At Berkeley, Professor Robinson teaches health policy and economics, focusing on the biotechnology, medical device, insurance, physician, and hospital sectors. He has published two books and over 100 papers in scientific and policy journals such as the New England Journal of Medicine, JAMA, and Health Affairs. The BCHT supports research and professional education projects related to coverage, management, and payment methods for innovative technologies including biopharmaceuticals, medical devices, and diagnostics.
Presentation Material (Acrobat)
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10:15 a.m. |
Using Regional Health Improvement Collaboratives to Drive Improvement and Reduce Costs
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The Network for Regional Health Improvement is a national coalition of regional and state collaboratives that includes the Integrated Healthcare Association, Minnesota Community Measurement, Massachusetts Health Quality Partners, and numerous other collaboratives across the country. Elizabeth Mitchell, President and Chief Executive Officer of NRHI, will discuss NRHI efforts to build a regional innovation infrastructure that can leverage performance measurement to improve health care and increase affordability.
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Elizabeth Mitchell
President and Chief Executive Officer, Network for Regional Healthcare Improvement (NRHI), Portland, ME
Speaker Bio
Elizabeth Mitchell is President and CEO of the Network for Regional Healthcare Improvement, a national network of 30+ Regional Health Improvement Collaboratives. Elizabeth serves on the National Quality Forum Board and Coordinating Committee of NQF's Measure Application Partnership and chaired the Task Force to develop measures for Health Insurance Exchanges.
Elizabeth was CEO of the Maine Health Management Coalition, leading public reporting, consumer engagement, and payment reform efforts and established the MHMC Data and Analytics program, becoming the nation's 4th Qualified Entity. MHMC was named ?Implementation Partner' in Maine's State Innovation Model grant.
Elizabeth served on the National Business Coalition on Health's Board of Directors and chaired their Government Affairs Committee. Elizabeth worked for MaineHealth, Maine's largest integrated health system leading quality improvement and transparency initiatives. She served two terms in the Maine State Legislature, and chaired the Health and Human Services Committee.
Presentation Material (Acrobat)
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10:45 a.m. |
Refreshment Break
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CONCURRENT SESSIONS
(Choose one Concurrent Session from each group.)
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11:00 a.m.
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CONCURRENT SESSIONS - GROUP 2
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Session 2.1: Can We Truly Measure Healthcare Efficiency? Efforts in Linking Cost and Quality
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As a starting place in understanding efficiency and value, NQF has undertaken several cost and resource use measure endorsement efforts. These measure endorsement efforts have raised critical concerns among stakeholders, one of which is the concern of potential unintended consequences of measuring cost in the absence of a quality signal. To provide guidance to key stakeholder groups in accelerating toward a high-performing, high-value healthcare system, the National Quality Forum (NQF) recently began examining the methods for linking cost and quality measures. This session will discuss their efforts and findings.
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Carole Flamm, MD, MPH
Executive Medical Director, Center for Clinical Value, Blue Cross Blue Shield Association, Chicago, IL
Speaker Bio
Carole Redding Flamm is Executive Medical Director for the Office of Clinical Affairs at the Blue Cross and Blue Shield Association (BCBSA), a national federation of 37 independent, locally operated Blue Cross and Blue Shield companies.
Dr. Flamm provides leadership and strategic direction in developing programs to evaluate and improve the quality and value of care experienced by Blue Cross and Blue Shield members, through collaboration with Blue Cross and Blue Shield companies, professional organizations and other key healthcare stakeholders. She directs the Center for Clinical Value and provides clinical leadership for the Blue Distinction® Specialty Care Program, which is a national designation program that recognizes hospitals that demonstrate expertise in delivering quality specialty care.
Previously, Dr. Flamm was Associate Director of BCBSA's Technology Evaluation Center (TEC), which conducts systematic reviews of medical literature and provides leadership in evidence-based decision-making for new medical technologies.
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Andrew (Andy) Ryan, PhD, MA
Associate Professor, University of Michigan; Former Assistant Professor, Weill Cornell Medical College, Ann Arbor, MI
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Ashlie Wilbon, RN, MPH
Managing Director, National Quality Forum, Washington, DC
Speaker Bio
Ashlie Wilbon joined NQF in 2009 and brings over 10 years of experience in healthcare service delivery; including acute care nursing, clinical education, and performance improvement. She earned a Bachelor of Science in Nursing at the University of Michigan and completed a Master of Public Health at Emory University's Rollins School of Public Health; she is currently completing a Master of Science in the University of Maryland's Family Nurse Practitioner program. As Managing Director at NQF, Ms. Wilbon is responsible for the oversight of day-to-day operations of the Quality Measurement Department and has lead NQF's cost and resource use measurement work since 2010.
Presentation Material (Acrobat)
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Session 2.2: Moving from Fee-for-Service to Fee-for-Value: Blue Cross Blue Shield of Michigan's Value Partnership Programs
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This presentation will describe value-based primary care, specialist, and hospital programs at Blue Cross Blue Shield of Michigan, all of which are designed to transition the health care system from a fee-for-service model to an approach that is rooted in what we call "fee-for-value." Using a variety of collaboratively-developed initiatives that span multiple areas of the health care landscape, BCBSM has experienced success in driving payment reform and health care transformation. This includes the largest regional PCMH development and recognition program in the country, with almost 1500 Michigan primary care practices achieving PCMH designation in 2014.
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Jean Malouin, MD, MPH
Medical Director, Value Partnerships, Blue Cross Blue Shield of Michigan, Detroit, MI
Speaker Bio
Dr. Jean Malouin has been a Medical Director with Blue Cross Blue Shield of Michigan since 2012, and works with the Value Partnerships team on the Patient-Centered Medical Home and other BCBSM initiatives. Dr. Malouin is also on the Family Medicine faculty at the University of Michigan. She is currently serving as Medical Director and Co-Project Lead for the Michigan Primary Care Transformation Project, a state-wide multi-payer PMCH demonstration project involving almost 400 Michigan PCMH-designated practices. Dr. Malouin received her medical degree and Master of Public Health degree in Health Management and Policy from the University of Michigan.
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Lisa Rajt, MSW
Manager - PCMH/PDCM Programs, Value Partnerships, Blue Cross Blue Shield of Michigan, Detroit, MI
Speaker Bio
Lisa Rajt* is a Health Care Manager for the Value Partnerships Program at Blue Cross Blue Shield of Michigan. She works on the award-winning Patient Centered Medical Home program, and the expansion of care management to primary care and oncology settings. In addition, Ms. Rajt develops initiatives to improve the quality of care for women. Prior to her work in Value Partnerships, Ms. Rajt worked in the Blues' Social Mission area, where she focused on grant-making and community development. She holds a Masters of Social Work in Community Organizing and a B.A. in Psychology and Communications, both from the University of Michigan.
*Last name is pronounced "right"
Presentation Material (Acrobat)
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Session 2.3: What Behavioral Economics Tells Us about Pay for Performance Design: Lessons from Some Medicaid Health Plans
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The relatively new, growing and interesting field of behavioral economics studies the psychology of economic behavior. This behavior is often predictably at odds with that predicted by traditional economic analysis of individual behavior, which assumes that humans carefully weigh the pros and cons of each decision and consciously work to maximize their personal benefit. This "predictably irrational" behavior helps explain often disappointing results of many studies of the effectiveness of Pay for Performance programs. Understanding and skillfully using the principles of behavioral economics will help healthcare payers and policy makers improve quality and cost outcomes and minimize negative consequences.
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Robert L. Moore, MD, MPH
Chief Medical Officer, Partnership HealthPlan of California, Fairfield, CA
Speaker Bio
Dr. Moore serves as Chief Medical Officer of Partnership HealthPlan of California, a County Organized Health System providing Medi-Cal Managed Care services to 515,000 members in 14 Northern California counties. He is a graduate of the UCSF School of Medicine, the Columbia University School of Public Health, and the Family Medicine residency at Ventura County Medical Center. He has completed post-graduate training in Health Center Management, Health Care Leadership, and Quality Improvement. His professional interests include delivery system transformation, palliative care, intensive outpatient care management, chronic pain, and addressing social determinants of health.
Presentation Material (Acrobat)
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Session 2.4: A Measure of the Quality and Value of Standardized Genomic Testing in an Integrated Health System: A Review From BayCare Health System
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This session will describe a health system's method to standardizing evidenced based genomic testing for breast cancer in order to provide a consistent approach to patient care management. St. Joseph's Hospital which is part of BayCare Health system incorporated a standardized process utilizing an evidenced based genomic test for breast cancer which led to improvements in quality measurements for patients care and fulfilled quality improvement requirements for accreditation of their breast center.
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Claudia Lago Toro, MD
Medical Director, Shimberg Breast Center, St. Joseph's Women's Hospital, BayCare Health System, Tampa, FL
Speaker Bio
Dr. Claudia Lago Toro is board certified in general surgery. As a breast surgical oncologist, her commitment to improving health in her community included establishing a comprehensive breast care program in Vineland, New Jersey, and overseeing her hospital's tumor board and cancer committee. Dr. Lago Toro treats male and female breast cancer patients, as well as benign breast disease. She has extensive experience in minimally invasive breast biopsies, mastectomies with reconstruction and the administration of breast brachytherapy for radiation therapy.
Dr. Lago Toro served as a resident clinical educator at Tufts University in Boston, Massachusetts. She is a member of the American Society of Breast Surgeons, Society of Surgical Oncology and American Society of Clinical Oncology. Dr. Lago Toro is fluent in Spanish.
Medical Education
Doctor of Medicine - University of Puerto Rico; San Juan, Puerto Rico
Graduate Medical Education
Surgical Residency - Baystate Medical Center; Springfield, Massachusetts
Breast Surgical Oncology Fellowship - Bryn Mawr Hospital; Bryn Mawr, Pennsylvania
Clinical Interests
Patient education
Breast cancer awareness
Presentation Material (Acrobat)
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12:00 p.m.
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National P4P Summit Adjourns
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