Agenda: Pay for Performance Summit: Preconferences
Monday, March 2, 2015
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8:00 a.m. |
Registration
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9:00 a.m. |
Preconference Sessions
(Choose one Preconference only)
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Pre-Conference I: Redesigning Plan Member Benefits to Optimize Consumer and Provider Incentives
Sponsored by the Health Care Incentives Improvement Institute (HCI3)
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Moving to value-based payment and price/quality transparency needs to be complemented with a similar rethinking of healthcare benefits. This session will consider new ideas for linking payment reform, transparency and benefits remodeling to transform the behaviors of both patients and providers, as well as some of the technology changes needed to enable such a system to work.
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9:00 a.m. |
Welcome and Introductions
Doug Emery
Program Implementation Leader, Western Region, Health Care Incentives Improvement Institute, Logan, UT
Speaker Bio
Doug Emery has been working in healthcare reform policy for nearly 25 years. Beginning in 1991, at the Institute of Political Economy, he and other colleagues began to work out a new microeconomic model for healthcare economics and episode of care purchasing. Since then, Mr. Emery has worked in the public sector (Public Employees Health Program of Utah), non-profit sector (eHealth Initiative) and the private sector as an executive and consultant (Oxford Health Plans, HealthSouth, HealthMarket, Medstat, Definity Health, etc.) He served as the Principal Investigator for the HRSA/OAT Connecting Communities for Better Health Cooperative Agreement, completed in May, 2007. Mr. Emery has published many articles and two books on moving towards episode of care, or Evidence-informed Case Rate purchasing. Currently, he serves as Program Implementation Leader, Western Region for HCI3 (Prometheus Payment and Bridges to Excellence). He is also Adjunct Professor, Jon Huntsman School of Business and Economics, Utah State University. From 1990 to 1998, Mr. Emery served in the Army National Guard in Fire Direction Control for self-propelled 8-inch howitzer battalions.
Presentation Material (Acrobat)
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Emma Hoo
Director, Pacific Business Group on Health, San Francisco, CA
Speaker Bio
Emma focuses on care redesign and payment reform initiatives, including implementation of an Intensive Outpatient Care Program for high-risk people, contracting principles and standardized measures for Accountable Care Organizations, community health and wellness initiatives, the Private Exchange Evaluation Collaborative and the administration of a group-based retiree exchange program. She has managed value purchasing initiatives including health plan and disease management vendor assessments, quality performance metric negotiations and group HMO and PBM purchasing programs on behalf of PBGH members. Other work includes adaptation of the eValue8 Health Plan Request for Information for Covered California QHP assessment, administration of performance standards and guarantees. She has implemented risk assessment and risk adjustment processes in managing a group purchasing collaborative for commercial and Medicare HMO plans, as well as PacAdvantage, a small group purchasing pool previously operated by PBGH. She has authored papers on consumer-directed health plans, ACOs and quality reporting requirements for health insurance exchanges. She received her AB from Harvard University.
Presentation Material (Acrobat)
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Adam C. Solander
Partner, Epstein Becker and Green, Washington, DC
Speaker Bio
Adam Solander, a member of the Health Care and Life Sciences practice, is based in Epstein Becker Green?s Washington, D.C., office. Solander concentrates his practice in reimbursement, regulatory, and compliance matters affecting health care manufacturers, service providers, and investors in health care organizations. He also advises health care clients on issues concerning ERISA preemption, obligations of plan fiduciaries and breach of fiduciary duties, prohibited transactions, and denial of benefits. Solander is a Certified CSF Practitioner, a designation given by the Health Information Trust Alliance (HITRUST), an organization that provides training to develop and maintain effective security programs for health care and life sciences companies that comply with security laws, regulations, and standards, including HITECH, HIPAA, PCI, JCAHO, CMS, ISO, NIST, and various other federal, state, and business requirements.
Presentation Material (Acrobat)
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12:00 p.m. |
Pre-Conference Sessions Adjourn (Lunch on Own)
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Pre-Conference II: Achieving Value: Evidence from Public and Private Payment Programs
Sponsored by the Agency for Healthcare Research and Quality (AHRQ)
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Taxpayers, policymakers, and employers are demanding that healthcare providers control costs while improving quality and access. State Medicaid programs, the Centers for Medicare and Medicaid Services (CMS), and private payers have implemented a wide variety of payment policies and benefit designs to incentivize quality improvement, penalize safety failures, and encourage affordable, efficient, evidence-based care. What does recent research tell us about the conditions for success in such programs? What unintended consequences should payers and policymakers watch out for? How do these state and national programs complement or conflict with one another? Leading health services researchers will present their latest findings and discuss how payment programs might draw on evidence as they work to improve value through payment strategies.
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9:00 a.m. |
Welcome and Introductions
Naomi Bardach, PhD
Assistant Professor, UCSF School of Medicine, San Francisco, CA
Speaker Bio
Naomi S. Bardach is an Assistant Professor of Pediatrics and Health Policy at the University of California San Francisco and the Philip R. Lee Institute for Health Policy Studies. Dr. Bardach's research interests include quality measurement and the use of the measures in interventions such as public reporting and financial incentive programs, to drive better health outcomes and reduce disparities in care.
Presentation Material (Acrobat)
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Tamara Konetzka, PhD
Associate Professor, University of Chicago, Chicago, IL
Speaker Bio
Dr. Konetzka is Associate Professor at The University of Chicago, Department of Public Health Sciences. She conducts research in health economics, aging and long-term care, and Medicare and Medicaid policy, focusing on the relationship between economic incentives and quality of care. Her research combines rigorous methodological training with extensive institutional knowledge of long-term care providers and policies acquired through previous experience in the industry. Prior to her current position, Dr. Konetzka completed a PhD in health economics at the University of North Carolina at Chapel Hill and a post-doctoral fellowship at The University of Pennsylvania and the Philadelphia VA.
Presentation Material (Acrobat)
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Andrew (Andy) Ryan, PhD, MA
Associate Professor, University of Michigan; Former Assistant Professor, Weill Cornell Medical College, Ann Arbor, MI
Presentation Material (Acrobat)
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Brent Sandmeyer, MPH
Social Science Analyst, Agency for Healthcare Research and Quality, Rockville, MD
Speaker Bio
Brent Sandmeyer, MPH is the extramural research grants lead for the Center for Delivery, Organization and Markets at the federal Agency for Healthcare Research and Quality (AHRQ). Sandmeyer oversees a broad portfolio of health services research aimed at improving care quality, increasing transparency, and making care more affordable. Sandmeyer received his Master of Public Health in Management and Policy from Portland State University, and his BA in Psychology from New York University.
Presentation Material (Acrobat)
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12:00 p.m. |
Pre-Conference Sessions Adjourn (Lunch on Own)
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Agenda: Pay for Performance Summit: Day I
Monday, March 2, 2015
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PAY FOR PERFORMANCE OPENING PLENARY SESSION
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1:00 p.m.
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Welcome and Opening Remarks
David Joyner, MBA
Chief Operating Officer, Hill Physicians Medical Group; Chair, Integrated Healthcare Association, San Ramon, CA
Speaker Bio
As COO, David is the senior executive over contracting, administration, physician network management and medical services. Prior to joining PriMed and Hill Physicians, David served for fourteen years as an executive of Blue Shield of California, a not-for-profit health with more than 3 million members. His most recent position was senior vice president large group and specialty benefits where he oversaw $2 billion in revenues for the large group employer, specialty benefits and stop loss insurance markets. His career also has included serving as president of Vivra Women's Health, a physician network and practice management company, and as a consultant for Bain & Company, a global strategy consulting firm.
David grew up in England and received his MA in chemistry from the University of Oxford and his MBA from The Wharton School at the University of Pennsylvania.
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1:10 p.m.
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Are we there yet? Tales from the field
Jill Yegian, PhD
Interim Chief Executive Officer and Senior Vice President, Programs and Policy, Integrated Healthcare Association, Oakland, CA
Speaker Bio
Jill Yegian, Ph.D. serves as Interim CEO and Senior Vice President for Programs and Policy at the Integrated Healthcare Association, a multi-stakeholder leadership group focused on improving the quality, affordability, and transparency of health care in California through performance measurement and payment innovation. Prior to joining IHA, she co-directed the American Institutes for Research's Health Policy and Research Group, a team of over 70 health services research professionals. At AIR, she led work related to cost and quality information, health insurance exchanges, and implementation of payment reform. Prior to joining AIR, Dr. Yegian spent 13 years with the California HealthCare Foundation, where she worked to improve the State's financing and delivery systems for health care. At CHCF, she led the foundation's efforts to increase coverage among California's uninsured, and served as its first director of research and evaluation.
Dr. Yegian has published widely in peer-reviewed journals, authored a book, and presents to research, policy, and industry audiences regularly. She received a bachelor's degree in human biology from Stanford University and a Ph.D. in health services and policy analysis from the University of California at Berkeley.
Presentation Material (Acrobat)
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1:30 p.m. |
Paying for Value -- What the Future Holds
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Moving away from fee-for-service to value-based payment has become a consistent bipartisan call to action in both the public and private sectors of U.S. healthcare. Realizing the full potential of this movement requires far-reaching operational and policy changes. To succeed, value-based payments must integrate the needs and motivations of consumers, purchasers, physicians and payers and overcome embedded business practices and organizational structures that exist in our current delivery and insurance systems. No small task, but a topic this panel of nationally recognized leaders is well equipped to address, exploring key elements of this challenge and offering perspectives on how this movement will unfold over the next decade.
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Francois de Brantes, MBA
Executive Director, Health Care Incentives Improvement Institute, Newtown, CT
Speaker Bio
Francois de Brantes is the Executive Director for the Health Care Incentives Improvement Institute, which is a not-for-profit company that designs and implements innovative payment and plan design programs to motivate physicians, hospitals and consumer-patients to improve the quality and affordability of care. Previously, Mr. de Brantes was the Program Leader for various healthcare initiatives at GE Corporate Health Care Programs, responsible for developing the conceptual framework and the implementation of GE's Active Consumer strategy. Mr. de Brantes attended the University of Paris IX - Dauphine where he earned a MS in Economics and Finance, and he attended the Tuck School of Business Administration at Dartmouth College, where he graduated with an MBA.
Mr. de Brantes has been published in peer-reviewed journals such as the New England Journal of Medicine and Health Affairs and is frequently quoted in national media including the New York Times. He has also published two books, the latest being The Incentive Cure: The Real Relief For Health Care.
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Richard Kronick, PhD
Director, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD
Speaker Bio
On August 19, 2013, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced Dr. Richard Kronick as the new director of the Agency for Healthcare Research and Quality (AHRQ).
Dr. Kronick joined the Department in January 2010 as Deputy Assistant Secretary for Planning and Evaluation, overseeing the Office of Health Policy. In that role, he conducted and coordinated research on policies relating to public health; health care delivery; health insurance; and health care financing programs, including Medicare, Medicaid, State Children's Health Insurance Program, and private insurance coverage. His work, and that of the Office of Health Policy under his leadership, was integral to the implementation of the Affordable Care Act. Additionally, his team provided insight and information critical to the effort to improve the health of the Nation.
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Peggy O'Kane
President, National Committee for Quality Assurance, Washington, DC
Speaker Bio
Margaret E. O'Kane is the founding and current president of NCQA.
She was elected a member of the Institute of Medicine in 1999 and received the 2009 Picker Institute Individual Award for Excellence in the Advancement of Patient-Centered Care. Modern Healthcare magazine has named O'Kane one of the "100 Most Influential People in Healthcare" nine times, most recently in 2014, and one of the "Top 25 Women in Healthcare" three times. She received the 2012 Gail L. Warden Leadership Excellence Award from the National Center for Healthcare Leadership.
She is a board member of the Milbank Memorial Fund, American Board of Medical Specialties and Chairman of the Board of Healthwise, a nonprofit organization that helps people make better health decisions.
O'Kane holds a master's degree in health administration and planning from Johns Hopkins University, and is a recipient of that university's Distinguished Alumnus Award.
Follow @PeggyNCQA
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Daniel Wolfson, MHSA
Executive Vice President and Chief Operating Officer, ABIM Foundation, Philadelphia, PA
Speaker Bio
Mr. Wolfson is Executive Vice President and COO of the ABIM Foundation, a not-for-profit foundation focused on advancing medical professionalism and physician leadership to improve the health care system. Mr. Wolfson has been instrumental in leading the Choosing Wisely® campaign ( www.choosingwisely.org), a multi-year effort engaging more than 60 medical specialty societies to promote conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may be unnecessary and could cause harm.
Previously, Mr. Wolfson served for nearly two decades as the founding president and CEO of the Alliance of Community Health Plans (formerly The HMO Group), the nation's leading association of not-for-profit and provider-sponsored health plans. During his tenure, Mr. Wolfson earned national recognition for spearheading the development of the Health Plan Employer Data and Information Set (HEDIS™).
Before serving at the Alliance of Community Health Plans, Mr. Wolfson was the Director of Planning and Research at the Fallon Community Health Plan. During that time, he led the product development team that launched the nation's first Medicare risk contract with the Health Care Financing Administration.
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Tom Williams, DrPH
Vice President and General Manager, Accountable Care Operations and Strategy, Stanford Health Care; Former President and Chief Executive Officer, Integrated Healthcare Association, Oakland, CA (Moderator)
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2:45 p.m. |
Reinventing Primary Care: An Approach to Fixing Health Care Nationally
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From its origins in San Francisco, One Medical Group has evolved into a fast-growing organization with offices across the country and modern technology systems supported by investment from Silicon Valley's premier firms. Tom X. Lee, MD, Founder and Chief Executive Officer of One Medical Group, will discuss his experience and challenges in building a patient-centered care model focused on quality, service, and affordability.
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Tom X. Lee, MD
Founder and Chief Executive Officer, One Medical Group, San Francisco, CA
Speaker Bio
Tom is the chief executive and visionary behind One Medical Group ? a rapidly growing model of primary care that integrates innovative design with leading technology to deliver higher quality care and service, while also lowering the total cost of health care.
Prior to One Medical, Tom served as Chief Medical Officer, Editor-in-Chief, and lead designer of mobile applications for Epocrates -- currently in use by millions of health care professionals worldwide to reduce medication errors.
Tom is a board-certified internist who completed training at Harvard's Brigham and Women's Hospital. He received his BS from Yale University, MD from the University of Washington School of Medicine, and MBA from Stanford University's Graduate School of Business.
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3:30 p.m. |
Refreshment Break in the Exhibit Hall
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MINI SUMMITS
(Choose one Mini Summit only)
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Mini-Summit I: State Health Insurance Exchanges and CO-OP Plans: Performance Measurement and Value-Based Payment
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4:00 p.m.
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Health insurance exchanges (also known as marketplaces) created by the Affordable Care Act have enrolled millions of Americans since October 2013 and are changing the landscape of the health insurance market across the country. Consumer Operated and Oriented Plans (CO-OPs) are now operating in two dozen states, supported by an ACA loan program providing seed funding for the establishment of these new cooperative insurance companies. Both exchanges and CO-OPs provide an opportunity for innovative approaches to performance measurement and value-based payment. Representatives from state-based exchanges and CO-OPs will outline their current activities and future direction in a session moderated by the former head of the Center for Consumer Information and Insurance Oversight, the regulatory agencies with responsibility for both programs.
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Gary Cohen
Owner and Principal, Gary M. Cohen Consulting; Former Director, Center for Consumer Information and Insurance Oversight, Department of Health and Human Services, San Francisco, CA
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Nicole Comeaux, JD, MPH
Deputy Executive Director, Office of the Kentucky Health Benefit Exchange (kynect), Lexington, KY
Speaker Bio
Nicole Comeaux is the Deputy Executive Director of kynect, Kentucky's Health Benefit Exchange. Prior to joining kynect, in 2014, Nicole served as the Acting Deputy Director for the State Operations Group in CMS's Center for Consumer Information and Insurance Oversight (CCIIO). Also at CCIIO, from 2012-2014, she served as a Health Insurance Specialist, managing the federal oversight of the establishment of State-based Health Insurance Marketplaces in California, Kentucky and New Mexico. From 2010-2012, she served as a Health Policy Analyst in the Federal Office of Rural Health Policy within the US DHHS conducting analysis and revision of ACA regulations that impacted HRSA safety net providers and populations. Nicole earned her J.D. with a certificate in Health Law from Saint Louis University School of Law, and her M.P.H. in Health Policy from Saint Louis University School of Public Health. She received her B.A. in Psychology from the University of San Diego.
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Mark Epstein MD, MBA
Chief Medical Officer, New Mexico Health Connections, Albuquerque, NM
Speaker Bio
Mark Epstein M.D., M.B.A., as Chief Medical Officer of New Mexico Health Connections, leads its Medical Management Division. In addition to implementing traditional health plan Medical Management programs, he and his team have designed and deployed innovative strategies to support highly coordinated care activities.
In prior roles, Dr. Epstein has served as Medical Director of Medical Specialties, Emergency Departments, and Inpatient Services, driving clinical integration, team-based care models, and provider alignment strategies.
Dr. Epstein is an Emergency Physician who earned a BA from Stanford University, an MD from Yale University School of Medicine, and an MBA from the University of Tennessee.
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Kevin Lewis
Chief Executive Officer, Maine Community Health Options, Lewiston, ME
Speaker Bio
Kevin Lewis is co-founder and CEO of Maine Community Health Options (MCHO), a new non-profit Consumer Operated and Oriented Plan that offers a range of qualified health plans both on and off the Health Insurance Marketplace for individuals, families and businesses in Maine and New Hampshire. Prior to starting MCHO, Kevin was the CEO of the Maine Primary Care Association. Kevin came to Maine from Wisconsin where he was the legislative liaison for the state?s Department of Health and Family Services. Kevin graduated cum laude from Dartmouth College, and holds a Master's in Public Policy from the University of Michigan.
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Anne Price
Director, Plan Management Division, Covered California, Sacramento, CA
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5:30 p.m.
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Day 1 Adjourns followed by Opening Networking Reception
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Mini-Summit II: Updates from CMS and the Private Sector on Value Based Purchasing
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4:00 p.m.
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Health care delivery is moving toward value-based care. The transformation will succeed, in part, based on CMS' ability to measure quality, align payment incentives with desired outcomes and across providers, and incent quality improvement. Recent efforts have resulted in significant savings and transparency. However, success will also depend on technology investment and innovations that help payers and providers scale their VBR initiatives and manage the complexity of mixed- and value-based reimbursement models. This session will explore current activities and plans for the future, and share how through collaboration, efficiencies are being achieved in both quality and cost. The speakers will also share strategies to support administrative and operational change.
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David Nace, MD
Vice President and Medical Director, McKesson Corporation/Relay Health; Chairman, Patient-Centered Primary Care Collaborative (PCPCC), Malvern, PA
Speaker Bio
David Nace serves as Vice President of Clinical Development for the McKesson Corporation. Prior to his current role, Nace served as Senior Vice President and Corporate Medical Director with United Health Group, Vice President and Chief Medical Officer with the Aetna Corporation , and founding principal of Health Strategy Solutions, LLC. He has also held medical directorships in a variety of academic and community based health care organizations, as well as a privately owned EAP company.
Nace has been involved in health care and health care financing strategies in the US since the early 1990s, and is a nationally recognized speaker on topics ranging from healthcare technology, healthcare reform, and the patient centered medical home.
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David Saÿen
Regional Administrator - Region IX, Centers for Medicare and Medicaid Services (CMS), San Francisco, CA
Speaker Bio
David Saÿen (pronounced "SIGN") is the Regional Administrator at the Centers for Medicare & Medicaid Services' San Francisco office. David's team is focused on external and intergovernmental affairs for the San Francisco region that serves over 14 million Medicare, Medicaid, Marketplace, and Children's Health Insurance Program beneficiaries. He brings more than 30 years of Federal experience in health and human services programs to the position. His experience at HHS includes work in Medicare health plan operations, financial management, program integrity, information technology, and public affairs. He earned his MBA in Health Administration from Temple University in Philadelphia.
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5:30 p.m.
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Day 1 Adjourns followed by Opening Networking Reception
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Mini-Summit III: IHA's Value Based Pay for Performance Program
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4:00 p.m. |
The Integrated Healthcare Association has been working with health plans and physician organizations on a California statewide pay for performance (P4P) initiative for over a decade. In 2013, P4P began transitioning to Value Based Pay for Performance -- shifting from a quality-based to a value-based incentive program that incorporates performance "gates" for quality and total cost of care. Blue Shield of California was the first health plan to fully adopt VBP4P, an incentive design featuring shared savings between health plans and physician organizations based on performance on appropriate resource use measures, adjusted for quality; three additional health plans are adopting VBP4P in 2014. This session will provide an overview of the program design, and a report from the plans and providers on the leading edge of shifting from volume to value.
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Lindsay Erickson, MSPH
Manager, Value Based P4P Program, Integrated Healthcare Association, Oakland, CA
Speaker Bio
Lindsay Erickson is a Senior Project Analyst at the IHA. Her work focuses on resource use measures and Value Based P4P incentive design. Prior to joining the Integrated Healthcare Association, she worked at the Governor's Office of Planning and Budget for the State of Georgia, where she developed and evaluated budget and policy recommendations for Medicaid and the Children's Health Insurance Program. Lindsay earned a Master of Science in Public Health with a concentration on health policy and services research from Emory University and a Bachelor of Science from the University of California, San Diego.
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Brian Jeffrey
Regional President, Network Management, UnitedHealthcare, Santa Ana, CA
Speaker Bio
Brian Jeffrey is Senior Vice President for Network Management for UnitedHealthcare Networks. In this role Brian oversees reimbursement modernization and network technology initiatives for UnitedHealthcare. Brian has served in a number of roles at United, including Regional President for Network Management and Senior Vice President for Medicare Network Strategy.
Brian has extensive experience in health care financing in both the public and private sectors. He served as a Peace Corps Volunteer in the Sultanate of Oman.
Brian received his bachelor's degree from Tufts University and his master's degree in Health Policy and Management from Harvard University.
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David Joyner, MBA
Chief Operating Officer, Hill Physicians Medical Group; Chair, Integrated Healthcare Association, San Ramon, CA
Speaker Bio
As COO, David is the senior executive over contracting, administration, physician network management and medical services. Prior to joining PriMed and Hill Physicians, David served for fourteen years as an executive of Blue Shield of California, a not-for-profit health with more than 3 million members. His most recent position was senior vice president large group and specialty benefits where he oversaw $2 billion in revenues for the large group employer, specialty benefits and stop loss insurance markets. His career also has included serving as president of Vivra Women's Health, a physician network and practice management company, and as a consultant for Bain & Company, a global strategy consulting firm.
David grew up in England and received his MA in chemistry from the University of Oxford and his MBA from The Wharton School at the University of Pennsylvania.
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Neil Solomon, MD, FACP
Vice President for Quality and Care System Transformation, Blue Shield of California, San Francisco, CA
Speaker Bio
Dr. Neil Solomon joined Blue Shield of California as the Vice President for Quality and Care System Transformation in April 2013. In that role he is responsible for designing and implementing the clinical quality strategy for the membership. His work in quality spans BSC's industry leading Accountable Care Organizations, specialty care transformation, and the use of health information technology to enable improvements in care. Under his direction, the Quality Department also evaluates and rewards performance among Blue Shield's provider community, introduces programs to improve clinical outcomes and member experience, and reports these findings to customers and regulators.
Presentation Material (Acrobat)
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5:30 p.m.
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Day 1 Adjourns followed by Opening Networking Reception
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Go to Agenda:
Day 2 | Day 3
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