Clinical Excellence Value Visit Evaluating the success of today s population health and payment strategies taking care delivery to the next level
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1 Clinical Excellence Value Visit Evaluating the success of today s population health and payment strategies taking care delivery to the next level November 3 6, 2015 Hotel Orlando Lake Buena Vista 1751 Hotel Plaza Boulevard AGENDA Hosted by: AvMed & Health First Health Plans AGENDA Tuesday, November 3, :30 8:00 Breakfast Crystal Room Sponsored by: Gorman Health Group 8:00 9:00 Welcome & Introductions North Ballroom Sara Neese, RN Health Plan Alliance 9:00 10:00 Connecting Communities: The Next Population Health Lever Deryk Van Brunt, DPh President & Chairman Healthy Communities Institute 10:00 10:15 Break Refreshment Breaks Sponsored By 10:15 11:00 NCQA Accreditation Update for 2016 What s new with health plan accreditation requirements for 2016 How are the Medicare and marketplace/exchange requirements for quality metrics aligning with NCQA standards? An overview of the transition from rankings to ratings for health plans. Frank Micciche VP, Public Policy & Communications NCQA 1
2 11:00 12:00 The Continued Evolution of Quality Measurement: Star Ratings and QRS Update 2016 Star Ratings updates 2016 QRS updates Alignment of Quality measurement programs Optimizing provider engagement amidst multiple Quality measurement systems Melissa Smith Senior Consultant Gorman Health Group 12:00 1:00 Lunch Crystal Room Sponsored by: Pharmaceutical Strategies Group LLC 1:00 2:00 Specialty Drugs & Biosimilars Trends & Spend Management Strategies Vanita Pindolia, PharmD VP, Ambulatory Clinical Pharmacy Program Henry Ford Health System/Health Alliance Plan 2:00 2:45 AvMed Case Study: Don t Let Your PBM Hold You Hostage PBM Market Dynamics Overview of AvMed PBM Procurement Steps Lessons Learned Shawn Barger, PharmD Director of Pharmacy AvMed Melissa Kuznik, PharmD Vice President and National Practice Leader, Managed Care, PSG 2:45-3:00 Break Refreshment Breaks Sponsored By 3:00 4:00 The Devil is in the Details-PBM Oversight Review the strategy and the framework for oversight of the delegated functions your PBM conducts on your behalf. Gain the knowledge needed to be able to conceptualize and understand a government programs compliant PBM oversight and monitoring program including: o PBM RFPs o Tips for PBM contracting o Framework for delegation oversight and monitoring o Best practices Debra Devereaux Senior Vice President Gorman Health Group 2
3 4:00 5:00 Health First Health Plan Case Study: The Embedded Pharmacist Program - How Managed Care Pharmacists Play an Important Role in Primary Care Define the role of the Managed Care Pharmacist Identify the timeline and potential barriers with implementation of the Embedded Pharmacist Program Evaluate the potential cost savings and increase in quality measures that are associated with implementation of the program Dr. Nancy Youssef, PharmD CPh Clinical Manager Pharmaceutical Services Health First Health Plans 6:00 pm Dinner at Bongos Cuban Café Disney Springs Sponsored by: Exact Sciences 3
4 AGENDA Wednesday, November 4, :00 8:30 Breakfast Crystal Room Sponsored by: Health Integrated 8:30 10:00 Connecting the Dots Bridging the Gap in Care Management to Drive Outcomes and Plan Financial Performance Dr. Sam Toney and Jane Scott of Health Integrated will discuss psych-social determinants and how these relate to managing your most difficult patient populations. Discussion points include: Identifying medical and psychological issues and their ties to health care outcomes, avoidable utilization, cost containment and revenue optimization; Suggested practices for care gap identification; and plan data mining opportunities. 10:00 10:30 Roundtable Discussion Plans share information about their behavioral health integration strategies and initiatives Sam Toney, MD Chief Medical Officer and Jane Scott, Sr. VP of Professional Services Health Integrated Roundtable Discussion 10:30 10:45 Break Refreshment Breaks Sponsored By 10:45 12:00 Reducing Readmission Rates in Collaboration with your IDN. Health First Health Plans has reduced their Medicare Advantage Readmission rate from an average of 15.2% in 2013 to less than 9%. HFHP leveraged a tool that was in place at the acute hospitals to integrate hospital and health plan data to automate risk stratification and alerts. In April of 2015, they were recognized by the Intelligent Health Association for the Most Innovative Use of Business Intelligence. Jennifer Brady, MD Chief Medical Officer Health First Health Plans 12:00 1:00 Lunch Crystal Room SPH Analytics 4
5 1:00 2:00 Health First Health Plan Case Study: Comprehensive Health Assessment Program 2:00 3:00 Resource Stewardship Tools with Population Management- the Model of Care. Review the tools to use for appropriate resource stewardship Discuss the importance of population health management, Share CHPW s proposed use of model of care to drive quality and resource improvements from a health plan perspective. Michelle Peake, Health First Health Plans Lindsey Schram, Health First Health Plans Victor Collymore, MD, CMO Jane Daughenbaugh, Director Delegated Healthcare Services David DiGiuseppe, Director of Program Development Medical Management Community Health Plan of Washington 3:00 3:15 Break Refreshment Breaks Sponsored By 3:15 4:30 Health New England Case Study: OB Bundled Payment Development Laurie Gianturco, MD Chief Medical Officer & Julie Bodde Director of Healthcare Informatics Health New England 6:00 Dinner on Your Own 5
6 AGENDA Thursday, November 5, :00 8:30 Breakfast North Ballroom 8:30 9:30 Home-Based Palliative Care: A Strategy for Caring for Your Sickest Patients What is home-based palliative care? What are the benefits of a home-based palliative care program? What is the ROI you can achieve from a homebased palliative care program? What are the key choices you have to make in standing up a home-based palliative care program? 9:30 10:30 Powering Person-Centric Care Through Digital Transformation As the health care industry shifts from FFS to Value Based Reimbursement models, healthcare organizations are looking for innovative ways to improve the care coordination and member/patient experience using multi-channel solutions and social, mobile and biometric devices. Two relevant digital solutions will be shared: How digital health is transforming how patients and providers interact with the healthcare system by enabling them to proactively connect through a multi-channel platform to improve discharge, monitor chronic conditions, streamline and improve PCP care, and improve the satisfaction of all care stakeholders. How personalized mobile interaction and interfaces with biometric devices can integrate with population health programs to transform the care and outreach paradigm. Brad Smith Chief Executive Officer Jonathan Ringo, MD,FACOG Chief Medical Information Officer LifeBridge Health Oliver Lignell, PMP,ARM Director, Healthcare Business Consulting Cognizant 10:30 10:45 Break Refreshment Breaks Sponsored By 10:45 12:00 Sentara Health Plan Case Study: Global Budgets, Population Health, Health Plan Analytics and the New World of Provider-Plan Collaboration Describe the key goals and objectives of the alternative payment models that Optima Health is Tom Lundquist, MD Chief Medical Officer Sentara Health Plans 6
7 bringing to the marketplaces they serve and the clinically integrated network partnerships they are engaged in, including Sentara Quality Care Network (SQCN) Discuss the significant investment in analytics that is necessary for successful provider-plan collaboration to ensure that these new innovative payment models succeed to all parties satisfaction Share early results of these partnership discussions, include quality and cost efficiency outcomes as they begin to reveal themselves. 12:00 1:00 Lunch North Ballroom 1:00 2:00 Johns Hopkins Case Study: Collaborative Approaches to Provider Engagement 2:00 3:00 AvMed Case Study: Aligned Provider Strategy Daniel J. Durand, MD Director of Accountable Care, Johns Hopkins HealthCare LLC. & Assistant Professor of Radiology, Adjunct Faculty, The Johns Hopkins University School of Medicine Ann Wehr, MD Chief Medical Officer AvMed 3:00 3:15 Break Refreshment Breaks Sponsored By 3:15 4:30 Care Management/Population Health Systems Industry Update Population Health What is Population Health and why it is important? How do I deliver solutions/capabilities to support my Population Health strategies? Population Health Vendor Market Overview What other Health Plans are implementing Discussion: Logical approach to building these capabilities and what the critical success factors might be for a successful strategy? Bob Hoover, Consulting Director & Felizitas Devine, Senior Manager of Clinical Consulting Services HTMS 6:00 Dinner at Morimoto Asia Disney Springs Sponsored by: Oleen Pinnacle Healthcare Consulting 7
8 AGENDA Friday, November 6, :00 8:30 Breakfast North Ballroom 8:30 11:00 Peer Group Roundtable Discussions You won t want to miss this networking opportunity to participate with your peer group and informally share your best practices and challenges. Topics of interest will be discussed in roundtable format and topics determined based on peer group input during the meeting! 11:00 11:30 Wrap Up 8
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