Senior Health Insurance Executives Responsible for:

Senior Hospital and Healthcare Executives Responsible for:

This program is also geared towards vendors, consultants, solution providers, law firms and Third Party Administrators offering services or tools to assist those in the healthcare industry with the network contracting process.

Network Contracting Innovations – Care Management Strategies to Support Improved Performance

This session will review current network contracting strategies including formation of ACOs and discuss the implications for care management strategies. The session will also include discussion of analytic strategies, program design, delegation and management activities designed to improve performance in new network arrangements.

Examples will be provided of new care management program designs and features as well as opportunities for enhancing existing programs. 

About the Workshop Leaders:
Patricia Jones, RN, MBA is Healthcare Management Consultant at Milliman. Patty specializes in analysis, strategy development, and designing and improving management, operations, and performance for healthcare management operations. She has more than 20 years of experience in delivery system and health insurance operations and has worked extensively with healthcare organizations involved in commercial, Medicare/Medicaid, and other government programs. This experience includes care management programs, network contracting and reimbursement, health and wellness programs, and information strategies.

Patty has led the process of analyzing data to determine care management opportunities and priorities, conducted assessments of operations and work processes, overseen the selection and implementation of information and analytical tools, and designed reporting and evaluation mechanisms. In addition to specific expertise in medical management and provider network contracting and management, she has extensive experience with data, decision support systems, performance benchmarking, and analytical tools. Patty has assisted clients in developing new and improving existing utilization management, case management, and quality and disease management programs. She has experience designing, implementing, and evaluating medical home and accountable care models.

David Mirkin, MD is a Principal & Healthcare Management Consultant at Milliman. He is also the Medical Director for Milliman's MedInsight data-warehousing and decision-support analytic tool system. David has 30 years experience in medical management. He serves as a senior consultant assisting clients in a variety of areas, including utilization management, provider profiling, disease management, length-of-stay management for hospitals, return-on-investment evaluations for disease management and wellness programs, and clinical data analysis. David has significant international experience consulting to clients in the U.K., Europe, South America, Middle East and Asia. Prior to joining Milliman, he was corporate medical director and senior medical director for Medicare risk at FHP International.

WORKSHOP SESSION B:
Tuesday, February 28, 2012 • 12:45 p.m. – 2:45 p.m.

Increasing Network Productivity and Quality by Aligning Measurements and Behavior

The care provided by physicians and hospitals should be efficient and effective. Physicians and hospitals “behave” in certain ways as they provide their care and services to the patient clients of health plans. It is critical that health plans and reviewers develop and promote systems and processes for “measuring” and “guiding” care that compliment (or are consistent with) the actual processes of effectively providing the care. In our zeal to be able to measure and guide the physician’s efficiency and effectiveness of providing care, we may develop measurement systems or incentives that unnecessarily create “tension” between the actual physician process of evaluating a patient and the admission or quality “measurement” process. That tension often translates into physician and hospital “non-compliance”, and the loss of intended cost savings. 

This workshop will explore:
• How we currently measure (and “incentivize”) physician and hospital behavior
• How physicians and hospitals currently “behave” in the provision of care to health plan patients
• How the systems and programs presented at this conference might be helpful to measure and incentivize physicians and hospitals
• How to increase physician and hospital compliance with measurement and incentive programs aimed at improving utilization and quality

About the Workshop Leader:
Edward M. “Mickey” Duke is the Chief Executive Officer of Oasis Health System in Las Vegas, Nevada, a multi-hospital alliance in southern Nevada that he created in 1995, which includes 8 acute care hospitals, plus sub-acute providers. That alliance has successfully operated a physician Management Services Organization, and has partnered with an IPA as a contracted “full risk” provider to United/PacifiCare of Nevada, managing the care of 52,000 Nevada lives. Using extensive “game theory” strategies, he was able to increase the net-revenue-per-inpatient-day of the Las Vegas multi-hospital system by 85% over a seven year period.

Mickey is also the President of E.M. Duke & Associates, LLC, through which he has helped hospitals negotiate managed care contracts with payers (including HMOs, PPOs, governmental third party payers, and self-funded / self-insured payers). Client engagements have ranged from the 6-hospital Health Alliance of Greater Cincinnati, to Baptist Health Systems’ multi-hospital facilities, to UCLA’s Resnick Neuropsychiatric Hospital, to small/ rural Critical Access Hospitals.

Day One – Monday, February 27, 2012

Venue:

Encore at Wynn
3131 Las Vegas Boulevard South
Las Vegas, NV 89109
Toll Free: (866) 770-7555

*Mention Priority Code '6CON0212' to get the discounted rate of $159/night.

Platinum Sponsor

HEOPS Inc. provides patient access solutions to public sector health plans, state agencies, commercial insurers, self insured employers and patients through the strategic design and creation of provider networks, call centers, competitive intelligence, data analytics and transportation solutions. HEOPS is the most robust full source patient access partner in the nation, providing turnkey support services such as custom mailing, email communication, contract administration, provider networks, call centers, data analytics, complex mapping and disruption analysis. Clients look to HEOPS for inspired concepts and performance excellence when stakes are high, time is short and results are a requirement. Through proven ISO processes, HEOPS delivers quick quality results that impact Client success and profitability. Over the past three years, HEOPS has successfully led 125+ network development projects for many of the nation’s top health plans yielding best practices and unparalleled industry perspective. Choose HEOPS for insight and strength in preparing and executing key strategies for health care reform.

Exhibitor

American Specialty Health Incorporated (ASH) is a national health and wellness company that provides prevention and wellness services, specialty network management programs, and fitness and exercise services to health plans, insurance carriers, employer groups, and trust funds.

For sponsorship opportunities please contact Justin Sanders at 800-646-9581 or email him at jsanders@globalmediadynamics.com