SUMMIT PRESENTATIONS
Speaker presentations are password protected for 90 days from the start of the Summit. Registrants may log in by clicking here. For further information, email registration@hcconferences.com or call 800-503-7414.
Speaker presentations are password protected for 90 days from the start of the Summit. Registrants may log in by clicking here. For further information, email registration@hcconferences.com or call 800-503-7414.
Agenda Links: Preconference/Day I | Day III
AGENDA: DAY 2
THURSDAY, JUNE 7, 2018
7:00 am
Registration Open; Networking Breakfast
DAY 2 OPENING PLENARY SESSION: BUNDLED PAYMENTS
8:00 am
Welcome and Introduction
Francois de Brantes, MBA
Senior Vice President, Commercial Group, Remedy Partners, Norwalk, CT (Co-Chair)
Senior Vice President, Commercial Group, Remedy Partners, Norwalk, CT (Co-Chair)
François de Brantes is a recognized expert in health care payment innovation and policy. As Executive Director of the Health Care Incentives Improvement Institute, he led a team that designed and implemented innovative payment and benefit plan programs to motivate physicians, hospitals, and consumer-patients to improve the quality and affordability of care. Mr. de Brantes’ work in developing breakthrough programs such as Bridges To Excellence and Prometheus Payment have paved the way for much of the movement in value-based payments.
Valinda Rutledge, MBA
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Co-Chair)
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Co-Chair)
Valinda Rutledge is the Vice President, Public Payor Health Strategy in the Care Coordination Institute at Greenville Health System, SC. She is responsible for identifying, analyzing, and supporting the implementation of opportunities related to government initiatives such as Bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs. She is also the Executive Policy Advisor at Parkland Center for Clinical Innovation (PCCI) in Dallas and the Chair of the PCCI Scientific Advisory Group. She previously worked as a member of the leadership team (Senior Advisor and Group Director) at the Center for Medicare and Medicaid Services Innovation (CMMI). Before joining CMS, Ms. Rutledge served as the Chief Executive Officer of several systems including Bon Secours, SSM Health, and CaroMont Health. She currently serves on several National Scientific Advisory Boards including NaviHealth and as a Subject Matter Expert for SG2.
8:15 am
Update on CMS Bundled Payment Policies
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). Chris has worked in many capacities at CMS in her career. Most recently she was the Deputy Director of the Hospital and Ambulatory Policy Group (HAPG), which handles Fee-for Service (FFS) payment policy for hospitals, physicians, Part B drugs, and laboratories, among others. Chris previously led payment policy for both the hospital outpatient prospective payment system and the physician fee schedule. In addition to FFS payment policy, Chris also has spent time working on coverage, Medicare Advantage quality measures, and the Medicare Drug Card program, a precursor to Part D drug payment.
8:45 am
Reflection on an Inflection
Francois de Brantes, MBA
Senior Vice President, Commercial Group, Remedy Partners, Norwalk, CT
Senior Vice President, Commercial Group, Remedy Partners, Norwalk, CT
François de Brantes is a recognized expert in health care payment innovation and policy. As Executive Director of the Health Care Incentives Improvement Institute, he led a team that designed and implemented innovative payment and benefit plan programs to motivate physicians, hospitals, and consumer-patients to improve the quality and affordability of care. Mr. de Brantes’ work in developing breakthrough programs such as Bridges To Excellence and Prometheus Payment have paved the way for much of the movement in value-based payments.
9:15 am
Creating a Patient-Centered Payment System
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
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Pittsburgh, PA
Harold D. 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.
9:45 am
Panel III: Bundling Complex Outpatient Medical Care: Strategies for Success in the Next Phase of Episode Based Payment
Kerin Bess Adelson, MD
Associate Professor, Chief Quality Officer, and Deputy Chief Medical Officer, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT
Associate Professor, Chief Quality Officer, and Deputy Chief Medical Officer, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT
Dr. Bess Adelson is the Chief Quality Officer, Deputy Chief Medical Officer, Acting Director of Breast Medical Oncology and Associate Professor at Smilow Cancer Hospital and the Yale Cancer Center. In this role, she developed the strategy for Yale’s participation in the Center for Medicare and Medicaid Innovation’s Oncology Care Model. She spent the first seven years out of fellowship in Breast Cancer Medicine at the Tisch Cancer Institute at Mount Sinai. During this time, she gained tremendous expertise in clinical oncology and saw first-hand how ingrained patterns of healthcare delivery can at times harm patients. After running the implementation of the EPIC electronic health record at Mount Sinai, she became increasingly focused on the field of cancer quality and the impact the changing economic and technologic environment could have on the practice of cancer medicine. She completed the Greater New York/United Hospital Fund Fellowship in Clinical Quality in 2013.
Sarah Cevallos, MBA
Chief Revenue Cycle Officer, Florida Cancer Specialists’ Physician Network, Fort Myers, FL
Chief Revenue Cycle Officer, Florida Cancer Specialists’ Physician Network, Fort Myers, FL
Chief Revenue Cycle Officer, Sarah Cevallos is responsible for providing strategic leadership and direction to all Revenue Cycle responsibilities for the Florida Cancer Specialists’ physician network. Since joining FCS in 2008, she has held several finance-related positions and provided strategic direction to various departments that lead to increasing responsibility. In addition to her work with FCS, Sarah serves as Clinical Practice Committee Member for the Florida Association of Clinical Oncology (FLASCO) and works closely with the Community Oncology Alliance (COA) on reimbursement and practice transformation strategies towards value based care. She has been recognized by the Florida Association of Clinical Oncology (FLASCO) as the inaugural recipient of the Distinguished Service Award for her continued support of facilitating resolution of reimbursement issues for oncologists in Florida.
Keely Macmillan, MSPH
General Manager of Bundled Payments for Care Improvement, Archway Health, Boston, MA
General Manager of Bundled Payments for Care Improvement, Archway Health, Boston, MA
Keely Macmillan oversees all aspects of Archway’s involvement in the Bundled Payments for Care Improvement (BPCI) Initiative from the Centers for Medicare & Medicaid Services (CMS). She is a recognized expert in alternative payment models, bringing to Archway more than 10 years of healthcare experience in guiding specialty providers to success in ACOs, bundled payments, value-based purchasing, and MACRA’s Quality Payment Program. Across the industry, she has worked closely with senior leadership to develop system-wide public payer strategy and advocacy. Previously, Ms. Macmillan was manager of government payment policy at Partners HealthCare, the largest health system in Massachusetts, where she managed public payer financial forecasting and led the government payment policy team in the analysis of performance-based reimbursement models.
Erin Smith, JD
Director II, Payment Innovation, Anthem; Former Director, Public Policy, Cardinal Health; Former Vice President, Policy and Government Affairs, naviHealth; Former Vice President and Executive Director, Post-Acute Care Center for Research, Washington DC
Director II, Payment Innovation, Anthem; Former Director, Public Policy, Cardinal Health; Former Vice President, Policy and Government Affairs, naviHealth; Former Vice President and Executive Director, Post-Acute Care Center for Research, Washington DC
Erin Smith is Director II of Payment Innovation at Anthem where she focuses on development and implementation of specialty payment models. Prior to Anthem, Erin was the Director of Public Policy at Cardinal Health where she serves as the lead policy expert for public payment policy and value-based care models for the Federal Government Relations group. She also led the policy arm for naviHealth, a Cardinal Health company, in which she focused on bundled payments, care transitions, and post-acute care. Prior to Cardinal Health, Erin worked at CMS in the Center for Medicare and Medicaid Innovation, leading the team that developed bundled payment models and implemented the Bundled Payments for Care Improvement Initiative. Erin served as a Medicare physician payment policy expert on the Physician Fee Schedule at CMS. She also brings experience from her time with the World Health Organization in Geneva, Switzerland, and Avalere Health.
Basit Chaudhry, MD, PhD
Chief Executive Officer and Founder, Tuple Health; Former Medical Scientist, IBM, Washington, DC (Moderator)
Chief Executive Officer and Founder, Tuple Health; Former Medical Scientist, IBM, Washington, DC (Moderator)
Dr. Chaudhry is an internal medicine physician and medical technologist whose expertise focuses on clinical service redesign and the use of data analytics to improve clinical and financial performance in healthcare.
Tuple Health products focus on data analytics and technologies focused on clinical re-design and population health. Tuple Health provides services including payment model design and implementation, utilization and financial analysis, and support for value based contracting.
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.
Tuple Health products focus on data analytics and technologies focused on clinical re-design and population health. Tuple Health provides services including payment model design and implementation, utilization and financial analysis, and support for value based contracting.
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.
10:30 am
Break
10:45 am
Panel IV: How to Succeed in BPCI Advanced: Clinical, Operational and Financial Strategies
Christopher Garcia, CPA
Chief Executive Officer, Remedy Partners; Former Managing Partner, Enhanced Equity Funds, New York, NY
Chief Executive Officer, Remedy Partners; Former Managing Partner, Enhanced Equity Funds, New York, NY
Christopher Garcia serves as Chief Executive Officer at Remedy Partners. Prior to his role as CEO, Chris was Vice Chairman and Chief Financial Officer at Remedy, responsible for the financial strategy, reporting, and direction for forward progress at the company.
Before Remedy Partners, Chris spent two years as a Managing Partner at Enhanced Equity Funds, leading their investments in hospital supply chain management, non-emergency transport services, specialty pharmacy distribution and pain management services.
From 2003 to 2010, Chris spent seven years with private equity team at the Charterhouse Group as an operating partner, leading their investments in behavioral healthcare services, out-patient rehabilitation, Medicaid eligibility and business process outsourcing for healthcare claims.
In 1992, Chris formed National Healthcare Resources, an episode management company focused on managing care for work-related injuries on behalf of property and casualty insurers.
Before Remedy Partners, Chris spent two years as a Managing Partner at Enhanced Equity Funds, leading their investments in hospital supply chain management, non-emergency transport services, specialty pharmacy distribution and pain management services.
From 2003 to 2010, Chris spent seven years with private equity team at the Charterhouse Group as an operating partner, leading their investments in behavioral healthcare services, out-patient rehabilitation, Medicaid eligibility and business process outsourcing for healthcare claims.
In 1992, Chris formed National Healthcare Resources, an episode management company focused on managing care for work-related injuries on behalf of property and casualty insurers.
Craigan Gray, MD, MBA, JD
Chief Medical Officer, Salient Healthcare; Former Director, North Carolina Medicaid, DHHS; Former Vice President for Medical Affairs, Bon Secours Health System Kentucky, Wake Forest, NC
Chief Medical Officer, Salient Healthcare; Former Director, North Carolina Medicaid, DHHS; Former Vice President for Medical Affairs, Bon Secours Health System Kentucky, Wake Forest, NC
Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings a rich experience from private practice, hospital leadership, and a governmental health-benefit program. His time as VPMA at Bon Secour’s Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS quality indicators. Dr. Gray is a Stanford University trained obstetrician/ Gynecologist with a preceptor/fellowship in the surgical management of breast disorders and breast cancer at the Royal Marsden Hospital in London. He is actively licensed in medicine and law. He is a Certified Physician Executive (CPE) and is published in various medical journals and on Salient’s blog.
Pamela M. Pelizzari, MPH
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY (Moderator)
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services, New York, NY (Moderator)
Pamela Pelizzari has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies, including developing gainsharing methodologies, claims adjudication techniques, and quality monitoring programs. Prior to joining Milliman, Pamela served as a senior technical advisor at the Centers for Medicare and Medicaid Services. She was responsible for developing and implementing novel payment methodologies such as the national Bundled Payments for Care Improvement models. She led the development of the Oncology Care Model and other specialty physicianfocused models. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders.
11:30 am
Panel V: Integrating BPCIA and ACOs into a Unified Strategy to Deliver People-Centered Care
Tricia Nguyen, MD, MBA
Chief Medical Officer, Inova; Chief Executive Officer, Commonwealth Health Network; Former President, Texas Health Population Health, Education & Innovation Center; Former CMO, Banner Health Network and CMO, Blue Cross Blue Shield of Kansas City, Washington, DC
Chief Medical Officer, Inova; Chief Executive Officer, Commonwealth Health Network; Former President, Texas Health Population Health, Education & Innovation Center; Former CMO, Banner Health Network and CMO, Blue Cross Blue Shield of Kansas City, Washington, DC
Dr. Nguyen is the SVP of Population Health at Inova Health System. She has more than 20 years of experience in healthcare. She has a broad range of experience working with health systems, networks and payers, all focused on establishing the foundations for population health and outcomes-based reimbursement.
Michail Reiche, MA, MBA
Executive Director, Medicare Accountable Care, Steward Health Care Network, Boston, MA
Executive Director, Medicare Accountable Care, Steward Health Care Network, Boston, MA
Michail 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. Michail holds an MBA from Harvard Business School, as well as MS in Chemistry and BA in Biochemistry from the University of Pennsylvania.
Valinda Rutledge, MBA
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC
Valinda Rutledge is the Vice President, Public Payor Health Strategy in the Care Coordination Institute at Greenville Health System, SC. She is responsible for identifying, analyzing, and supporting the implementation of opportunities related to government initiatives such as Bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs. She is also the Executive Policy Advisor at Parkland Center for Clinical Innovation (PCCI) in Dallas and the Chair of the PCCI Scientific Advisory Group. She previously worked as a member of the leadership team (Senior Advisor and Group Director) at the Center for Medicare and Medicaid Services Innovation (CMMI). Before joining CMS, Ms. Rutledge served as the Chief Executive Officer of several systems including Bon Secours, SSM Health, and CaroMont Health. She currently serves on several National Scientific Advisory Boards including NaviHealth and as a Subject Matter Expert for SG2.
Emily 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 (Moderator)
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 (Moderator)
Emily DuHamel Brower serves as Senior Vice President of Clinical Integration and Physician Services for Trinity Health, one of the largest multi-institutional Catholic health care delivery systems. In this role, Emily provides leadership within the accountable healthcare environment, with an emphasis on clinical integration and transformation under alternative payment models.
Emily joined Trinity Health from Atrius Health in Massachusetts, where she last served as Vice President of Population Health. Emily’s team delivered among the highest reported quality and highest per-capita savings among Pioneer ACOs. Prior to Atrius Health, Emily spent fifteen years in clinical model development, healthcare financial operations, and payer contracting.
Emily joined Trinity Health from Atrius Health in Massachusetts, where she last served as Vice President of Population Health. Emily’s team delivered among the highest reported quality and highest per-capita savings among Pioneer ACOs. Prior to Atrius Health, Emily spent fifteen years in clinical model development, healthcare financial operations, and payer contracting.
12:15 pm
Networking Luncheon
AFTERNOON MINI SUMMITS GROUP I: 1:15 pm – 2:15 pm
(Choose one Mini Summit only)
Mini-Summit I: MACRA: What Is PTAC’s Role in Fostering the Development of APMs?: Key Insights into Organizing a Successful APM
1:15 pm
Introductions, Panel Discussion and Q&A
Robert A. Berenson, MD
Institute Fellow, Urban Institute, Member, Physician-Focused Payment, Model Technical Advisory Committee (PTAC), Former Vice Chair, MedPAC, Washington, DC
Institute Fellow, Urban Institute, Member, Physician-Focused Payment, Model Technical Advisory Committee (PTAC), Former Vice Chair, MedPAC, Washington, DC
Robert Berenson is an Institute Fellow at the Urban Institute. He is a board-certified internist who had tours of duty on the Carter White House Domestic Policy Council, and at CMS as a senior political appointee in charge of Medicare payment policy and contracting with private health plan. He was vice chair of MedPAC in 2010-2012. He conducts policy research analysis on payment policy, market consolidation, and Medicare more generally.
Frank Opelka, MD, FACS
Medical Director, American College of Surgeons, Former Vice Chancellor for Clinical Affairs,LSU Health Science Center, New Orleans, LA
Medical Director, American College of Surgeons, Former Vice Chancellor for Clinical Affairs,LSU Health Science Center, New Orleans, LA
Dr. Opelka is a physician executive for the American College of Surgeons with expertise in health policy development, quality measurement and payment programs. He has provided senior leadership in academic medicine for over 20 years as a general and colorectal surgeon. Dr. Opelka serves the editorial staff as a reviewer and comments for five peer reviewed journals. He is recognized in several publications and textbooks for his scholarly contributions. Dr. Opelka has received two Distinguished Surgical Service Awards. He is also a military veteran having served in the US Army for over a decade.
Albert L. Siu, MD, MSPH
Professor & Chair Emeritus, Geriatrics and Palliative Medicine, Professor of Population Health Science and Policy, and Professor of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Professor & Chair Emeritus, Geriatrics and Palliative Medicine, Professor of Population Health Science and Policy, and Professor of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Dr. Siu is Professor of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, and the director of the Geriatric Research, Education, and Clinical Center (GRECC) at the James J. Peters Veterans Affairs (VA) Medical Center. He is the Chair Emeritus (Chair from 2003-17) of the Department of Geriatrics and Palliative Medicine and currently directs Mount Sinai at Home. Dr. Siu’s career spans time in academia (UCLA and Mount Sinai), policy research organizations (RAND), non-profit boards, Apartment, suite, unit, building, floor, etc. and government (past Deputy Commissioner of the New York State Department of Health and past member and Chair of the US Preventive Services Task Force).
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and Chief Executive Officer, Cornerstone Health Care, Huntsville, AL
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and Chief Executive Officer, Cornerstone Health Care, Huntsville, AL
Dr. Terrell is CEO of Envision Genomics, a company helping clinicians diagnose rare disease through the integration of genomic data into clinical care. She is a national thought leader in health care innovation and delivery system reform, and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. Previously, she started Cornerstone Health Care, a multi-specialty medical practice, and CHESS, a population health management company that brought the innovations of the Cornerstone care model redesign process to a wider group of health care systems. Dr. Terrell currently serves on the U.S. Department of Health and Human Services’ Physician-Focused Payment Model Technical Advisory Committee, the Board of Directors of the American Medical Group Association, and the Oliver Wyman Health Innovation Center’s Leadership Alliance.
S. Lawrence Kocot, JD, LLM, MPA
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, CMS, Washington, DC (Moderator)
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, CMS, 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 has served on a number of boards including the Partnership for a Healthier America, ICF International, Inc. and the Commonwealth Health Research Board.
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 has served on a number of boards including the Partnership for a Healthier America, ICF International, Inc. and the Commonwealth Health Research Board.
2:15 pm
Transition Break
Mini-Summit II: How to Improve Operational Performance through Participating in Bundled Payments
1:15 pm
Introductions, Panel Discussion and Q&A
Robert Dean, DO, MBA
Senior Vice President, Performance Management, Vizient, Inc.; Former Vice President of Performance Solutions, VHA Inc.; Former Chief Medical Officer/Vice President of Medical Affairs, Northern Michigan Regional Hospital, Grand Rapids, MI
Senior Vice President, Performance Management, Vizient, Inc.; Former Vice President of Performance Solutions, VHA Inc.; Former Chief Medical Officer/Vice President of Medical Affairs, Northern Michigan Regional Hospital, Grand Rapids, MI
As senior vice president, performance management, Robert Dean leads the Vizient Transformation of Clinical Practice Initiative team and the Vizient Practice Transformation Network. He is also responsible for providing medical leadership and expertise across a range of clinical, advisory and nursing projects as well as development of interprofessional practice resources.
Dean joined Vizient as vice president of clinical affairs and performance improvement for the Central Region and has held various positions within the organization, including vice president of performance solutions. Most recently, he was principal, performance improvement, physician resources.
A cardiac anesthesiologist, Dean served in numerous physician leadership roles prior to joining Vizient. He has led a large anesthesia practice, co-founded an independent physician association, served as the first medical director of perioperative services at Spectrum Health in Grand Rapids, Michigan, and was chief medical officer and vice president of medical affairs at Northern Michigan Regional Health System in Petoskey, Michigan.
Dean joined Vizient as vice president of clinical affairs and performance improvement for the Central Region and has held various positions within the organization, including vice president of performance solutions. Most recently, he was principal, performance improvement, physician resources.
A cardiac anesthesiologist, Dean served in numerous physician leadership roles prior to joining Vizient. He has led a large anesthesia practice, co-founded an independent physician association, served as the first medical director of perioperative services at Spectrum Health in Grand Rapids, Michigan, and was chief medical officer and vice president of medical affairs at Northern Michigan Regional Health System in Petoskey, Michigan.
Babar Khokhar, MD, MBA
Assistant Professor of Neurology and Chief Clinical Transformation Officer, Yale Medicine; Vice-Chairman, Operations; Chief, Division of General Neurology; Director, MDA-ALS/Motor Neuron Disease Clinic, New Haven, CT
Assistant Professor of Neurology and Chief Clinical Transformation Officer, Yale Medicine; Vice-Chairman, Operations; Chief, Division of General Neurology; Director, MDA-ALS/Motor Neuron Disease Clinic, New Haven, CT
Dr. Babar Khokhar is the Chief Clinical Transformation Officer (CCTO) for Yale Medicine (YM). As the CCTO he oversees clinical optimization, population health and clinical innovation. He is the founder of Yale Clinical Optimization Services (YCOS), a team dedicated to the transformation of ambulatory care focusing on value, efficiency and the patient and physician/provider experience. Within the Department of Neurology Dr. Khokhar serves as the Vice-Chairman of Operations, Director of the MDA-ALS Clinic and Medical Director of the Yale-New Haven Hospital Electromyography Laboratory.
After completing his Neurology residency and Neuromuscular Medicine fellowship at Yale-New Haven Hospital he joined the Yale Department of Neurology as a faculty member. His clinical interests include motor neuron diseases such Amyotrophic Lateral Sclerosis (ALS) as well as other neuromuscular disorders. His other interests included medical education and healthcare administration, focusing on optimizing the delivery of ambulatory care and improving both the patient and provider experience in such delivery models.
After completing his Neurology residency and Neuromuscular Medicine fellowship at Yale-New Haven Hospital he joined the Yale Department of Neurology as a faculty member. His clinical interests include motor neuron diseases such Amyotrophic Lateral Sclerosis (ALS) as well as other neuromuscular disorders. His other interests included medical education and healthcare administration, focusing on optimizing the delivery of ambulatory care and improving both the patient and provider experience in such delivery models.
Valinda Rutledge, MBA
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Moderator)
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Moderator)
Valinda Rutledge is the Vice President, Public Payor Health Strategy in the Care Coordination Institute at Greenville Health System, SC. She is responsible for identifying, analyzing, and supporting the implementation of opportunities related to government initiatives such as Bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs. She is also the Executive Policy Advisor at Parkland Center for Clinical Innovation (PCCI) in Dallas and the Chair of the PCCI Scientific Advisory Group. She previously worked as a member of the leadership team (Senior Advisor and Group Director) at the Center for Medicare and Medicaid Services Innovation (CMMI). Before joining CMS, Ms. Rutledge served as the Chief Executive Officer of several systems including Bon Secours, SSM Health, and CaroMont Health. She currently serves on several National Scientific Advisory Boards including NaviHealth and as a Subject Matter Expert for SG2.
2:15 pm
Transition Break
Mini-Summit III: Hospital Global Budgets
1:15 pm
Introductions, Panel Discussion and Q&A
Donna Kinzer
Executive Director, Maryland Health Services Cost Review Commission, Baltimore, MD
Executive Director, Maryland Health Services Cost Review Commission, Baltimore, MD
Donna Kinzer has been the Executive Director of Maryland Health Services Cost Review Commission for last 5 years. She led implementation of Maryland’s per capita hospital model. She has previously had an extensive consulting career in payment and delivery systems with Berkeley Research Group LLC and Navigant Consulting.
Gene Ransom, JD
Chief Executive Officer, The Maryland State Medical Society (MedChi), Baltimore, MD
Chief Executive Officer, The Maryland State Medical Society (MedChi), Baltimore, MD
Gene M. Ransom III is the current CEO of MedChi, The Maryland State Medical Society. As MedChi executive Ransom works to implement MedChi’s mission as an advocate for physicians, patients and the public health of Maryland. He is the former President of the County Commission. Gene was elected to the Queen Anne’s County Commission in November 2002, and was the only incumbent County Commissioner re-elected in the 2006 election.
Ransom served in numerous leadership positions during his career, including President of the Commission, Vice President of the Commission, and as a voting member of the Queen Anne’s County Planning Commission, Gene also served the public as an elected member of the Democratic Central Committee, a member of the 2008 Electoral College, President of the Young Democrats of Maryland as well as numerous local and state appointments to Boards and Commissions.
Ransom served in numerous leadership positions during his career, including President of the Commission, Vice President of the Commission, and as a voting member of the Queen Anne’s County Planning Commission, Gene also served the public as an elected member of the Democratic Central Committee, a member of the 2008 Electoral College, President of the Young Democrats of Maryland as well as numerous local and state appointments to Boards and Commissions.
Eric T. Roberts, PhD
Assistant Professor, Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Assistant Professor, Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Eric Roberts is an Assistant Professor of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health. Dr. Roberts’ research examines policies surrounding the provision and financing of health care services, particularly in low-income populations. His research uses simulation and econometric methods for causal inference to inform policymakers about the public health and financial impacts of payment and delivery system innovations. One stream of work examines the implementation of alternative payment models (including value-based purchasing and global budgets), their impacts on care quality and utilization, and their financial implications for providers serving socially disadvantaged patients. A second stream of work examines complementarities between health insurance programs (e.g., Medicaid and Medicare) for high-cost and high-need populations.
Kate Slatt, MHA
Senior Director, Innovative Payment and Care Delivery, The Hospital and Healthsystem Association of Pennsylvania; Former Strategic Provider Relations and Initiatives Director, Highmark, Harrisburg, PA
Senior Director, Innovative Payment and Care Delivery, The Hospital and Healthsystem Association of Pennsylvania; Former Strategic Provider Relations and Initiatives Director, Highmark, Harrisburg, PA
Kate Slatt is the senior director, innovative payment and care delivery, at The Hospital & Healthsystem Association of Pennsylvania (HAP). In this role, she leads the association’s efforts related to value-based payment programs. Ms. Slatt also identifies and analyzes important public policy issues related to Medical Assistance, Medicare, and programs for the uninsured. Prior to joining HAP, Ms. Slatt worked as Strategic Provider Relations and Initiatives Director for Highmark, Inc., where she was responsible for developing and leading strategic relationships with provider partners and developed and launched Highmark’s first accountable care arrangement Apartment, suite, unit, building, floor, etc. in central Pennsylvania. Ms. Slatt also previously worked as Senior Consultant at Health Strategies & Solutions, Inc., where she developed strategic plans for hospitals, health systems, and physician practices nationwide.
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 D. 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.
2:15 pm
Transition Break
Mini-Summit IV: Strengths, Weaknesses and Areas for Improvement for the MSSP
1:15 pm
Introductions, Panel Discussion and Q&A
Travis Broome, MBA, MPH
Vice President of Policy and ACO Administration, Aledade, Inc.; Former Team Lead for Policy and Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Vice President of Policy and ACO Administration, Aledade, Inc.; Former Team Lead for Policy and Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Travis Broome is Vice President of Policy at Aledade, a new company helping doctors stay independent and thrive in the transition to value based care. Joining Aledade early on, Travis helped Aledade grow from 2 ACOs to 20 ACOs. Today, he is a thought leader on accountable care and is responsible for strategy development, policy analysis and economic modeling. Prior to Aledade, Travis was a Regional Director at CMS. He earned his MPH and MBA from the University of Alabama at Birmingham.
Tim Gronniger, MPP, MHSA
Senior Vice President, Development and Strategy, Caravan Health, Former Deputy Chief of Staff, Centers for Medicare and Medicaid Services; Former Senior Adviser for Health Care Policy, White House Domestic Policy Council, Washington, DC
Senior Vice President, Development and Strategy, Caravan Health, Former Deputy Chief of Staff, Centers for Medicare and Medicaid Services; Former Senior Adviser for Health Care Policy, White House Domestic Policy Council, Washington, DC
Tim Gronniger is the Senior Vice President of Development and Strategy for Caravan Health. Tim is the former Chief of Staff and Director of Delivery System Reform at CMS. He was previously a senior adviser for health care policy at the White House Domestic Policy Council. Before joining DPC he was a senior professional staff member for Ranking Member Henry Waxman at the House Committee on Energy and Commerce, responsible for drafting and collaborating to develop elements of the Affordable Care Act. Tim began his career in Washington at the at the Congressional Budget Office.
Danielle Lloyd, MPH
Senior Vice President, Private Market Innovations and Quality Initiatives, AHIP; Vice President, Policy and Advocacy, Premier; Senior Associate Director, American Hospital Association, Washington, DC
Senior Vice President, Private Market Innovations and Quality Initiatives, AHIP; Vice President, Policy and Advocacy, Premier; Senior Associate Director, American Hospital Association, Washington, DC
Danielle Lloyd is the senior vice president, private market innovations & quality initiatives at AHIP, the national association representing organizations that provide coverage for health care and related services. She is responsible for assessing insurance market trends and developing policy in the areas of emerging payment models, quality measurement and health information technology interoperability. Previously, Danielle led Premier’s policy analysis and development activities working with lawmakers, policymakers, and other major stakeholders representing the interests of more than 3,500 hospitals nationwide. She served as a national expert on value-based purchasing and alternative payment models and played a leading role in Premier’s large-scale provider collaboratives. Prior to Premier, Lloyd worked on an array of healthcare issues including Medicare and Medicaid payment, quality policies, and health information technology for the American Hospital Association, California Hospital Association, the U.S. House of Representatives Committee on Ways and Means and the Centers for Medicare & Medicaid Services.
David B. Muhlestein, PhD, JD
Chief Research Officer, Leavitt Partners, LLC; Adjunct Assistant Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth College; Visiting Policy Fellow, Margolis Center for Health Policy, Duke University; Visiting Fellow, Accountable Care Learning Collaborative, Washington, DC (Moderator)
Chief Research Officer, Leavitt Partners, LLC; Adjunct Assistant Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth College; Visiting Policy Fellow, Margolis Center for Health Policy, Duke University; Visiting Fellow, Accountable Care Learning Collaborative, Washington, DC (Moderator)
Dr. Muhlestein is Chief Research Officer at Leavitt Partners. 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.
2:15 pm
Transition Break
Mini-Summit V: ACOs, Bundles — How Do I Choose? A Case Study
1:15 pm
Introductions, Panel Discussion and Q&A
James (Jim) M. Daniel, Jr., MBA, JD
Attorney, Hancock, Daniel & Johnson, PC, Richmond, VA
Attorney, Hancock, Daniel & Johnson, PC, Richmond, VA
Jim Daniel practices exclusively in the healthcare transactional and regulatory areas. He devotes his efforts to transactions, joint ventures, mergers and acquisitions, contracting and regulatory matters involving proprietary and non-profit integrated healthcare delivery systems healthcare providers, ambulatory surgery centers, physicians and physician organizations. In connection with these matters, Mr. Daniel routinely provides advice on issues related to tax-exempt status, including private inurement, private benefit, and intermediate sanctions, tax-exempt financing, antitrust compliance and fraud and abuse. Since 2010 and the adoption of the Patient Protection and Affordable Care Act, Mr. Daniel has dedicated a significant amount of his time and efforts counseling clients in strategy development under health reform, including the planning and development of medical homes, accountable care organizations, clinically integrated networks and gainsharing initiatives. Mr. Daniel also advises long term care facilities, home health agencies, hospices, durable medical equipment companies and other providers on various legal and regulatory matters.
Travis B. Turner, MBA
Senior Vice President of Clinical Integration, Mary Washington Healthcare; Former Director of Physician Relations/ Executive Director of Cayuga PHO, Cayuga Medical Center at Ithaca, Washington, DC
Senior Vice President of Clinical Integration, Mary Washington Healthcare; Former Director of Physician Relations/ Executive Director of Cayuga PHO, Cayuga Medical Center at Ithaca, Washington, DC
2:15 pm
Transition Break
Mini Summit VI: Lessons Learned from BPCI and Overview of the CMMI BPCI Toolkit
1:15 pm
Introductions, Panel Discussion and Q&A
Elizabeth Currier, MBA/MPH, LSSGB, FACMPE
Senior Advisor, Episode Based Models, Learning and Diffusion Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Service, US Department of Health and Human Services, Baltimore, MD
Senior Advisor, Episode Based Models, Learning and Diffusion Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Service, US Department of Health and Human Services, Baltimore, MD
Elizabeth Currier is a Senior Advisor, Episode Based Models, Learning and Diffusion Group at the Center for Medicare and Medicaid Innovation, also known as the CMS Innovation Center. Elizabeth has years of experience and knowledge of medical group management, strategy, governance and operations. Prior to joining the Innovation Center, Elizabeth worked at Sullivan Cotter & Associates focusing on Physician Compensation specifically in the areas of compensation design, evaluation and redesign of physician compensation programs. Elizabeth has spent most of her career, working in specialty physician practice management for large Integrated Delivery Systems in the Medicine and Surgical Service lines. Elizabeth began her career as an Administrator in a large independent Cardiology group.
Lisa Davis, MS
Learning System Lead, BPCI and BPCI-Advanced, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Learning System Lead, BPCI and BPCI-Advanced, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Lisa Davis has a background in clinical quality improvement having recently worked in a local hospital on performance improvement projects to improve patient care. Lisa is a certified, licensed Occupational Therapy Assistant. She is now employed at the CMS Innovation Center for 15 months as a LS lead for BPCI and BPCI-Advanced.
Steven A. Farmer, MD
Senior Advisor and Senior Medical Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Senior Advisor and Senior Medical Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Dr. Steven A. Farmer is Senior Advisor and Senior Medical Officer at the Center for Medicare and Medicaid Innovation (CMMI). He advises the center on development, implementation, and refinement of alternative payment models that link healthcare payments with value. He is a practicing noninvasive cardiologist and remains an Associate Professor of Medicine and Health Policy and Management at George Washington University. He is also Adjunct Associate Professor of Medicine and Business Strategy and distinguished fellow of Law, Regulation, and Economic Growth at Northwestern University.
Geoffrey Frost
Project Coordinator and Program Manager, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Former Manager Pharmacy Services, UnitedHealthcare/OptumHealth, Baltimore, MD
Project Coordinator and Program Manager, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Former Manager Pharmacy Services, UnitedHealthcare/OptumHealth, Baltimore, MD
Karen McIntosh, MSN, RN, CCM
Vice President Transition of Care, Washington Regional Hospital, Fayetteville, AR
Vice President Transition of Care, Washington Regional Hospital, Fayetteville, AR
Karen McIntosh is the Vice President of Care Transitions at Washington Regional Medical Center where she leads both inpatient and outpatient initiatives. During her tenure at WRMC, she has held numerous leadership roles including Trauma Program Manager and Director positions in Clinical Integrity and Case Management. Karen is a graduate of the University of Arkansas and Vanderbilt University where her focus was in Health Systems Management. She was recently recognized as the 2018 Eleanor Mann School of Nursing Outstanding Alumni through the University of Arkansas.
Alicia Goroski, MPH
Vice President, The Lewin Group, Former Director Of Performance Measurement, Center for Improving Value in Health Care, Former Associate Director of National Programs, Colorado Foundation for Medical Care, Littleton, CO (Moderator)
Vice President, The Lewin Group, Former Director Of Performance Measurement, Center for Improving Value in Health Care, Former Associate Director of National Programs, Colorado Foundation for Medical Care, Littleton, CO (Moderator)
Alicia Goroski is a Vice President in the Center for Learning and Diffusion at The Lewin Group. Ms. Goroski is currently directing the learning system contract for CMS’ Bundled Payments for Care Improvement Initiative and Comprehensive Care for Joint Replacement Model as well as Lewin’s work on the Quality Improvement Network National Coordinating Center. Prior to joining Lewin, Ms. Goroski was the Director of Performance Measurement at the Center for Improving Value in Health Care (CIVHC). Prior to joining CIVHC, Alicia was the Associate Director of National Programs at CFMC, the Medicare Quality Improvement Organization (QIO) for Colorado. Dedicated to improving the delivery of health care services, she has worked in public health and quality improvement for 19 years.
2:15 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP II: 2:30 pm – 3:30 pm
(Choose one Mini Summit only)
Mini Summit VII: MACRA: The All-Payer Combination Option for Qualifying as an APM
2:30 pm
Introductions, Panel Discussion and Q&A
Jane Eilbacher
Senior Advisor, Payment Innovation at Anthem, Inc., Anthem, Inc., Former Health Insurance Specialist, Centers for Medicare & Medicaid Services, Former Senior Payment Reform Specialist, Association of American Medical Colleges, Washington, DC
Senior Advisor, Payment Innovation at Anthem, Inc., Anthem, Inc., Former Health Insurance Specialist, Centers for Medicare & Medicaid Services, Former Senior Payment Reform Specialist, Association of American Medical Colleges, Washington, DC
Jane Eilbacher is the Senior Advisor, Payment Innovation in Provider Alignment Solutions. Prior to joining Anthem, Jane spent four years at the CMS Innovation Center working on ACO initiatives and new model development, including designing and implementing the Next Generation ACO Model. She also served in an advisory capacity for leadership of the Seamless Care Models Group, which oversees initiatives across Medicare fee-for-service and Parts C and D. Jane began her career at the Association of American Medical Colleges working on hospital payment and regulatory issues, specifically related to academic medical centers and payment reform. She also led AAMC’s participation in CMS’ bundled payment initiative.
Pamela M. Pelizzari, MPH
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare & Medicaid Services, New York, NY (Moderator)
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare & Medicaid Services, New York, NY (Moderator)
Pamela Pelizzari has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies, including developing gainsharing methodologies, claims adjudication techniques, and quality monitoring programs. Prior to joining Milliman, Pamela served as a senior technical advisor at the Centers for Medicare and Medicaid Services. She was responsible for developing and implementing novel payment methodologies such as the national Bundled Payments for Care Improvement models. She led the development of the Oncology Care Model and other specialty physicianfocused models. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders.
3:30 pm
Transition Break
Mini-Summit VIII: Issues and Opportunities in Value-Based Payment for Outpatient Specialty Care
How to design bundles not triggered by a Hospital Admission (Required in BPCI Advanced, except for a few Outpatient procedures), or a specific procedure or treatment (Required for the Outpatient Part of BPCI Advanced and the Oncology Care Model)
2:30 pm
Introductions, Panel Discussion and Q&A
Linda V. DeCherrie, MD
Clinical Director, Mount Sinai at Home, Mount Sinai Health System; Professor, Department of Geriatrics and Palliative Medicine; Associate Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Clinical Director, Mount Sinai at Home, Mount Sinai Health System; Professor, Department of Geriatrics and Palliative Medicine; Associate Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Dr. DeCherrie’s professional passion is home based medical care. She is the Clinical Director of Mount Sinai at Home, which is a service line at the Mount Sinai Health System that includes multiple home based programs including the Mount Sinai Visiting Doctors Program, Hospitalization at Home and Rehabilitation at Home programs. Dr. DeCherrie’s interests include resident education in geriatrics and home care as well as systems and policy implications for Home Based care of all types.
Gabrielle B. Rocque, MD
Member, UAB Oncology Care Model Steering Committee, Assistant Professor of Medicine, Divisions of Hematology and Oncology and Gerontology, Geriatrics and Palliative Care, UAB School of Medicine, Birmingham, AL
Member, UAB Oncology Care Model Steering Committee, Assistant Professor of Medicine, Divisions of Hematology and Oncology and Gerontology, Geriatrics and Palliative Care, UAB School of Medicine, Birmingham, AL
Dr. Gabrielle Rocque is an Assistant Professor of Medicine in the Divisions of Hematology & Oncology and Gerontology, Geriatrics, & Palliative Care at the University of Alabama at Birmingham (UAB). She is a medical oncologist specializing in the care of women with breast cancer. Dr. Rocque’s research interests include improving the quality of healthcare delivery for cancer patients with an emphasis on shared decision-making, payment reform, and provision of supportive care services to patients. She served as Medical Director and focused on improving health and healthcare costs by implementing a lay navigator workforce to support cancer patients across from diagnosis through survivorship and end-of-life. She is active within both local and national payment reform initiatives, serving as a member of UAB’s Oncology Care Model Steering Committee and as a co-author of the American Society for Clinical Oncology (ASCO) Patient-Centered Oncology Payment (PCOP) program. She also is engaged in quality at a national level, as a former chair of the ASCO Measures Task Force and is the chair-elect of the ASCO Quality of Care Committee.
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 D. 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.
3:30 pm
Transition Break
Mini-Summit IX: Actuarial and Risk Management Updates
2:30 pm
CMS ACOs Actuarial Insights and Findings
Jonah Broulette, ASA, MAAA
Actuarial Analyst, Milliman, New York, NY
Actuarial Analyst, Milliman, New York, NY
Jonah is an associate actuary with the New York office of Milliman. He joined the firm in 2007. Jonah has provided actuarial and consulting services to a broad range of clients, including ACOs, HMOs, commercial insurers, government agencies, pharmaceutical companies, and healthcare providers and vendors. He has assisted clients with benefit design, pricing, healthcare cost projections, provider contract review and benchmarking, rate filings, and utilization benchmark analyses. He has substantial experience analyzing and pricing provider risk arrangements such as CMMI’s Bundled Payment initiative and Medicare Shared Savings Program. Jonah is adept at analyzing large data sets and leveraging different statistical techniques in order to draw meaningful conclusions. He is skilled in using SAS, Excel, VBA, and SQL to analyze data.
Howard Kahn, FSA, MAAA
Principal and Consulting Actuary, Milliman, New York, NY
Principal and Consulting Actuary, Milliman, New York, NY
Howard Kahn is a principal and consulting actuary in Milliman’s New York health practice. He joined the firm in 2009. Howard provides actuarial and consulting services to a broad range of organizations including providers, health plans, and government agencies. He has extensive experience with assessing and developing alternative payment contracts between ACOs and health plans, health claims data warehousing, ongoing assessment, analysis, and report generation for ACO performance, financial projections, and development and assessment of risk adjustment methodologies.
3:00 pm
Risk Identification Assessment Tools and Care Coordination Risk Mitigation Strategies
Debbie Reber, MHA
Vice President, Clinical Services, Brooks Rehabilitation, Jacksonville, FL
Vice President, Clinical Services, Brooks Rehabilitation, Jacksonville, FL
Debbie Reber is the Vice President of Clinical Services for Brooks Rehabilitation and a clinical and operations expert with strong quality, leadership and project management skills. For the last five years Debbie has lead the Brooks system for successful formulation and implementation of the Medicare Bundled Payments for Care Improvement initiative. The focus of this initiative was system wide integration and decision-making for care redesign for orthopedics joints, hip fractures, spinal surgeries and congestive heart failure. Brooks Rehabilitation is modeling the way using their experience in post-acute care coordination to assist acute facilities managing Medicare Shared Savings Program beneficiaries as well as commercial Accountable Care Organization agreements.
3:30 pm
Transition Break
Mini-Summit X: The Missing Voice: The Patient/Consumer Role in Payment Reform
2:30 pm
Introductions, Panel Discussion and Q&A
Leonardo Cuello, JD
Director, Health Policy, National Health Law Program; Former Staff Attorney, PA Health Law Project, Washington, DC
Director, Health Policy, National Health Law Program; Former Staff Attorney, PA Health Law Project, Washington, DC
Leonardo Cuello is the Director of Health Policy for the National Health Law Program (NHeLP), based out of NHeLP’s Washington, D.C. office. Leonardo’s current work focuses on Medicaid managed care and delivery system reform, Medicaid expansion, Medicaid benefits packages, and Medicaid and Marketplace demonstration authority. Prior to joining NHeLP, Leonardo worked at the Pennsylvania Health Law Project for over six years, focusing on a wide range of health care issues dealing with eligibility and access to services in Medicaid and Medicare, and serving as legal counsel to the Consumer Subcommittee of Pennsylvania’s Medical Care Advisory Committee.
Katie Martin, MPA
Vice President for Health Policy and Programs, National Partnership for Women & Families, Former Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services (HHS), Washington, DC
Vice President for Health Policy and Programs, National Partnership for Women & Families, Former Acting Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services (HHS), 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 Apartment, suite, unit, building, floor, etc. Health Financing Branch and as Branch Chief for Health Insurance Data and Analysis.
Frederick Isasi, JD, MPH
Executive Director, Families USA; Former Health Division Director, National Governors Association; Former Vice President Health Policy, Advisory Board Company; Former, Senior Legislative Counsel for Health Care, Finance Committee and Committee on Health, Education, Labor, and Pensions, US Senate, Washington, DC (Moderator)
Executive Director, Families USA; Former Health Division Director, National Governors Association; Former Vice President Health Policy, Advisory Board Company; Former, Senior Legislative Counsel for Health Care, Finance Committee and Committee on Health, Education, Labor, and Pensions, US Senate, Washington, DC (Moderator)
Frederick Isasi is the Executive Director for Families USA. In his 20s, Mr. Isasi was a leader of various gay rights and AIDS/HIV student organizations and founded a volunteer organization that provided support to the children of parents dying from AIDS and a summer camp for children with HIV/AIDS. Before joining Families USA, Mr. Isasi served as the Health Division Director at the bipartisan National Governors Association’s (NGA) Center for Best Practices. Prior to NGA, Mr. Isasi served as Vice President for Health Policy at the Advisory Board Company where he founded its Health Policy Department. Mr. Isasi served as Senior Legislative Counsel for Health Care on both the U.S. Senate Finance Committee and Senate Committee on Health, Education, Labor, and Pensions (HELP) for former Senator Jeff Bingaman (D-NM), Earlier in his career, Mr. Isasi served as a health care attorney with Powell Goldstein.
3:30 pm
Transition Break
Mini-Summit XI: Case Studies in Successful Integrated Value-based Care
2:30 pm
MSSP ACOs in New York State — A Report from the Field
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 is Director, Innovation Strategies at New York’s United Hospital Fund. Over the past eight years, he has focused on two specific innovations – the adoption of the Patient Centered Medical Home, and the evolution, spread and performance of the state’s Medicare ACOs – publishing numerous reports tracking and analyzing those two phenomena. Greg served as Assistant Dean at the University of Connecticut School of Medicine, and as VP, Planning at Montefiore Medical Center, from 1982 to 2010, where he helped craft Montefiore’s population-based strategy.
3:00 pm
Use of Electronic Patient Reported Outcomes and Wearables for Heart Failure Disease Management
Ashish Atreja, MD, MPH
Chief Innovation Officer, Medicine, at Mount Sinai; Co-founder Rx.Health, New York, NY
Chief Innovation Officer, Medicine, at Mount Sinai; Co-founder Rx.Health, New York, NY
Over the last fifteen years, Dr. Atreja has led many public health and informatics initiatives at Cleveland Clinic and Mount Sinai Medical Center including developing online education modules, leading EHR implementation, performing analytics on healthcare data and developing enterprise-wide mobile apps. As Chief Innovation and Engagement Officer, Medicine, he leads the Sinai AppLab that is one of the first collaborative hubs within an academic medical center to build and test disruptive mhealth technologies. He serves on the Innovation Advisory Board for American College of Cardiology. Dr. Atreja has successfully licensed technologies from academic centers and advises startups, accelerators and Fortune 500 companies in digital medicine. Dr. Atreja serves as Scientific Co-founder and Chief Strategy Officer for Mount Sinai Spinoff, Rx.Health that brings first enterprise-wide app curation, prescription and engagement platform to risk sharing hospitals and payers in an affordable and scalable manner.
3:30 pm
Transition Break
Mini-Summit A: What if FedEx and Amazon delivered Bundles?
Come to this session to learn how the same technology that powers JPMorgan’s portfolio accounting and Amazon’s logistics and customer experience personalization is being applied by leading organizations such as John Muir Health, Hoag Orthopedic Institute, and Orthopedic Centers of Colorado to drive success in bundles, ACO’s, and Medicare Advantage.
- Learn how emerging technology is filling the gaps in care across episodes and boosting early adopters to the top of the charts (e.g., John Muir Health earning $1,900 per CJR episode, placing it 4th in the US)
- Learn why precise case-mix adjustment matters in understanding total-cost-of-care at the patient, physician, facility, post-acute care partner, and market level
- Discuss proven strategies providers and service line leaders can implement to improve care coordination and collaboration across teams while reducing care team burden by 3x
- Find out how to use what you’ve learned to grow your value-based programs at scale
2:30 pm
Introductions, Presentation and Q&A
Jean Drouin, MD
Founder and CEO of Clarify Health Solutions, San Francisco, CA
Founder and CEO of Clarify Health Solutions, San Francisco, CA
Jean Drouin is the CEO and founder of Clarify Health Solutions, which enables health systems to deliver more satisfying and affordable care through an AI-enabled real-time care guidance platform. He was formerly a Senior Partner at McKinsey & Co, where he led the global Healthcare IT and Digital Practice, setting up the UK and Australian Healthcare Practices and serving as the founding Head of McKinsey Advanced Healthcare Analytics (MAHA). He also served as Head of Strategy for National Health Service (NHS) London, which oversaw London’s hospitals and primary care services.
3:30 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP III: 4:00 pm – 5:00 pm
(Choose one Mini Summit only)
Mini-Summit XII: MACRA: Advanced Issues in APM Development and Qualification
- Many applicants are submitting to PTAC more than one payment model proposal for a particular care model. The impetus appears to be the desire to qualify as an advanced APM by adding on a risk payment model.
- Do the incentives to become an advanced APM overly emphasize risk when it may not be necessary or desirable to achieve the goals, in order to avoid MIPS and get the increased fee differential as an AAPM?
- Are there modifications in the current fee schedule that could in and of itself meet many of the objectives of MACRA (such as improvement in care coordination codes and other payment modifiers)?
- How can we redefine the relationship between care models and payment models in ways that can lead to enhanced care redesign?
- How can the move towards measuring outcomes versus process measures be approached in the constraints of MACRA at the beginning of the age of precision medicine?
4:00 pm
Introductions, Presentation and Q&A
Karen Cannon, MD, CPE
Chief Medical Operations Officer, CHESS Health Enablement Solutions; Clinical Documentation Improvement Officer, Cornerstone Health Care, High Point, NC
Chief Medical Operations Officer, CHESS Health Enablement Solutions; Clinical Documentation Improvement Officer, Cornerstone Health Care, High Point, NC
Dr. Karen Cannon serves as the Chief Medical Operations Officer for CHESS, a role designed to provide operational support for CHESS clients as they move along their journey of value based care initiatives including care management, quality improvement and lowering the cost of care. Dr. Cannon is a managed care contracting executive with expertise in Medicare Advantage (HMO/PPO) and Commercial value based contract negotiations with proficiency in understanding both the opportunities and challenges facing health care providers within the value based contracting arena. She has accomplished leadership skills as a Certified Physician Executive with experience in building successful and productive relationships internal and external to the organization. Formerly the Clinical Documentation Improvement Officer for CHESS and Cornerstone Health Care, PA., Dr. Cannon has a proven track record in implementing a Clinical Documentation Improvement Program to accurately and compliantly document and code the burden of illness for populations of patients.
Tricia Nguyen, MD, MBA
Chief Executive Officer, Commonwealth Health Network; Former President, Texas Health Population Health, Education and Innovation Center; Former Chief Medical Officer, Banner Health Network, Washington, DC
Chief Executive Officer, Commonwealth Health Network; Former President, Texas Health Population Health, Education and Innovation Center; Former Chief Medical Officer, Banner Health Network, Washington, DC
Dr. Nguyen is the SVP of Population Health at Inova Health System. She has more than 20 years of experience in healthcare. She has a broad range of experience working with health systems, networks and payers, all focused on establishing the foundations for population health and outcomes-based reimbursement.
Grace Emerson Terrell, MD, MMM, FACP, FACPE
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and Chief Executive Officer, Cornerstone Health Care, Huntsville, AL (Moderator)
Chief Executive Officer, Envision Genomics; Member, Physician-Focused Payment Model Technical Advisory Committee (PTAC); Former President and Chief Executive Officer, Cornerstone Health Care, Huntsville, AL (Moderator)
Dr. Terrell is CEO of Envision Genomics, a company helping clinicians diagnose rare disease through the integration of genomic data into clinical care. She is a national thought leader in health care innovation and delivery system reform, and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. Previously, she started Cornerstone Health Care, a multi-specialty medical practice, and CHESS, a population health management company that brought the innovations of the Cornerstone care model redesign process to a wider group of health care systems. Dr. Terrell currently serves on the U.S. Department of Health and Human Services’ Physician-Focused Payment Model Technical Advisory Committee, the Board of Directors of the American Medical Group Association, and the Oliver Wyman Health Innovation Center’s Leadership Alliance.
5:00 pm
Transition Break
Mini-Summit XIII: Making Value-Based Payment Work for Small and Rural Physician Practices and Hospitals
4:00 pm
Introductions, Panel Discussion and Q&A
Don Klitgaard, MD
President, Heartland Rural Physicians Alliance and Heartland Physicians ACO; Chief Executive Officer and Chief Medical Officer, MedLink Advantage, Harlan, IA
President, Heartland Rural Physicians Alliance and Heartland Physicians ACO; Chief Executive Officer and Chief Medical Officer, MedLink Advantage, Harlan, IA
Don Klitgaard is the founding CEO and CMO of MedLink Advantage (MLA), a healthcare consulting and ACO management firm. MLA organizes and provides full management and support of ACOs made up of independent physicians, practices and hospitals. For 15 years, Dr. Klitgaard practiced full scope rural Family Medicine and served as Medical Director of the Myrtue Medical Center clinics in Harlan, Iowa. During this time, he served as the physician champion for the AAFP’s TransforMED National Demonstration Project and helped lead their subsequent Patient-Centered Medical Home transformation efforts. In 2012, Dr. Klitgaard helped found Heartland Rural Physician Alliance, an Iowa statewide IPA dedicated to assisting independent practices thrive. He currently serves as Heartland Board Chair and ACO Medical Director for both Medicare Shared Savings and Wellmark BC/BS ACOs.
Shane McGuire
Chief Executive Officer, Columbia County Health System;
Participant, National Rural Accountable Care Organization, Dayton, WA
Chief Executive Officer, Columbia County Health System;
Participant, National Rural Accountable Care Organization, Dayton, WA
Shane A. McGuire has been the CEO of Columbia County Health System since December of 2015 after having spent the previous 5-years as the Health System’s Chief Operating Officer. The Health System is comprised of a 25 bed, critical access hospital with emergency department; a skilled nursing, long term care facility; and two rural health clinics. Shane is a proven leader with 15 years of operational, management experience in both telecommunications and healthcare; he has a combined 23 years of experience in information technology management. His specialties include L&I and DOH plan review, project management, data center construction, healthcare information systems, electronic health record systems, telecommunications solutions, and plant and facilities management.
Michelle Mitchell, MD
Founder and Chief Executive Officer, Hawaii Family Health, Participant, CMS Comprehensive Primary Care Plus Initiative, Hilo, HI
Founder and Chief Executive Officer, Hawaii Family Health, Participant, CMS Comprehensive Primary Care Plus Initiative, Hilo, HI
Michelle Mitchell has been serving rural Hawaii as a Family Physician for over 10 years. She has advanced Hawaii Family Health on the principles of team-based health care, utilizing registered nurses, nutritionists, mental health team and telemedicine to provide high quality health care to East Hawaii. In spite of its rural location, Hawaii Family Health continues to participate in advanced models of care and payment reform, including PCMH, global payment models and CPC+.
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 D. 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
Transition Break
Mini-Summit XIV: Lessons Learned from CJR
4:00 pm
Introductions, Panel Discussion and Q&A
Will Hahn, MBA
Director of Strategy and Business Development, Sutter Health; Former Director of Performance Excellence and Project Management, Palo Alto Medical Foundation, Santa Cruz, CA
Director of Strategy and Business Development, Sutter Health; Former Director of Performance Excellence and Project Management, Palo Alto Medical Foundation, Santa Cruz, CA
William M. Hahn has over 20 years of management experience in the healthcare industry. Since 2015, Mr. Hahn led CJR program planning and implementation for 10 hospitals in the Sutter Health system. He also lectures in undergraduate and graduate programs.
Lana Smith
MSN Nursing, Corporate Director, Service Lines at Adventist Health, Bakersfield, CA
MSN Nursing, Corporate Director, Service Lines at Adventist Health, Bakersfield, CA
Lana’s experience with Adventist Health spans over 25 years. As a leader, primarily in the surgical services area, Lana Smith holds a Bachelor’s and Master’s Degree in Nursing Administration and is a member of Sigma Theta Tau International Nursing Honor Society. Currently, as System Director for Service Lines, her attention is focused on leading clinical initiatives that support Care Redesign to patient-centered, safe, reliable and evidence-based care. Leading the Orthopedic Service Line, Lana worked with clinicians and surgeons to develop a standardized pathway for the care of hip and knee replacement patients, at the same time achieving a $4.4M cost reduction in total joint implants. Prior to her current role she worked with AH Hospital Surgical Services and Cath Lab Value Analysis teams to lower supply costs and in 2013 was recognized in the Journal of Healthcare Contracting as one of the top ten people to watch in healthcare contracting.
David Terry, MBA
Founder and Chief Executive Officer, Archway Health, Boston, MA
Founder and Chief Executive Officer, Archway Health, Boston, MA
Dave P. Terry is Co-founder and CEO of Archway Health and brings with him more than 20 years of experience as a healthcare payment reform strategist and expert. Mr. Terry is responsible for establishing the corporate vision and ensuring the team is delivering on its promise of enabling payors and providers to succeed within bundled payment programs.
Throughout his career, Mr. Terry has served as a senior executive and trusted advisor to design, implement and measure effective payment strategies that deliver value to payors, and providers, and, ultimately, to patients. Some of his previous industry experience includes work with Partners Healthcare, Harborside Healthcare, and The Chartis Group.
He currently serves on the board of The Bottom Line, a national, educational non-profit, and is a past board member of the Harvard Business School Health Industry Alumni Association.
Mr. Terry is a thought leader and frequent speaker on bundle payments and other pay reform initiatives. He has been working on care and risk management with healthcare providers all along the continuum of care for over 20 years. Dave has worked within all types of reimbursement systems and has been focused on Bundle Payment Programs since Medicare created its first major demonstration in 2011. Dave’s mission is to fix healthcare reform by designing and implementing market leading bundle payment initiatives.
Throughout his career, Mr. Terry has served as a senior executive and trusted advisor to design, implement and measure effective payment strategies that deliver value to payors, and providers, and, ultimately, to patients. Some of his previous industry experience includes work with Partners Healthcare, Harborside Healthcare, and The Chartis Group.
He currently serves on the board of The Bottom Line, a national, educational non-profit, and is a past board member of the Harvard Business School Health Industry Alumni Association.
Mr. Terry is a thought leader and frequent speaker on bundle payments and other pay reform initiatives. He has been working on care and risk management with healthcare providers all along the continuum of care for over 20 years. Dave has worked within all types of reimbursement systems and has been focused on Bundle Payment Programs since Medicare created its first major demonstration in 2011. Dave’s mission is to fix healthcare reform by designing and implementing market leading bundle payment initiatives.
Peggy Crabtree, MBA, RN
Principal, Premier; Former Chief Executive Officer, Cardiology Consultants of the South Bay, El Segundo, CA (Moderator)
Principal, Premier; Former Chief Executive Officer, Cardiology Consultants of the South Bay, El Segundo, CA (Moderator)
Mrs. Crabtree is a Principal in Premier’s Strategy and Advisory Consulting practice. She has over 30 years of clinical and operational experience in academic and community hospitals and ambulatory settings. She specializes in service line planning and integration, operational excellence through care redesign, bundled payment, physician alignment models, and pre-hospital merger and acquisition integration efficiencies. Prior to joining Premier, Ms. Crabtree was a vice president with The Camden Group and the practice lead for the clinical and operational improvement service line. She has held executive positions in many organizations including Providence/St Joseph, Adventist Health, Daughters of Charity, and Huntington Health Services as well as large physician organizations. She has been featured in Trustee, Becker’s Hospital Review, Payers and Providers, Physicians Practice, Governance Institute, and Issues in Oncology.
5:00 pm
Transition Break
Mini-Summit XV: Bundled Payment Updates
4:00 pm
Success in Physician Led Bundles
Nicholas Jewell
Program Manager, Stryker’s Performance Solutions, Cornwall, CT
Program Manager, Stryker’s Performance Solutions, Cornwall, CT
Nick Jewell is an experienced healthcare executive with a special focus on the shift to value-based medicine. He brings a wealth of knowledge and experience from many healthcare settings including private physician group practices and post-acute facilities. His expertise and time has been focused around CMS bundled payment models for physician group practices and acute hospitals. In his previous role, Nick assisted in implementing the largest private practice bundle for Medicare’s BPCI program.
Robyn McGann, MBA
Senior Consultant and BPCI Compliance Officer, Stryker Performance Solutions, Chicago, IL
Senior Consultant and BPCI Compliance Officer, Stryker Performance Solutions, Chicago, IL
Robyn McGann, Senior Consultant & BPCI Compliance Officer Robyn has over 20 years as a nurse executive with recent time spent as the COO of a large orthopedic surgical group. She brings a wealth of knowledge and experience from a variety of healthcare settings including hospital inpatient/outpatient specialty areas, ambulatory surgical centers, large physician multispecialty practices, home health care, and private practice billing and contracting. Robyn also has a background in geriatric population based risk mitigation and maintains this as a career focus. Because of her operational background, she is able to identify specific organizational opportunities for change that drive clients towards success in today’s reform environment. Since 2012, Robyn has spent the majority of her time immersed in CMS bundled payment models with conveners, physician groups, and hospitals around the country.
4:30 pm
Non-elective Bundles
Bipin Mistry, MD, MBA
Vice President and Senior Medical Director, Remedy Partners, Darien, CT
Vice President and Senior Medical Director, Remedy Partners, Darien, CT
Dr. Mistry is Vice President, Senior Medical Director at Remedy Partners providing clinical and strategic guidance to providers and health systems on government and commercial bundled payment programs. In addition, he is developing the episodes of care benefit design and commercial product offerings. As a physician executive he has worked in strategic growth for health care systems. Prior to Remedy Partners, he was a Senior Research Fellow at Harvard Business School working with Professor Michael Porter and Professor Robert S. Kaplan. His research has been focused on Value Based Health Care. He is board certified in Internal Medicine, a member of the Royal College of Physicians (Ireland) and a Senior Fellow in Hospital Medicine.
Devon Zoller, MD
Chief Medical Officer, Transitional Care, Sound Physicians, Tacoma, WA
Chief Medical Officer, Transitional Care, Sound Physicians, Tacoma, WA
Dr. Zoller is the Senior Physician executive for Sound Physicians’ Transitional Care service line. Under this program, care delivery is provided under a risk-based model of healthcare, specifically Medicare’s Bundled Payments for Care Improvement initiative (BPCI). Dr. Zoller currently leads through matrixed relationships across more than 3,000 providers in 34 states. He has held previous leadership roles as associate medical director, chief hospitalist, medical director, and market medical director for Sound Physicians. In addition, Devon previously practiced as a primary care physician and is still active as a practicing hospitalist.
5:00 pm
Transition Break
Mini-Summit XVI: Case Studies in Successful Integrated Value-based Care
4:00 pm
BPCI Advanced Episode Selection: Analytic Framework and Strategies from Northwestern Medicine
Jessica Walradt, MS
Manager, Value-based Care, Northwestern Medicine; Former Lead Specialist, Value-based Care Models, Association of American Medical Colleges (AAMC), Chicago, IL
Manager, Value-based Care, Northwestern Medicine; Former Lead Specialist, Value-based Care Models, Association of American Medical Colleges (AAMC), Chicago, IL
Jessica Walradt currently manages Northwestern Medicine’s engagement in BPCI and BPCI Advanced. Prior to this, she led AAMC’s data, policy and advocacy efforts related to alternative payment models. In this role, she supported the bundled payment implementation efforts of over 60 hospitals/PGPs through numerous efforts including episode selection, the development of gainsharing methodologies, and successfully advocating for programmatic improvements, Jessica completed graduate internships with Partners HealthCare and the White House Office of Management and Budget.
4:30 pm
A Case Study on Post-Acute Care Costs: Overcoming a Roadblock on the Path to Shared Savings
Craigan Gray, MD, MBA, JD
Chief Medical Officer, Salient Healthcare; Former Director, North Carolina Medicaid, DHHS; Former Vice President for Medical Affairs, Bon Secours Health System Kentucky, Wake Forest, NC
Chief Medical Officer, Salient Healthcare; Former Director, North Carolina Medicaid, DHHS; Former Vice President for Medical Affairs, Bon Secours Health System Kentucky, Wake Forest, NC
Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings a rich experience from private practice, hospital leadership, and a governmental health-benefit program. His time as VPMA at Bon Secour’s Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS quality indicators. Dr. Gray is a Stanford University trained obstetrician/ Gynecologist with a preceptor/fellowship in the surgical management of breast disorders and breast cancer at the Royal Marsden Hospital in London. He is actively licensed in medicine and law. He is a Certified Physician Executive (CPE) and is published in various medical journals and on Salient’s blog.
Amy Kotch, MHA
Senior Business Consultant, Salient Healthcare, Fort Lauderdale, FL
Senior Business Consultant, Salient Healthcare, Fort Lauderdale, FL
Amy Kotch is Salient’s Lead Business Consultant working with ACOs nationwide. She recently completed a master certification in population health through a federal grant from the Office of the National Coordinator for Health Information Technology in conjunction with the Johns Hopkins University and Normandale Community College. Her prior work includes being the operations coordinator at Triple Aim Development Group consulting with ACOs and MSOs nationwide.
5:00 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP IV: 5:15 pm – 6:15 pm
(Choose one Mini Summit only)
Mini-Summit XVII: MACRA: Integrating MACRA into Your Strategic Plan
5:15 pm
Introductions, Panel Discussion and Q&A
Lauren Seno, MA
Director, Payment and Policy, Sg2, Chicago, IL
Director, Payment and Policy, Sg2, Chicago, IL
As a member of Sg2’s Intelligence team, Lauren Seno works with clients to understand the strategic implications of policy developments at both the federal and state level. She leads on-site and virtual presentations related to payment and policy topics, including alternative payment models, MACRA strategy and the evolution of value-based care, and works with Sg2 senior thought leaders to develop research publications and presentations related to enterprise strategic planning and value-based care.
Prior to joining Sg2, Lauren was a dedicated advisor at Advisory Board, where she worked with hospital leadership to leverage performance technologies for quality and utilization management with a specific focus on the CMS Hospital Readmission Reduction Program.
Prior to joining Sg2, Lauren was a dedicated advisor at Advisory Board, where she worked with hospital leadership to leverage performance technologies for quality and utilization management with a specific focus on the CMS Hospital Readmission Reduction Program.
Valinda Rutledge, MBA
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Moderator)
Vice President, Public Payor Health Strategy, Care Coordination Institute, Greenville Health System; Former Group Director, Patient Care Model Group and BPCI Lead, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Greenville, SC (Moderator)
Valinda Rutledge is the Vice President, Public Payor Health Strategy in the Care Coordination Institute at Greenville Health System, SC. She is responsible for identifying, analyzing, and supporting the implementation of opportunities related to government initiatives such as Bundled payments, Medicare advantage, Medicaid pilots, Dual Eligible, PCMH, and ACOs. She is also the Executive Policy Advisor at Parkland Center for Clinical Innovation (PCCI) in Dallas and the Chair of the PCCI Scientific Advisory Group. She previously worked as a member of the leadership team (Senior Advisor and Group Director) at the Center for Medicare and Medicaid Services Innovation (CMMI). Before joining CMS, Ms. Rutledge served as the Chief Executive Officer of several systems including Bon Secours, SSM Health, and CaroMont Health. She currently serves on several National Scientific Advisory Boards including NaviHealth and as a Subject Matter Expert for SG2.
6:15 pm
Adjournment
Mini-Summit XVIII: Bundled Payment Updates
5:15 pm
Examining BPCI Advanced: How Have We “Advanced” Since the Original Models?
L. Daniel Muldoon, MA
Healthcare Consultant, Milliman; Former Health Insurance Specialist, Center for Medicare and Medicaid Innovation, New York, NY
Healthcare Consultant, Milliman; Former Health Insurance Specialist, Center for Medicare and Medicaid Innovation, New York, NY
Daniel Muldoon is a healthcare consultant with the New York office of Milliman.Daniel has an extensive background in healthcare payment reform and value-based contracting. This includes designing and implementing episode-based payment risk adjustment and pricing methodologies and analyzing administrative health insurance claims data. Prior to joining Milliman, Daniel worked as a technical advisor at the Centers for Medicare and Medicaid Innovation (CMMI), implementing and developing payment methodologies for CMMI’s episode-based payment models, including BPCI, OCM, CJR, and EPM.
Pamela M. Pelizzari, MPH
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services. New York, NY
Healthcare Consultant, Milliman; Former Senior Technical Advisor and Program Lead, Centers for Medicare and Medicaid Services. New York, NY
Pamela Pelizzari has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies, including developing gainsharing methodologies, claims adjudication techniques, and quality monitoring programs. Prior to joining Milliman, Pamela served as a senior technical advisor at the Centers for Medicare and Medicaid Services. She was responsible for developing and implementing novel payment methodologies such as the national Bundled Payments for Care Improvement models. She led the development of the Oncology Care Model and other specialty physicianfocused models. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders.
5:45 pm
Navigating Today’s CJR Bundled Payment Program
Dawn Rakiey, MA
CJR Coordinator, University Medical Center, Lubbock, TX
CJR Coordinator, University Medical Center, Lubbock, TX
Dawn Rakiey has been with University Medical Center in Lubbock, Texas for over 10 years. She holds a Masters of Physical Therapy from Texas Tech University Health Sciences Center with work experience as a therapist in acute care, home health, and the outpatient setting. She is currently the CJR Coordinator at University Medical Center with responsibility for total joint replacement pre-op education, CMS compliance, patient outcomes, and analytical data for all CJR elective total joint replacements, and hip/femur fracture patients. She also oversees Medicare Spending Per Beneficiary (MSPB) data as well as UMC’s Preferred Provider Post-Acute Care Network for the hospital.
6:15 pm
Adjournment
Mini-Summit XIX: Bundling Oncology: Managing High Intensity Patients in Alternative Payment Models
5:15 pm
Bundling Oncology
Celeste Roschuni, PhD
Design Research Lead, Tuple Health, Washington, DC
Design Research Lead, Tuple Health, Washington, DC
Celeste Roschuni is the Design Research Lead at Tuple Health, focuses on creating human-centered technologies and services for healthcare. Her expertise centers on understanding clinical workflows, payment models, and patient experiences from the end user’s perspective, drawing on diverse fields including service design, anthropology and engineering. She has taught human-centered design at UC Berkeley, the California College of the Arts, and the University of Maryland. Prior to Tuple, she spearheaded TheDesignExchange.org: a joint project between UC Berkeley and MIT on design methods and approaches.
Susanna Supalla, PhD
Tuple Health, Data Science Lead, Washington, DC
Tuple Health, Data Science Lead, Washington, DC
Susanna Supalla is a Data Science Lead at Tuple Health, where she works with hospital systems and practices across the country that are making the transition to value-based payment. In her role, Dr. Supalla leverages available data, including claims data, to identify and track opportunities for interventions and process improvement, all to empower clinicians to offer better quality care at a lower cost. Dr. Supalla’s past experience includes building predictive models, conducting surveys, and designing field experiments to increase the effectiveness and efficiency of organizations’ outreach efforts.
Basit Chaudhry, MD, PhD
Chief Executive Officer and Founder, Tuple Health; Former Medical Scientist, IBM, Washington, DC (Moderator)
Chief Executive Officer and Founder, Tuple Health; Former Medical Scientist, IBM, Washington, DC (Moderator)
Dr. Chaudhry is an internal medicine physician and medical technologist whose expertise focuses on clinical service redesign and the use of data analytics to improve clinical and financial performance in healthcare.
Tuple Health products focus on data analytics and technologies focused on clinical re-design and population health. Tuple Health provides services including payment model design and implementation, utilization and financial analysis, and support for value based contracting.
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.
Tuple Health products focus on data analytics and technologies focused on clinical re-design and population health. Tuple Health provides services including payment model design and implementation, utilization and financial analysis, and support for value based contracting.
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.
5:45 pm
Implementation of a Homecare-Based Bundled Payment Navigator Program
Heather Peiritsch, MSN, RN
Bundled Payment Program Manager, Abington Jefferson Hospital, Willow Grove, PA
Bundled Payment Program Manager, Abington Jefferson Hospital, Willow Grove, PA
Ms. Peiritsch serves as the Bundle Payment Program Manager at Abington Hospital Jefferson Health. In her role, she has helped to create the vision for the Bundle Program; oversees nurse navigators for both the bundle and 30 day readmission penalty programs. She has created a collaborative working group with post-acute skilled nursing facilities and has developed processes to enhance communication from inpatient to post-acute providers. Ms. Peiritsch works aggressively to prevent readmissions and participates on numerous safety initiatives throughout the organization. She also oversees the Telemonitoring Program for Jefferson Home Care and has created workflow processes for clinicians and staff. Ms. Peiritsch is a member of the Delaware Valley ACO Post-Acute Subcommittee. She currently is an adjunct professor at Pennsylvania State University, Abington Campus where she teaches nursing students.
6:15 pm
Adjournment
Mini-Summit XX: Key Issues in Accountable Care Implementation
5:15 pm
Pitfalls and Success Factors for ACOs under MSSP and NextGen Programs
Donald Lovasz
President and Chief Executive Officer, KentuckyOne Health Partners, Lexington, KY
President and Chief Executive Officer, KentuckyOne Health Partners, Lexington, KY
Christopher S. Stanley, MD, MBA
Director, Value Transformation Practice, Navigant; Former System Vice President of Population Health, Catholic Health Initiatives; Former Senior Medical Director and Chief Medical Officer, United Healthcare of Colorado, New Mexico, Wyoming and Montana, Denver, CO
Director, Value Transformation Practice, Navigant; Former System Vice President of Population Health, Catholic Health Initiatives; Former Senior Medical Director and Chief Medical Officer, United Healthcare of Colorado, New Mexico, Wyoming and Montana, Denver, CO
Chris Stanley has over 30 years of experience as a physician, health system and health plan leader. He is a former national leader of Population Health at Catholic Health Initiatives with 10 ACOs under MSSP Tracks 1 & 3 as well programs to effectively manage CHI’s 100,000 employees and dependents. Prior to CHI, he was a Medical Director/Chief Medical Officer with UnitedHealthcare, especially focused on value-based payment programs. At Navigant, Chris assists hospitals, health systems, physician groups and health plans to develop, implement and optimize value-based programs including total population health (such as ACOs/CINs) and bundle programs.
5:45 pm
Regional Benchmarking
Travis Broome, MBA, MPH
Vice President for Health Care Policy, Aledade, Inc.; Former Team Lead for Policy and Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Vice President for Health Care Policy, Aledade, Inc.; Former Team Lead for Policy and Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Travis Broome is Vice President of Policy at Aledade, a new company helping doctors stay independent and thrive in the transition to value based care. Joining Aledade early on, Travis helped Aledade grow from 2 ACOs to 20 ACOs. Today, he is a thought leader on accountable care and is responsible for strategy development, policy analysis and economic modeling. Prior to Aledade, Travis was a Regional Director at CMS. He earned his MPH and MBA from the University of Alabama at Birmingham.
6:15 pm
Adjournment
Mini-Summit XXI: The Use of Prospective Payment in Payment Bundles and ACOs
5:15 pm
Introductions, Panel Discussion and Q&A
Jennifer Mann
Senior Product Manager, Cognizant, Chicago, IL
Senior Product Manager, Cognizant, Chicago, IL
Jennifer Mann, Sr. Product Manager, with Cognizant Technology Services 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 plans. Worked with 2nd largest Federal employees’ health plan with responsibility for oversight of national provider networks with project and account management roles.
Jay Sultan
Vice President, Product Management, Cognizant, Watkinsville, GA (Moderator)
Vice President, Product Management, Cognizant, Watkinsville, GA (Moderator)
Jay Sultan is Vice President, Product Management at Cognizant. Sultan began work on implementing episodes for payment over 15 years ago and has authored two patents in payment bundling. He has participated in both commercial and the Centers for Medicare and Medicaid Services (CMS) payment bundling programs – for both retrospective and prospective episodes, and is currently working on one of the largest episode of care programs in the industry. Jay has served and/or still serves as subject matter expert in payment bundles to the CMS, several states, various non-profits (such as IHA), and over 100 payer and provider organizations.
6:15 pm
Adjournment
Agenda Links: Preconference/Day I | Day III