Opal Events - Medical Management in Medicare Advantage: Payer/Provider Collaborative Care Summit

Opal's Life Sciences, Pharmaceutical and Healthcare Events

2nd Annual Medical Management in Medicare Advantage: Payer/Provider Collaborative Care Summit

August 25-26, 2011

Hyatt Regency Mission Bay Spa and Marina, San Diego, CA

	VIEW CONFERENCE DETAILS
	(Agenda current as of 8-24-11)

2011 Attendees:

Partner / Administrator, 4C Medical Group
DVP, Corporate Accounts, Abbott
AE & Associates
President/CEO, AE & Associates
Medical Economics Consultant, Aetna
National Medical Director, Retiree Markets, Aetna
Vice President, Aetna
CFO, Affinity Medical Group
President, Alabama Physical Rehabilitation Service
National Director of Quality, Alliance Healthcare Services
Administrator, All-Inclusive Community Health Center
Billing Manager, All-Inclusive Community Health Center
Office Manager, All-Inclusive Community Health Center
Director of Medical Management, AltaMed Health Services Corp
Director of Quality Improvement & Patient Safety AltaMed Health Services Corp.
Medical Director Medical Management, AltaMed Health Services Corp.
VP & Chief Medical Officer, AltaMed Health Services Corp.
Clinical Research Manager, Anthem Blue Cross
COO, AppleCare Medical Group
Chief Medical Officer, Arizona Integrated Physicians
Principal, Ascendent Care
Clinical Intelligence Manager, Athena Health
Payer Outreach, Athena Health
Founder and Owner, Atrinea Health, LLC
CFO, Bakersfield Family Medical
HCC Department Supervisor, Bakersfield Family Medical
Admitting, Banner Health
Chief Medical Officer, Banner Medical Group
Director, Bear Valley Community Healthcare District
Director, Medicare Revenue, Blue Shield of California
Regional Medical Director, Blue Shield of California
Director, BlueCross BlueShield of Florida
Director, Managed Care Contracting, Brown & Toland Physicians
VP, Government Affairs, California Association of Physician Groups
Medical Office Specialist/Biller/Coder, Capital Colon and Rectal Surgery
Practice Manager, Capital Colon and Rectal Surgery
VP of Medical Services, Care1st Health Plan
President, CareMore Health Plan
President & CEO, Care Continuum Alliance
EVP Business Development, Care to Care
Administrator, Carriage House
SVP and Chief Medical Officer, Catholic Health Initiatives
Chief Executive Officer, Center for Neurosciences
Administrator, Central Medical Clinic, Inc.
Director, Provider Relations, CEP America
Administrator, Charles W. Jackson MD, Inc.
Senior Manager of Primary Care Services, Cheyenne Health Services Management
Administrative Assistant, Children's Hospital Los Angeles
Director of Clinical Services, Chinese Community Health Plan
Executive Director, Chinese Community Health Plan
Manager, Quality, CIGNA Healthcare of Arizona
Clinical Program Manager Cigna Medical Group
Chief Financial Officer, Citizens Choice HealthPlan
Consultant, Citizens Choice HealthPlan
Consultant, Citizens Choice HealthPlan
HCC Auditor, Citizens Choice HealthPlan
HCC Project Manager, Citizens Choice HealthPlan
Senior Financial Analyst Citizens Choice HealthPlan
Senior HCC Manager, Citizens Choice HealthPlan
COO, Clinics of North Texas, LLP
Director Corporate Quality, Community Health Group
Strategic Planner, Comprehensive Care Management
Vice President, Strategy Planning and Analysis, Comprehensive Care Management
Information Systems Coordinator, County of Los Angeles
Director of Medicare/Medicaid Solutions, DCA
Senior Director of Risk Management, Patient Safety Officer, Desert Regional Medical Center
Director of Finances, ECS
VP of Sales, ECS
Clinical Service Manager, Edmonds Family Medicine
VP, Primary Care, Eisenhower Argyros Health Center
Interim Director, El Centro Regional Medical Center
CEO Episource
President, Episource
Manager, Episource
Executive Vice President, Essence Healthcare, Essence Healthcare
VP of Medicare Revenue Management, Freedom Health Inc
Senior Consultant, Gorman Health Group
SVP, Strategic Development, Gorman Health Group
VP of Medicare & Medicaid Services, Gorman Health Group
Executive Director, Grandview Terrace - Clinic
Director of Risk Adjustment, Greater Tri Cities IPA
HCC Supervisor, Greater Tri Cities IPA
Project Manager, Greater Tri Cities IPA
CMO, Group Practice Forum
Consultant, HCA - Sunshine Hospital
Vice President Clinical Assessments and Solutions, HealthCare Partners of Nevada
Integrated Care Manager, Health New England
Manager, UM, Health New England
COO, Health ProMed
Executive Director, Health ProMed
Human Resources Director, Health ProMed
Medical Director, Health ProMed
Organizational Director, Health ProMed
Medical Director, HealthSpan
Manager, Population Health HealthSpan
Chief Operating Officer, Hospitalists Now
Innovation Strategist Healthcare Analytics, IBM Research and The Patient Centered Primary
Care Collaborative
Medicare Project Manager, Humana PR
Sr VP Medical Management, IHC Health Solutions
PASS Operations Director, Independent Living Systems
VP, Business Development, Independent Living Systems
SVP Clinical Operations, Independent Living Systems
Director IT, Inter Valley Health Plan
Associate Medical Director/Network & Strategy, Kaiser Permanente
Senior Vice President, Keystone Mercy Health Plan
Senior Director, Member Services, L.A. Care Health Plan
Senior Medicare Operations Specialist, L.A. Care Health Plan
Assistant Risk Management, LAC USC Medical Center
Emergency Medicine QIM, LAC USC Medical Center
Medical Director, Utilization Review, LAC USC Medical Center
Chief Medical Officer, Leprechaun
Director of Corporate Training and Coding Services, Leprechaun
Director of Business Development, Leprechaun
Regional VP of Business Development, Leprechaun
Chief Medical Officer, Lifeprint Health
Physician Engagement Coordinator, Lifeprint Health
CFO, LightBridge Hospice and Palliative Care
Medical Director, LightBridge Hospice and Palliative Care

Contract Analyst, Loma Linda University Health Care
Contract Coding Specialist, Loma Linda University Health Care
Executive Director of IS & Decision Support, Loma Linda University Health Care
Project Manager, Loma Linda University Health Care
Consultant, Lychlyter Consulting
Chief Operations Officer, Martin Luther King, Jr. Multi-Service Ambulatory Care Center
Chief Medical Officer, Matrix Medical Network
Executive Vice President, Matrix Medical Network
Sr. VP Product Development, Matrix Medical Network
VP of Sales, Matrix Medical Network
Sr. Special Projects Manager, Revenue Cycle, Mayo Clinic
CEO, MD Care Health Plan
Director of Business Development, MedAssurant
Marketing Specialist, MedAssurant
SVP, Quality & Care Management, MedAssurant
Business Development Manager, MedeAnalytics
Chief Compliance Officer, MedeAnalytics
Director of Payer Solutions, MedeAnalytics
Risk Adjustment Director, Medicare Risk Adjustment
Executive VP, Business Development, MediConnect Global
Director, Revenue Enhancement, Memorial Health Care IPA
Manager, Managed Care & Planning, Memorial Sloan-Kettering Cancer Center
Executive Director, Mercy Physicians Medical Group
CEO, Mid Coastal IPA
Chief Medical Officer, Molina Healthcare of CA
Director of Admissions, Mount St Francis
Executive Director Health Services, Mount St Francis
Senior Consultant, National Research Network/DARTNet, American Academy of Family
Physicians
VP, Healthcare Services & Government Relations, NextGen Healthcare
Stragic Account Manager, NextGen Healthcare
SVP and GM Community Connectivity, NextGen Healthcare
Executive Director, NovaHealth, LLC
Chief Medical Officer, NOVA-Intermed
Senior Regional Account Manager, Novartis
VP, Accountable Care, Ochsner Health System
Physician, Omni Medical Group
Executive Vice President, Peak Health Solutions
National Sales Executive, Peak Health Solutions
Vice President of Product Development, Peak Health Solutions
Sr. Director, Team Leader, Pfizer
Director, Corporate Program Development, Physicians United Plan
CEO, Positively Kids
CEO, Precision Health Systems
Director of Commercial Operations, Primaris
Deputy CIO, Providence Health and Services
Director, Application Services, Providence Health and Services
Medical Practice Manager, Regional Medical Center
Business Development and Recruiting Consultant, Registry of Physician Specialists
Physician Recruiter, Registry of Physician Specialists
Quality Director, Riverside Physician Network
Director, Primary Care Clinics, Samaritan Health Services
Regional Operations Director, Samaritan Mental Health and Integrative Medicine, Samaritan
Health Services
CEO, San Diego Physicians Medical Group
Director, Network Management, San Diego Physicians Medical Group
Doctor, Santa Ana Health Center
HCC Director, SCAN Health Plan
Clinical Project Manager, Scripps Green Hospital
Clinical Information Systems Nurse Specialist, Scripps Health
Marketing Director, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Nurse Specialist Info. Services, Scripps Health
Scripps Health Plan Services, Scripps Health
Director, Quality, Scripps Medical Foundation
Manager, Quality, Scripps Medical Foundation
Program Director, Senior Health Insurance Program (SHIP)
Senior Vice President of Sales and Marketing, SeniorBridge
Vice President of Managed Care Sales, SeniorBridge
Vice President of Sales, Care Management, SeniorBridge
Senior Financial Analyst, Sharp Community Health Group
Coder, Sharp Health Plan
Coder, Sharp Health Plan
Coder, Sharp Health Plan
Claims Auditor Department of Defense, Sharp Health Plan
Claims Research Specialists, Sharp Health Plan
Claims Research Specialists,,Sharp Health Plan
Compliance Manager, Sharp Health Plan
Manager of Health Services, Sharp Health Plan
Manager Network Dev/Provider Services, Sharp Health Plan
Medical Director, Continuum of Care, Sharp Rees-Stealy Medical Group
CEO, Shova Healthcare
Director of Patient Care Services, Shriner Hospital For Children
Infection Control Coordinator, Shriner Hospital For Children
Student, Student
Quality and Risk Manager, Summit Orthopedics
CEO, Tampa Family Health Centers, Inc.
Deputy Commissioner, Texas Department of Insurance
CEO, TherAccess
Director of Operations, The Caring Connection
Owner/CEO, The Caring Connection
Project Director, The Caring Connection
Director of Business Development, Twin Cities Community Hospital
Regional Affiliations Officer, UC Davis Medical Center
SVP, Universal American
Managing Principal, University of California-Irvine
Director of Business Applications, University of Southern California
Research Associate, University of Utah, Department of Family & Preventive Medicine
Director, Project Management Office, Univita Health
Senior Program Manager, Univita Health
Senior Director of Operations, US Behavioral Health Plan
MD, Urology of Indiana
Director, Marketing Operations Tampa, WellMed Medical Management
Manager, Performance & Quality WellPoint
Senior Vice President WellPoint
RVP Medical Director, WellPoint
RVP, Network Management, WellPoint/Anthem
Senior Growth Lead, WellPoint/Anthem
Executive Director, West County Health Centers
Medical Director, West County Health Centers
Director of Nursing, Willow Urgent Care
Physician, Woodland Healthcare

Conference Day One

7:00a	Continental Breakfast & Registration
7:45a	Opal Events' Welcome
7:50a	Chair’s Welcome & Audience Demographics Conference Chair: Innovation Strategist Healthcare Analytics, IBM RESEARCH and THE PATIENT CENTERED PRIMARY CARE COLLABORATIVE
8:15a	Keynote Address: Improving Star Ratings by Intersecting Risk Adjustment and Care Management... for Payers AND Providers Perform baseline assessment that combines specific data streams to assess historical trends and root cause analysis Determine individual and synergistic Star Rating, risk adjustment and care coordination intervention strategies Foster collaboration across the provider network leveraging member-specific gap closure focus Create transparent mechanisms to review monthly progress versus plan, update intervention strategy and measurable ROI Speaker: Executive Vice President, Strategic Development, GORMAN HEALTH GROUP
9:00a	Practical Strategies: Provider Case Studies ACOs, Medical Homes, IDNs and other examples of evolving medical management; speakers will come from physicians groups and hospitals. Moderator: VP, Government Affairs, CALIFORNIA ASSOCIATION OF PHYSICIANS GROUPS (CAPG) Panelists: CEO, CAREMORE HEALTH PLAN Director, Managed Care Contracting, BROWN & TOLAND PHYSICIANS VP & Chief Medical Officer, ALTAMED HEALTH SERVICES
9:45a	Morning Refreshment & Networking Break
10:15a	How Medicare Payment Changes Foster Physician-Centered Medical Management How the HCC system changes medical management from a cost to a revenue center Why primary care physicians are critical in this new medical and revenue management paradigm The impact of these changes on traditional medical and disease management strategies Lessons learned in implementing innovative programs in this new environment Speakers: Chief Executive Officer, Precision Healthcare Systems VP and General Manager, HIE Connectivity Solutions, NEXTGEN HEALTHCARE
11:00a	Connecting the Dots Between Payer & Provider Quality Programs to Drive Alignment and Collaboration Understand how providers and payer collaboration improve Star Ratings Learn why aligning programs in quality, care and risk adjustment improve provider satisfaction Encourage providers and payer alignment to improve member health Speaker: Senior Director of Business Development, MEDASSURANT
11:45a	Technology Spotlight! Utilizing Technology to Enable a Smooth Transition of Care from Inpatient to PCP Objective: Improving outcomes by creating provider-friendly, actionable data: Developing data analytics to improve documentation and prospective evaluation of high risk patients Tools for risk adjustment Prospective referrals for case management, disease management, etc. Real time sharing portals ROI outcomes: Tangible and in-tangible returns Implementing this type of process/technology enables the providers to complete prospective assessments themselves versus the traditional use of "surrogate PCP networks" employed by a vendor Speaker: Director, Corporate Program Development, PHYSICIANS UNITED PLAN MEDEANALYTICS
12:30p	Luncheon with Keynote Speaker 12:45p Luncheon Keynote: Linking Care Management and Risk Adjustment Why claims data fails to identify members with greatest care management needs Benefits of in-home evaluations Impact on care management and RAF scores Using home evaluations to affect Star Ratings Speaker: Director of Corporate Training and Coding Services, LEPRECHAUN NOTE: The afternoon sessions will break into tracks for Payers and Providers.
1:30p	Payer Session: Health Plan Best Practices: Supporting the Patient-Centered Medical Home Strategy and goals: Defining what you want to accomplish and measure Infrastructure of medical management: Is your health plan team ready to help Designing the program offering: Addressing the various needs of your entire provider network... Speaker: President & CEO, Care Continuum Alliance	Provider Session: The Clinical Impact of ICD-10 Impact on the clinicians workflow How does a clinical observation, patient examination or procedure result in the proper ICD-10 coding of that diagnosis or procedure? What if documentation is not adequate to allow for proper coding using ICD-10? Speaker: Sr. Special Projects Manager, Revenue Cycle, MAYO CLINIC, AHIMA Approved ICD-10 Trainer
2:15p	Afternoon Refreshment & Networking Break
2:45p	Payer Session: New Strategies for Provider Contracting How provider contracting is changing New models for pay for performance (PFP)/pay for quality (PFQ) Speaker: CFO, AFFINITY MEDICAL GROUP Executive Director, NOVA HEALTH	Provider Session: Risk Adjustment & Star Ratings: Choose Your Own Adventure...Take Control of Your Destiny How provider groups can take control of their own destiny using risk adjustment and star ratings...your payers will love you for it! Speaker: MD, Chief Medical Officer, ARIZONA INTEGRATED PHYSICIANS
3:35p	Payer Session: Five Secrets of Accountable Care: Discover the Key Role that Health Plans Must Play in Facilitating Collaborative Care Incentive change Information liberation Speaker: President / COO, ESSENCE HEALTHCARE	Provider Session: P4P in California... And in the Future Speaker: MBA Medical Director, SHARP REES-STEALY MEDICAL GROUP
4:20p	Payer Session: Prospective Assessments and Medical Management: Emerging Opportunities to Create Value Prospective assessments: The current state-of-the-art science Impact of PPACA health reform and HITECH EHR stimulus funding HCCs in a broader context of integrated patient information and managing population health Prospective assessments: Creating value along the path from insight to action What will care management "networks" look like in the future Speaker: SVP, Product Development, MATRIX MEDICAL NETWORK	Provider track ends
5:05p	Day One Closing Remarks and Cocktail Reception in the Exhibit Hall

Conference Day Two

7:00a	Continental Breakfast & Registration
7:30a	Breakfast Session ACO Working Group "Workshop" ACO Feasibility, 90-Day Post Reg Launch Update & Thinking Ahead to Partial Capitation Regulations 90-day update Is your ACO planning on track...or off the rails? On the ACO sidelines? How do you know if ACO is right for you? Steps to Building an ACO: Resources available Checklist: Competencies required Benefit design CMS: What questions should you be prepared to answer? Payer contributions: Payment reconciliation Advanced member/customer service Panelists: VP Business Development, INDEPENDENT LIVING SYSTEMS Moderator: Open NOTE: Continental Breakfast & Registration will continue outside the ballroom for those not interested this early morning session.
9:00a	Chair's Day Two Welcome Back Conference Chairs: Innovation Strategist Healthcare Analytics, IBM RESEARCH and THE PATIENT CENTERED PRIMARY CARE COLLABORATIVE
9:05a	Keynote Address: Overview of the Political Regulatory Environment in Washington...And How it Impacts You Campaign environment: What happens if budget issues dominate? How do we move forward with mitigating against un-due risk? Balanced billing issues: Role of care coordination Role of quality Speaker: SVP, UNIVERSAL AMERICAN FINANCIAL CORP.
9:45a	Readmission Avoidance: A Critical Component of a Successful ACO Using analytics to identify high-risk patients Integrating patient care flows across the continuum Targeting and tailoring intervention to improve care transitions Connecting providers of care Bridging post-discharge care and population health management Speaker: SVP, Clinical Operations, independent living systems
10:30a	RADV Audits: A Veteran's Perspective Speaker: VP, Medicare Revenue Management, FREEDOM HEALTH INC.
11:00a	Morning Refreshment & Networking Break
11:15a	What Is the Role of Innovation in Health Care? Speaker: RVP, Network Management, WELLPOINT/ANTHEM Senior Consultant and Advisory Board Member, National Research Network at AMERICAN ACADEMY OF FAMILY PHYSICIANS and CINA
12:00p	Collaborative Team-Based Care: The Road to Outstanding Quality and Patient Satisfaction Learn about team-based collaborative care: Learn how to apply the care team structure to achieve "best in class" outcomes Achieve outstanding patient experience scores Gain the tools to go from "good to great" in patient engagement and service excellence Speaker: Executive Medical Officer, GROUP PRACTICE FORUM, Board Certified Diplomate, AMERICAN BOARD OF FAMILY PRACTICE
12:45p	Luncheon w/ Keynote Speaker 1:00p Lunch Keynote Risk Adjustment: A Clear and Compliant Vision A new way of managing hyour HCC score Retrospective: The good, the bad, the ugly Prospective: Your new best friend Reducing risk while driving revenue and member satisfaction Speaker: Sr. Vice President, GORMAN HEALTH GROUP
1:45p	Panel Discussion: Care Coordination Success Stories Panelists: Staff VP, Care Management, Senior Business, WELLPOINT/ANTHEM Chief Medical Officer, NOVA-INTERMED Moderator: National Medical Director, Retiree Markets, AETNA
2:45p	3-Part Medical Home Spotlight: Part 1: Back by Popular Demand! What Will the Patient-Centered Medical Home Look Like in 2014 and What Should You Do to Get There? Speaker: Vice President, Primary Care & DIO, EISENHOWER GEORGE & JULIA ARGYROS HEALTH CENTER
3:30p	Afternoon Refreshment & Networking Break
3:45p	3-Part Medical Home Spotlight: Part 2: The Medical Home Model A Look at What's Working CMS PGP demo Various market places: Urban, suburban, rural Speakers: Medical Director, WEST COUNTY HEALTH CENTERS Executive Director, WEST COUNTY HEALTH CENTERS and Vice Speaker, CALIFORNIA PRIMARY CARE ASSOCIATION BOARD
4:30p	Part 3: Performance Measurement, PCMH, and Lean Six Sigma: Entrepreneurial Innovation and Practice Transformation in Independent Clinics Tools of measuring provider and clinic performance Operations management using Lean Six Sigma in PCMH facilities Business fundamentals in successful primary care practices Profitability in volume-based reimbursement while preparing for and transitioning to value-based funding Speaker: Founder & Owner, ATRINEA HEALTH, LLC
5:15p	The Stars are Aligning for a Resurgence of Primary Care Speaker: Director, Managed Care Contracting, BROWN & TOLAND PHYSICIANS
6:00p	Conference Adjourns