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Medicare Advantage Strategic Business Symposium


Designed specifically for Medicare Advantage providers and payers in the 50 states of the US, and Puerto Rico.
TBD
San Juan
Puerto Rico

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Conference Details:
Come be a part of the biggest Medicare Advantage conference anywhere! Our Medicare Advantage Business series returns to beautiful San Juan, Puerto Rico to discuss MA topics that pertain specifically to payers and providers. In 2012, 400 payers and providers came together to brainstorm and collaborate on the changing world of Medicare Advantage – Risk Adjustment, Star Ratings, ACO development, payer/provider collaboration & incentives, compliance, etc. Whether you are on the mainland, in Puerto Rico, or in the Virgin Islands, if you are working in Medicare Advantage, this is the conference for you!

Our speakers will come from all over and include health plans, physician groups, hospitals, service providers, government officials, and various trade association executives. The conference sessions will be conducted in English.

Sneak Peak at Topics to be Covered in 2013:
  • Getting Your Voice Heard in Washington
  • Transitioning to ICD-10
  • Strategies & Initiatives for Improving Star Ratings
  • Care Coordination Tools
  • Telehealth Technology in the Medical Home
  • Mental Health Spotlight: Quality Issues
AAPC
*This program has the prior approval of AAPC for 5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor
Who Will Attend:
This unique event has been researched and developed specifically for Medicare Advantage executives in the 50 states of the US, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. People who will benefit most from this conference will come from Hospitals and Community Hospitals, IPAs, Physician Groups, and Health Insurance firms.

Job titles include:

- Chief Executive Officers
- Chief Marketing Officers
- Chief Operating Officers
- Chief Compliance Officers
- Vice Presidents, Directors, Managers, and Analysts of:
  • Care Management
  • Utilization Management
  • Chief Actuaries
  • Inpatient Nurse
  • Observation Management
  • Disease Management
  • Quality Management
  • Case Management
  • Quality Improvement
  • Outreach Management
  • Care Coordination
  • Clinical Program Management
  • Medical Management
  • Health Promotion
  • Wellness
  • Compliance
  • Clinical Research
  • Medical Affairs
  • Health Economics
  • Patient Engagement
  • Network Contracting
  • Network Management
  • Provider Relations
Our conference will also appeal to:
  • Government representatives
  • Academics
  • Third-party administrators
  • Pharmacy Benefits Managers (PBMs)
  • Disease Management Companies
Hotel Info:
TBA
Conference Registration Prices:
First 200
After 200
Continental US:
Medicare/Medicare Advantage/Medicaid Health Plans, Physician Groups, Hospital & Government Employees
FREE
$495
Behavioral Health, Vision Plans, Dental Plans, Radiology, Vascular Access, Rehabilitation Services, Diagnostic Laboratory Testing Services
$495
Puerto Rico:
Medicare/Medicare Advantage/Medicaid Health Plans, Physician Groups, Hospital & Government Employees
Complimentary passes SOLD OUT!
Now $495
Service Providers
$1895

Register Now!

Group Discounts:
Register 3 people and receive 10% off ***
Register 4 people and receive 15% off ***
Register 5 people or more and receive 20% off ***

If you'd like to be invoiced, please submit your contact details on the registration page and select "Please invoice me" at the bottom of the page.

If you are interested in sponsorship, exhibiting, or speaking opportunities, please call 212-532-9898 or email information@opalevents.org
* TERMS & CONDITIONS
Subject to approval. To qualify you must be currently employed by a non-vendor company. Eligibility will be verified by conference producer. Opal reserves the right to allocate places and to refuse applications.

*Non-Sponsor Health Plans may receive a maximum of 5 complimentary registrations

*Health plans must be CMS approved as Medicare, Medicare Advantage or Medicaid health plans

***Registrations must be made online on the same date. Discount will be applied after all registrants have been received.

Registration price reflects $100 online discount
Media Partners:
Kong Push
Untitled Document
2012 Attendees & Agenda
CEO, Access Health Care Physicians
Chief Compliance Officer, Access Health Care Physicians
Executive Director, AE & Associates
Executive Director, Aguadilla Medical Services, Inc
Service Line Director, Strategic Analytics, Altegra Health
Vice President- Senior Economist, Altegra Health
Provider Relations Supervisor, American Family IPA
MRA Quality Assurance Senior Auditor, American Family IPA
Medicare Risk Adjustment QA Senior Auditor, American Family IPA
Supervisor Provider Relations Department, American Family IPA
Senior Executive Vice President, American Health Medicare
Vice President of Network Operations, American Health Medicare
Vice President of Finance, American Health Medicare
Chief Information Officer, American Health Medicare
Chief Medical Officer, American Health Medicare
Chronic Care Management Director, American Health Medicare
Quality, Delegated Entities, American Health Medicare
Vice President, Medicare Policy and Market Development, Amerigroup Corporation
Development, Planning & Director, Ashford Presbyterian Community Hospital
Doctor, Ashford Presbyterian Community Hospital
Financial Director, Ashford Presbyterian Community Hospital
Chief Executive Officer, Ashford Presbyterian Community Hospital
COO, Ashford Presbyterian Community Hospital
Educational Director, Asociacion de Facturadores Medicos de Puerto Rico
Executive Assistant, Asociacion de Facturadores Medicos de Puerto Rico
Executive Director, Asociacion de Facturadores Medicos de Puerto Rico
President, Asociacion de Facturadores Medicos de Puerto Rico
Trainer, Asociacion de Facturadores Medicos de Puerto Rico
Director, Asociacion de IPAS de PR
Director, Asociacion de IPAS de PR
Director, Atencion Medica En El Hogar
Administrator, Atencion Medica En El Hogar
Administrative Assistant, Atencion Medica En El Hogar
Social Worker, Atencion Medica En El Hogar
RN, Baltimore VA Hospital
CMO, Banner Health Network
Administrator, Bay Area Total Health
Director of Market Strategy, Blue Cross Blue Shield MA
Director II, Senior Markets Strategy, Quality & Medical Management, BlueCross BlueShield MI
Chief Medical Officer and Vice President of Healthcare Management, Blue Cross and Blue Shield of Oklahoma
Assistant Vice President, Bronx Lebanon Hospital Center
QI Manafer, CalOptima
Billing & Collection Administrator, Cardiovascular Center PR and the Caribbean
Executive Director Assistant, Cardiovascular Center PR and the Caribbean
Sub Executive Director, Cardiovascular Center PR and the Caribbean
Finance Director, Cardiovascular Center PR and the Caribbean
Health Information Administrator, Cardiovascular Center PR and the Caribbean
Auditor, Caribbean Medical Center
Administrator, Caribbean Medical Center
Doctor, Caribbean Medical Center
Billing Assistant, Carro Doctor’s Office
President of Managed Care, Castellana Medical Group
Executive Vice President, Central Massachusetts Independent Physician Association
Medical Billing, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Facturadora, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Facturadora, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Facturadora, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Facturadora, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Facturadora, Centro De Intervensiones Endovasculares Y Cirguia Cardiovascular
Billing, Centro Isabelino Medicina Avanzada
Billing, Centro Isabelino Medicina Avanzada
Billing, Centro Isabelino Medicina Avanzada
Billing, Centro Isabelino Medicina Avanzada
Executive Director, Centro Isabelino Medicina Avanzada
Chief Operating Officer, Chapters Health System
Chief Financial Officer, Chapters Health System
Chief Medical Director, Chapters Health System
Director of Process Improvement, Citizens Choice Health Plan
Executive Vice President of Operations, Citizens Choice Health Plan
Utilization Management Director, Clinica De Salud Familiar
Director, Clinica Española, Inc.
Medical Director, Clinica Española, Inc.
Director of Medical Records, Clinica Española, Inc.
Health Plan Specialist, CMS
Health Plan Specialist, CMS
Representative, CompCare Puerto Rico
Representative, CompCare Puerto Rico
Office Manager, CompCare Puerto Rico
Representative, CompCare Puerto Rico
Medical Director, CompCare Puerto Rico
President, Complex Care Solutions
Supervisor, Consolidated Radiology Complex
Supervisor, Consolidated Radiology Complex
Biller, CONSULTORIO DR. FERNANDO ZAPATER
Clerk, CONSULTORIO DR. FERNANDO ZAPATER
Clerk, CONSULTORIO DR. FERNANDO ZAPATER
Coder, CONSULTORIO DR. FERNANDO ZAPATER
Medical Biller, CONSULTORIO DR. FERNANDO ZAPATER
VP of Business Development & Healthcare Economics, CSI Infusion & Network Services
Billing Assistant, David Azzaro, Doctor's Office
Medical Director, David Azzaro, Doctor's Office
Facturador Medico, Dr. Luis Rodriguez Carrasquillo
Medical Management, Dr. Roberto H. Hau Rosa Office
QI Manager, Easy Choice Health Plan
Surgeon, Edmee Soltero, General Surgeon Office
CFO, Emerson Hospital
President, Fajardo Medical Group
CEO & President, Family Physicians Group
Owner, Felix Maldonado, MD
Compliance Director, First Medical Health Plan
IT Director, First Medical Health Plan
Compliance Corporate Director, First Medical Health Plan
Senior Medical Director, First Medical Health Plan
Part D Compliance AVP, First Medical Health Plan
VPA Finance, First Plus Health Plan
Compliance Coordinator, First Plus Health Plan
Benefits Consultant, Florida Healthcare Plus
VP, Florida BlueCross Blue Shield
Senior Director, Florida BlueCross Blue Shield
Administrative Assistant, Gateway Health Plan
Principal, Gateway Health Plan
CEO, Geriatric Associates of America
CEO, Gorman Health Group
VP, Clinical Services, Gorman Health Group
V.P, Grove Hill Medical Center
Physician, GRUPO MEDICNA PRIMARIA
Medical Advisor, GRUPO MEDICNA PRIMARIA
Assistant, GRUPO MEDICNA PRIMARIA
Medical Director, GRUPO MEDICINA PRIMARIA
MD,MPH, Grupo Medico San Pablo
Sr. Business Manager/Administrator, Grupo Medico San Pablo
Chief Operating Officer, Gurabo Community Health Center
Billing and Collection Supervisor, Gurabo Community Health Center
Chief Executive Director, Gurabo Community Health Center
Chief Financial Officer, Gurabo Community Health Center
Pharmacy Services Director, Gurabo Community Health Center
Director of Medicare Programs Administration, Hawaii Medical Service Administration
Medical Program Administrator, Health Choice Arizona
Billing Supervisor, Health ProMed
Registration Supervisor, Health ProMed
Medical Record Supervisor, Health ProMed
Medical Director, Hector Luiz General Surgery
VP Health Services, HealthSpring
VP of Human Resources, HealthSpring
VP of Network Operations, HealthSpring
VP of Contracting, HealthSpring
COO, HealthSpring
Director, HealthTrio
Health Information Manager, HIMA Group
HIM Manager, HIMA Group
Him Supervisor, HIMA Group
HIM Manager, HIMA Group
Billing Sub-Director, HIMA Group Sao Paolo
Medical Director, HIMA Group Sao Paolo
COO Director, HIMA San Pablo Fajardo Hospital
Emergency Room Director, HIMA San Pablo Fajardo Hospital
Senior Manager of Medicare, HMSA
Health Information Management Director, Hospital Buen Samaritano
Fiscal Services Manager, Hospital Buen Samaritano
Medical Director, Hospital Buen Samaritano
Medical Subdirector, Utilization Review Consultant, Hospital Buen Samaritano
Billing Manager, Hospital Damas
Manager of Contracting and Collections, Hospital Damas
Director of Home Care, Hospital Damas
Finance Director, Hospital Damas
Medical Director, Hospital Damas
Administrator, Hospital Damas
Medical Record Director, Hospital Damas
Supervisor Facturacion, Hospital Damas
Executive Director, Hospital Metropolitano De La Montana
Programas Institucionales, Hospital Metropolitano De La Montana
Facturación, Hospital Metropolitano De La Montana
Utilización, Hospital Metropolitano De La Montana
Medical Records Coordinator, Hospital Metropolitano De La Montana
Executive Director, Hospital Metropolitano Cabo Rojo
Billing Supervisor, Hospital Oriente
Medical Record Technician, Hospital Oriente
Administrator, Hospital Oriente
Billing, Hospital Oriente
Directora de Finanzas, Hospital Oriente
Agente de Cobro, Hospital Oriente
Utilization Supervisor, Hospital Oriente
Finance Director, Hospital Pediatrico Departamento de Salud
Executive Director, Hospital Pediatrico Departamento de Salud
Billing Director, Hospital Pediatrico Departamento de Salud
HISM Director, Hospital PR Medical Services Administration
Billing Department Director, Hospital Universitario de Adultos
Billing Department Director, Hospital Universitario de Adultos
Billing Manager, Hospital Universitario de Adultos
Finance Department Director, Hospital Universitario de Adultos
Utilization Director, Hospital Universitario de Adultos
Departmental Executive Officer, Howard University Hospital
Director, Humana
Sales Director, Humana
Project Manager, Humana
Project Manager, Humana
Delegation Compliance Manager, Humana
President, Humana
Compliance Director, Humana
Executive President, Instituto Gastroenterologia de PR
Administrator, Instituto Gastroenterologia de PR
Billing, Instituto Gastroenterologia de PR
Manager, Instituto Gastroenterologia de PR
Ambulatory, James J. Peters VA Medical Center
Director Utilization, Kindred Healthcare
Sr. Manager Programs and Compliance, KPMAS
Owner, Laboratorio Clinico Cayabo
Manager, Laboratorio Clinico Cayabo
Secretary, Laboratorio Clinico Cayabo
Vice President, Laboratorio Clinico Michelsan
President, Laboratorio Clinico Michelsan
Physician, Laboratorio Clinico Michelsan
Physician, Laboratorio Clinico Michelsan
Medical Director, Lynette Ortiz, Internal Medicine
Administrator, M&Y Medical Services
Admin, Manati Physician Group
Admin, Manati Physician Group
Gerente, MAPFRE
Controller, MAPFRE
Gerente, MAPFRE
Assistant VP IT Health Applications, MAPFRE
Eligibility Department Supervisor, MAPFRE
Gerente, MAPFRE
Quality Representative, MAPFRE
Utilization Coordinator, MAPFRE
Senior Vice President, MAPFRE
VP Auxilar, MAPFRE
Utilization Management Director, Mayaguez Medical Center
Case Manager Nurse, Mayaguez Medical Center
Physician Advisor, Mayaguez Medical Center
Senior Director, Mayo Clinic, Abu Dhabi
Administrator, Medical Interventions
Billing Assistant, Medical Office of Dr. David T. Sicard
Factruradora, Medical Office of Dr. David T. Sicard
Chief of Radiation Oncology, MedStar
RN Clinical Case Manager, Medstar Georgetown University Hospital
Compliance Assistant, Metro Pavia Health System
Corporate Compliance Director, Metro Pavia Health System
Utilization Review Corporate Director, Metro Pavia Health System
Corporate Business Manager, Metro Pavia Health System
Clinic, Migrant Health Center
MD, MSO of Puerto Rico
Family Medicine, MSO of Puerto Rico
Family Medicine, MSO of Puerto Rico
Medical Director, MSO of Puerto Rico
SMA President, MSO of Puerto Rico
AVP Contracting, MSO of Puerto Rico
CMO, MSO of Puerto Rico
Pheumo MSO, MSO of Puerto Rico
Provider Management Network Director, MSO of Puerto Rico
IM MSO MD, MSO of Puerto Rico
Administrator, My Family Medical Group
Corporate Assistant, Near North Health Services
Executive Director, Near North Health Services
Medical Director, Near North Health Services
Director of Finance and Accounting, Near North Health Services
Performance Measurement Specialist, NOVA Healthcare Consortium
SMP Counselor, Oficina del Procurador
SMP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Counselor, Oficina del Procurador
SHIP Program Coordinator, Oficina del Procurador
SMP Program Coordinator, Oficina del Procurador
Physician, Ofic. Dr. Ramsis F. Olazagasti
VP of Operations, Physicians Providers Network
Administrator, Plan de Salud del Hospital Menonita
Compliance Director, Plan de Salud del Hospital Menonita
Compliance Officer, PR Department of Health
CEO, Precision Health Systems
CPC-CDI Specialist, Preferred Care Partners
Director of Medical Economics, Preferred Care Partners
Director, PriceWaterhouseCoopers
Head, Government Programs Initiative, PriceWaterhouseCoopers
Physician, Primary Care Associates
President, Providers Network
HIM Administrator, Puerto Rico Medical Services Administración
HIM Director, Puerto Rico Medical Services Administración
Billing Director, Rafael Martinez, Doctor's Office
Medical Director, Rafael Martinez, Doctor's Office
Medical Director, Ramon Santiago General Surgery
Administrator, Recinto de Ciencias Medicas PPMI Carolina
Coordinator, Recinto de Ciencias Medicas PPMI Carolina
Administrator, Recinto de Ciencias Medicas PPMI Carolina
Coordinator, Recinto de Ciencias Medicas PPMI Carolina
Provider, RedMD
Director of CPS, RedMD
Administrator, RedMD
Medical Director, RedMD
President, R&R Business & Compliance Consulting
Medical Director, San Juan Aids Program (SJAP)
Manager, San Juan Aids Program (SJAP)
Quality Control Coordinator, San Juan Aids Program (SJAP)
Billing, San Juan Aids Program (SJAP)
Board Secretary, School of Public Health
Executive President,Sociedad De Educacion Y Rehabilitacion De Puerto Rico
Administrator, Sociedad De Educacion Y Rehabilitacion De Puerto Rico
Oficial Facturación y Cobro/Billing, Sociedad De Educacion Y Rehabilitacion De Puerto Rico
Gerente Centro de Ponce/ Manager,Sociedad De Educacion Y Rehabilitacion De Puerto Rico
Supervisor, Sociedad De Educacion Y Rehabilitacion De Puerto Rico
Administrator, Spine Sport & Manual Medicine Clinic
Billing Department, Spine Sport & Manual Medicine Clinic
VP of Operations and CEO, SHW Hadley
Chairman of Medical Department, Swedish Covenant Hospital
Sr. Medical Coder, Tactical Management Inc
Principal, Tactical Management
Vice President, Tactical Management
Vice President of Compliance, Therapy Network
Associate Medical Director, Therapy Network
Network Director, Therapy Network
Medical Director, Therapy Network
CEO, Therapy Network
Compliance Officer, Transamerica
Administrative Assistant, Triple S
Associate Medical Director, Triple S
Internal Audit Vice President, Triple S
Gerente, Triple S
Medicare Advantage Compliance Officer, Triple S
Medicare Advantage Compliance Officer, Triple S
Director, Quality Measurement and Analysis, UMPC Health Plan
Vice President, UMPC Health Plan
Professor, Universidad Interamericana de Puerto Rico, Recinto de Guayama
Professor, Universidad Interamericana de Puerto Rico, Recinto de Guayama
Professor, Universidad Interamericana de Puerto Rico, Recinto de Guayama
President and CEO, University Health Systems
Senior Vice President, University Health Systems
Director, Practice Development, University Health Systems
Director of Business Services, University Health Systems
Executive Vice President, Ambulatory Services, University Health Systems
School of Medicine Faculty Practice Plan, Executive Director, UPR School of Medicine
Payer Relationship Specialist, VA Caribbean Healthcare System
DSS Site Manager, VA Caribbean Healthcare System
Utilization Management Specialist, Veteran Affairs Hospital
CMO, Visiting Nurse Service of NY
Planning and Development Director, Visiting Nurse Service of NY
Billing, Vita Healthcare
Billing, Vita Healthcare
Billing, Vita Healthcare
President, White Cliff Corporation
Quality Management Director, White Cliff Corporation
Human Resources Director, White Cliff Corporation
Accounting Director, White Cliff Corporation
Faculty Medical Director, White Cliff Corporation
Medical Director, White Cliff Corporation
Compliance Manager, Weill Cornell Medical College
Utilization Management, WellMed Medical
Marketing Assistant, Your Home Advantage
2012 Agenda (current as of 11/28/12)
Past Conference Day One: Tuesday, December 4, 2012
10:45 am
Registration & Breakfast
11:45 am
Opal Events' Welcome
11:50 am
Chair's Welcome & Audience Demographics

Chair:
Quality, Delegated Entities, Medical Management Director, AMERICAN HEALTH MEDICARE, Puerto Rico
12:00 pm
Keynote:
Industry Update: How an Election, the Supreme Court, and CMS Are Changing the Game for MA
  • Washington leadership's agenda for Medicare: What to expect from Capital Hill
  • The effect of the ACA so far: What's changed, what's stayed the same, and what to anticipate looking ahead
  • CMS priorities for MA and their impact on industry trends: Keys to navigating the regulatory landscape successfully
Speaker:
CEO, GORMAN HEALTH GROUP llc, Washington DC
12:45 pm
Keynote:
Political Update: Election Digest What The Results Mean for the MA Marketplace

Speaker:
Managing Director, PRICEWATERHOUSE COOPERS, Washington DC
1:15 pm
Telemedicine: Its Impact on Patient Satisfaction and Outcomes
  • Payments systems and reimbursement of telehealth services
  • Telemedicine video conferencing
  • Medical home spotlight
Speaker:
Ambulatory Care Management, JAMES J PETERS VA MEDICAL CENTER, New York
2:00 pm
Mid-Afternoon Refreshment & Networking Break
2:30 pm
Case Study: Full-Risk MSOs Answer the Five Ws
Who, what, where, when, and why from globally capitated outpatient healthcare delivery systems:
  • Who
    • Identifying the players
      • Plans
      • Patient populations, SNP vs PFFS vs plain  old MAPD
    • MSO staff core competencies
      • Who does what
  • What
    • Delegation of services by plans
    • Fraud, waste and abuse and other mandatory annual training
    • MRA oversight
    • 5 STAR oversight
    • Utilization management
    • Appeals and denials
    • Managing the money
    • Case and care management
  • When
    • Sensitive time-frames
      • Upcoming deadlines for measures and impact on MRA and 5 STAR
  • Where
    • MSO vs provider office – where does the responsibility lie
  • Why
    • Because we said so...?
Speakers:
Chief Compliance Officer, ACCESS HEALTH CARE PHYSICIANS, Florida
CEO, ACCESS HEALTH CARE PHYSICIANS, Florida
3:15 pm
Reducing the Medical Record Frustration for Both Providers and Plans
  • "Electronic Requesting" – introducing a new solution for health plans
  • Top 12 Provider Pain Points in the Medical Record Fulfillment Process
  • How to Reduce/Eliminate the Providers' Frustration
  • Increasing HIPAA Compliance in the Request/Delivery Process
  • How to Build Stronger Provider-Plan Relationships
Speakers:
SVP of HIM and Privacy Officer, HEALTHPORT, Georgia
Vice President of Sales, Health Plan Solutions, HEALTHPORT, Georgia
Regional Director of Sales, Provider Solutions, HEALTHPORT, Georgia
4:00 pm
Executing a Win-Win Clinical Documentation Plan
  • Engaging physicians at the right level
  • Creating a feedback loop towards improving:
    • Coding
    • Quality measures
    • Care management
  • Monitoring progress with efficient and effective tools
Moderator:
President, CEO, SIRENA COMMUNICATIONS, Florida

Panelists:
CPC-CDI Specialists, PREFERRED CARE PARTNERS, Florida
Compliance Manager, Department of Emergency Medicine, NEW YORK PRESBYTERIAN HOSPITAL - WEILL CORNELL MEDICAL CENTER, New York
Chief Medical Coder & Project Manager, TACTICAL MANAGEMENT INC, Florida
4:45 pm
Population Health Management: Integrating Quality, Utilization and HCC Risk Adjustment into Your Member and Provider Engagement
Medicaid, Medicare and Integrated Plans will need to employ a population health management approach to best serve their low, mid and high risk members.  Industry leaders are adopting an integrated approach that improves quality, utilization and risk adjusted revenue results.  This session will provide a practical framework for implementing population health management across each of your books of business.  It will provide you with a structured methodology for identifying and aligning members to proven interventions, aligning incentives with your health care providers and partners, and a mechanism to determine the effectiveness of your interventions.

Speakers:
Sr. National Medical Director, OPTUM INSIGHT, California
Sr. Vice President OPTUM INSIGHT, Minnesota
5:30 pm
Reducing Hospital Readmissions
  • Advanced illness management is crucial to reducing cost and improving the quality of life for those with life limiting illnesses
  • Palliative care can reduce readmissions and generate a return on investment
  • Quality metrics tied to palliative care are important to evaluate the programs impact
  • Targeting members who are most likely to benefit from advanced illness care is important to achieve quality and cost benefits
Speaker:
Chief Medical Officer, VNSNY CHOICE HEALTH PLANS, New York
6:15 pm
Day One Adjourns; Cocktail Reception Immediately to Follow
Population Health Management
Thank you to our Cocktail Sponsor!
Past Conference Day Two: Wednesday, December 5, 2012
7:00 am
Breakfast & Check-In
8:00 am
Chair's Day Two Welcome Back

Chair:
Quality, Delegated Entities, Medical Management Director, AMERICAN HEALTH MEDICARE, Puerto Rico
8:05 am
Keynote
Payment Reform as the Key to Healthcare Reform
  • Implementing a plan to keep the increased cost of care on par with inflation and implementation of true pay for quality
  • Quality payments
  • The base payment system
  • Alternative financial models
  • Outsourcing the revenue cycle: Viable?
Speakers:
Senior Vice President, UNIVERSAL AMERICAN, Illinois
SVP Analytics, UNIVERSAL AMERICAN corporation, Illinois
8:45 am
The Failures of Disease Management and the New Paradigm of Impactability

Speaker:
President, COMPLEXCARE SOLUTIONS, New York
9:30 am
DUAL ELIGIBLES ROUNDTABLE DISCUSSION (PART 1)
  • Global capitation for Medicaid managed care
  • Integration demos: BH/PH integration & Medicaid/Medicare integration
  • Integration Part 2: Acute/long-term care integration
    • Specialty medical home models (serious mental illness, spinal cord
      issues, movement disorders, etc.)
  • SNPs
Panelists:
Vice President, UPMC HEALTH PLAN INC., Pennsylvania
Vice President, Medicare Policy and Market Development, AMERIGROUP CORPORATE, Virginia
MBA, DDS, Vice President, Medicare, GATEWAY HEALTH PLAN INC., Maryland
10:00 am
PART 2: DUALS DEMONSTRATIONS

Speaker:
Vice President, Medicare Policy and Market Development, AMERIGROUP CORPORATION, Virginia
10:30 am
Mid-Morning Refreshment & Networking Break
11:00 am
Quality Measures Panel Discussion
  • Supporting improved quality reporting: Spotlight on EMRs
    • Which EMRs are doing the best to support improved quality reporting? How?
  • Stars focus: Member engagement as the next frontier for stars
    • How to engage members and motivate them to action
    • How to cut through your own plan's clutter to engage your members touch points across the enterprise
  • HEDIS spotlight: Improving screenings for breast and colorectal cancers (American Health Medicare case study)
  • Medication management: It's role in care management and it's importance for Star Ratings
  • New strategy spotlight: Inserting process improvement engineers into your Quality Committee Panelist:

Moderator:
 CEO, GORMAN HEALTH GROUP, Washington

Panelists:
Performance Measurement Specialist, NOVA HEALTHCARE CONSORTIUM, Maryland
Quality, Delegated Entities, Medical Management Director, AMERICAN HEALTH MEDICARE, Puerto RIco
Chief Medical Officer, VNSNY CHOICE HEALTH PLANS, New York
11:45 am
Quality Measures, Part 2: Star Ratings Case Study

Speaker:
Medical Director, Senior Products, TUFTS HEALTH PLAN, Massachusetts
12:15 pm
Luncheon
1:15 pm
Engaging Your Dual Eligible Population: Meeting Their Unique Needs by Extending Beyond Traditional Outreach
  • Boost chronic disease management, education and member satisfaction by leveraging dynamic, member-specific multi-channel communications
  • Help your care managers work more efficiently, while simultaneously engaging members to improve quality performance and satisfaction.
  • Take a holistic approach to health: address socioeconomic factors that directly effect member health by enrolling members in community program.
Speakers:
VP, Sr. Economist, ALTEGRA HEALTH, Arizona
VP, ALTEGRA HEALTH, Arizona
2:00 pm
New Programs: Creating a Pipeline to Reduce Cost Trends... While Not Loosing the Old Programs

Speaker:
National Medical Director, Medicare, AETNA, New Jersey
2:45 pm
Mid-Afternoon Refreshment & Networking Break

3:15 pm
Revenue Management: Risk Adjustment and the Impact on Providers
  • Evaluation of RAF on contract terms
  • Physician revenue enhancement strategies:
    • IT tools
    • PCP Capitation Adjustment
    • Surplus distribution
  • Coding compliance
Speaker:
Executive Vice President, CENTRAL MASSACHUSETTS INDEPENDENT PHYSICIAN ASSOCIATION, Massachusetts
3:45 pm
ACOs Spotlight
  • Turning heads: Can you compete with ACOs?
    • Are ACOs competitors to the MA plans? Or are they feeders?
    • Competing for attention from members with ACOs and other demonstration projects
  • ACOs and clinical integration: The scales are balanced  
Speakers:
President & CEO, PENDULUM HEALTHCARE, Illinois
BLUE CROSS BLUE SHIELD, Massachusetts
4:45 pm
Puerto Rico Market: In-Depth Spotlight Session
  • Key differences between PR and mainland care delivery
    • Areas to focus on
    • The managed care market in PR
  • keys to developing good monitoring programs
  • Quality improvement case studies
  • Clinical quality focus
  • Update on the Partnership for Patients Hospital Engagement Network initiative
Speaker:
Associate Executive Director, HOSPITAL ASSOCIATION OF PUERTO RICO, Puerto Rico
6:15 pm
Symposium Adjourns
Register:
Service Providers
$1,895.00
:
Behavioral Health, Vision Plans, Dental Plans, Radiology, Vascular Access, Rehabilitation Services, Diagnostic Laboratory Testing Services
$495.00
:
Puerto Rico: Medicare/Medicare Advantage/Medicaid Health Plans, Physician Groups, Hospital & Government Employees*
As of 8/13/2012, the first 200 free passes have been claimed. Register now for the discounted rate of $495.00
$495.00
:
Continental US: Medicare/Medicare Advantage/Medicaid Health Plans, Physician Groups, Hospital & Government Employees*
First 200 Free
Regular Price: $495.00
Price: $0.00
:
Pending Registrations
You have 1 registration pending.
Sub-Total: $537.00
    register now
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