Evaluating the Forces Shaping Healthcare in 2024, and what it means for leaders of health plans, life sciences, and digital health and other healthcare organizations

With 2024 underway, healthcare leaders must navigate an overwhelming array of challenges, from declining patient health and quality of care, to regulatory shifts and new market entrants.

Advisory Board's new report cuts through the noise to highlight the pivotal shifts happening in healthcare and what leaders must know to stay ahead, including:

• How healthcare organizations are evolving strategy amid the shift to ecosystem-based care
• How new technologies will shift care team roles
• How high-cost, bespoke therapies will shift traditional healthcare management

This CMS Hospice Provider Webinar addresses what providers need to know bbout Calendar Year (CY) 2024. The agenda includes: 
- Overview
- Hospice Benefit Component
- Returning Policies and Requirements for CY 2024
- CY 2024 Medicare Advantage Organization (MAO) Participants
- Billing and Claims Processes
- VBID Evaluation Report – Hospice Benefit Component
- Contacting the VBID Model Team

Access and convenience are the new benchmarks for organizations, even in healthcare. Yet, many make technology-focused decisions instead of prioritizing experience. Join us as we delve into the possibilities this evolving standard offers healthcare, from AI to telehealth, ROI to vendor relationships.

Key takeaways:

• Start with the customer experience and let technology follow, just like Steve Jobs advised.
• Focus on integrating AI where it adds value and don't feel pressured to develop a stand-alone AI strategy.
• Take an incremental innovation approach to drive meaningful change in healthcare organizations.

This 90 minute webinar eatures a panel of experts discusses the future of the public option in the U.S. healthcare system. Faculty includes John Baackes, CEO, L.A. Care Health Plan, Liz Hagan, Director of Policy Solutions, United States of Care, and Richard M. Scheffler, Professor of Health Economics, UC Berkeley. 

Although a public option health plan was stricken from the Affordable Care Act shortly before it was enacted in 2010, the idea never went away. Both Washington State and Colorado offer public option health plans on their ACA-compliant exchanges. A dozen more states – including healthcare influencers such as Minnesota and Nevada – either plan to offer public option plans on their exchanges, or are closely studying the situation.

Although the public option plans are different as originally conceived for the ACA, they still follow the same principal of a health plan with premiums and benefits closely regulated by the state government, with the intent of offering premiums lower than those offered by commercial payers.

Washington and Colorado’s experiences with the public option have had their share of teething pains, but regulators in both states are determined to offer such coverage for the foreseeable future. And with many other states potentially offering public option plans soon, this concept could not only be reborn and rejuvenated, but exert tremendous influence on healthcare delivery and payment in the future.

This session discusses:

• A brief history of the public option and why it has made a comeback
• What the public option looks like in Colorado and Washington State and what has been accomplished to date
• Issues with the new public option plans
• Which states are considering public option plans and their motivations
• The benefit and premium structure of public option plans
• How commercial payers are responding to – and participating in – public option coverage
• How hospitals, medical groups and other providers are responding to public option plans
• The structure and offerings of future public option plans

This webinar was recorded on Wednesday, October 25, 2023 and features a panel of distinguished healthcare labor experts examining the current workforce challenges in healthcare delivery, and how it might be addressed in the coming years. Faculty includes Eric Dickerson of Kaye/Bassman International, Matthew Fontana of the global law firm Faegre Drinker, and Elizabeth DuBois of COPE Health Solutions. 

The labor market in the United States has been tight in recent years, but perhaps no other sector is tighter than healthcare. The Health Resources Services Administration recently concluded that the U.S. needs more than 38,000 more physicians, dentists and mental health professionals than the number currently employed. The Bureau of Labor Statistics says there are currently more than 200,000 job openings for nurses, and that more than 30,000 new advanced practice nurses (nurse practitioners, nurse anesthetists, etc.) are needed every year through 2030 just to keep up with demand. The current workforce itself is traumatized, coping with such issues as job burnout and potential violence from patients and their family members

That the workforce shortage is chronic and current labor conditions are demanding at best means that providers and recruiters must think outside the box. As simply filling the positions is no longer feasible, they must work on creating education-to-labor pipelines. And they must also contend with dramatic changes to the workforce since the COVID-19 pandemic and factor in changes such as telemedicine and hybrid work arrangements.

A group of drugs known as glucagon-like peptides 1 (GLP-1) were originally developed to better manage diabetes. But GLP-1 drugs such as Ozempic, Mounjaro and Wegovy have more recently been used to combat obesity, with some users reporting weight loss of 60 pounds or more that remains permanent so long as they continue taking the medication. A new study released by the manufacturer of Wegovy also concluded that using the drug for weight loss reduces the risk of serious cardiovascular episodes by about 20%. Manufacturers are also formulating new GLP-1s that may be even more effective in achieving dramatic and permanent weight loss.

That begs the question: Will these drugs play a role in value-based care for patients with chronic conditions such as obesity, or will the cost of GLP-1s take such a proposition off the table?

Learning Objectives:

• What are GLP-1 drugs and how do they work?
• The GLP-1 price/cost curve
• The impact of GLP-1 on the health of patients/users
• Who is being prescribed GLP-1 drugs?
• How GLP-1s have been contributing to overall healthcare costs in the U.S.
• Will GLP-1 drugs impact the volumes of bariatric surgery?
• Employer, payer and provider opinions and responses to the use of GLP-1s for weight control
• What the future holds for GLP-1 drugs and value-based cared

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.4% in 2022, slower than the growth in 2021 at 2.6%. The Account and Membership Administration accelerated to an increase of 5.7% in 2022, up from an increase of 1.3% in 2021.

This analysis is based on the twenty-first annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of about 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of fifteen plans who collectively served 15.5 million people in comprehensive products. Ten of this year’s participants also participated in the prior year. The average plan participating in the Medicaid Sherlock Benchmarks this year served 1.0 million people under comprehensive products and the median membership was 675,000. The geographic reach of this universe extended from coast to coast.

Medicare-Focused plans experienced a 1.9% increase in administrative expenses from 2021 to 2022 compared with a 0.6% increase in the prior year. The largest cluster of functions, Account and Membership Administration, increased by 3.7%, shown in Figure 1. This is a more modest growth than reported by the Blue Cross Blue Shield and Independent / Provider – Sponsored universes despite Sales and Marketing growth being faster.

Eleven plans participated in the 2023 edition of the Medicare Sherlock Benchmarks, reflecting 2022 results. The participating plans collectively served 1.7 million Medicare Advantage members. These single state or regional plans served 16.4% of Medicare Advantage not served by the five largest share plans. An average of 30% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products, exceeded 20% of revenues in all cases, and was the plurality product in several cases. Eight plans participated in both the 2022 and 2021 benchmarking cycles and these were used for trend purposes.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of approximately 1,000 health benefit organization years.

CMS webinar regarding the Making Care Primary (MCP) Application process and timeline.

CMS is partnering with state Medicaid agencies and other payers in MCP states to align MCP and state programs. While CMS is implementing MCP for Medicare beneficiaries, other payers are encouraged to partner with CMS to realize the goals and elements of improved primary care across all patients, including those covered by Medicaid, commercial, and other payers. 

This webinar discusses the CMS payer partnership program for Makling Primary Care, the MCP model features, and next steps for payers interested in partnerships.

This 90 minute webinar features Katherine Hempstead of the Robert Wood Johnson Foundation, Robert Saunders of the Margolis Center for Health Policy at Duke University and Ronald Vance of Alvarez & Marsal Healthcare discussing how payers and providers might stand to benefit from the MCP model, and what concerns might need to be addressed as part of this HealthExecWire webinar event, What to Make of CMS’s New “Making Care Primary” Model.

Learning Objectives:

• Understanding the components of the Making Care Primary model, and how both providers and payers may benefit.
• How the MCP model might impact existing and future value-based care models.
• What may be required to participate in the MCP model initiative.
• What incentives CMS will be paying to participants, and what level of performance is expected.
• How findings from the MCP model might apply to providers and payers, whether MCP participants or not.

Independent / Provider - Sponsored plan cost growth sharply accelerated in 2022 based on the results of 9 continuously participating plans in the Sherlock Benchmarks. Total per member costs increased from an increase of 1.9% to an increase of 6.7%. After holding the universe’s product mix constant, the real cost growth was 7.5%, compared to a 4.2% increase in 2021.

This analysis is based on the twenty-sixth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by October, approximately 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation is open to all Independent / Provider - Sponsored Plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

Blue Cross Blue Shield cost growth sharply accelerated in 2022 based on the results of 14 continuously participating Plans in the Sherlock Benchmarks. Total per member costs increased from a 0% increase to an increase of 7.2%. After holding the product mix constant, the real cost growth was exactly the same, 7.2%, compared to a 0.4% decline in 2021.

The Sherlock Benchmarks are the health plan industry’s metrics informing the management of administrative activities. They are based on validated surveys of health plans serving 60 million Americans and provide costs and their drivers on key administrative activities.

Please join us  for this sixty-minute webinar in which Dr. Andrew Ziskind and Alan Trimakas of BDC Advisors explore the challenges and opportunities of value-based care and the role that CINs can play in improving patient outcomes and reducing costs. The evolution of the CIN model will be discussed, including its early focus on care coordination and its expansion to include a variety of stakeholders. The challenges facing CINs, including how to measure and demonstrate value, and how to optimize their operations and processes will be explored.  This means focusing on the 3-5 high impact areas that generate true value.   

The Medicare Shared Services Program (MSSP) offers significant benefits for patients, providers, AND payers. But there are substantial hurdles to implementation.

The Biden administration has announced its ambitious goal of “having all people with Traditional Medicare in an accountable care relationship with a health care provider by 2030.” Achieving this goal will require short- and long-term changes for a broad spectrum of healthcare professionals. To help you understand what’s happening - and what’s GOING to happen - HealthExecWire has teamed up with two top Washington attorneys on a new interactive webinar: MSSP, ACOs and You. 

Philo and Kevin will be answering these questions and more:

• What are the latest changes to the MSSP?
• How does CMS get us from the current system to an all-ACO model?
• What does this mean for providers in current Medicare value-based payment models?
• In what ways will the present ACO REACH program change?
• Will the patient experience be impacted?
• Integration of specialty care into ACOs – how will this be accomplished?

An Overview of Calendar Year (CY) 2024 Request for Applications (RFAs), Hospice Benefit Component Payment Methodology, and Application Process. The agenda includes:

Overview of VBID Model • What’s New for CY 2024? • CY 2024 Preliminary Hospice Benefit Component Payment Methodology • CY 2024 Application Timeline & Process • CMS Technical Assistance and Applicant Resources

Health plans know that the Medicare Advantage market is a crowded space—and that competition is fierce to attract seniors' attention. Success in Medicare Advantage is dependent on your ability to stand out—and grow—despite this crowded market. Join us as we explore three crucial levers to driving growth in Medicare Advantage products: crafting a desirable product, leaning on sales and marketing to enroll more members, and increasing the profitability of your current membership. This session will leave you with an understanding of not just where we're seeing growth in the Medicare Advantage space, but also why seniors choose MA over other products, how they receive and process information when shopping for MA plans, and where to improve marketing and outreach to prospective members. 

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.6% in 2021, a deceleration from 2020’s increase of 5.8%. Similarly, the Account and Membership Administration decelerated by 4.2 percentage points, from 5.5% to 1.3%. The rates of change reflected here hold both surveyed plans and their product mix constant in each year-over-year comparison. Cost trends in 2021 for both Core and Account and Membership Administration were below average, both of which were approximately 4%, since 2010. The cost trends for 2021 discussed are based on the results of ten continuous plans serving 11.2 million members in comprehensive products, of which 6.3 million were Medicaid or CHIP.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data.

Administrative expenses for Medicare-focused plans increased by 0.6% from 2020 to 2021. The largest cluster of functions, Account and Membership Administration, increased by 0.3%. Ten plans participated in the 2022 edition of the Medicare Sherlock Benchmarks, measuring 2021 data. The ten participating plans collectively served 12.3 million members. A median of 34% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products. Eight plans participated in both the 2021 and 2022 benchmarking cycles and these were used for trend purposes.

This analysis is based on the nineteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicare-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This 19th analysis of Medicare plans is based on a peer group of 10 plans who collectively serve 12.3 million people. Of the ten plans, eight were repeat participants from a year ago.

The Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and the Administration of Community Living (ACL) led a discussion on how VBID flexibilities are being leveraged to improve equity in transportation access at our Health Equity Incubation Program webinar event held on Thursday, September 15, 2022.

This event, the third in VBID’s series of Heath Equity Incubation Program (HEIP) webinars, began with an overview of the vital need and opportunity to address transportation barriers for Medicare beneficiaries as a means to improve health equity and beneficiary experience. The session started with a presentation by a panel of national experts highlighting the trends in transportation access, the economic and health burdens of transportation barriers, and evidence-based strategies to reduce transportation barriers. Next, the VBID Model team summarized how flexibilities in the VBID Model can be used to improve access and equity in care of enrollees facing transportation barriers. The webinar also featured a panel of leaders from UnitedHealth Group and Medical Card System to discuss their programmatic strategies, successes and challenges in using VBID flexibilities to improve transportation access for their enrollees. Following the panel discussion, the session concluded with an opportunity for attendees to ask questions.

Social determinants of health (SDoH) are the environmental conditions in patients’ lives – which can be social, economic, or physical – that contribute to or detract from health. Such factors can explain up to 60% of an individual’s health status.

In this webinar, Suzanne Doran and Emily Ferguson, Managing Editor and Associate Managing Editor for post-acute and case management content at MCG Health, dive into the expanding body of evidence supporting interventions to address SDoH. The presentation will cover foundational initiatives and activities designed to address SDoH, recent evidence for how SDoH impact different patient populations, and specific interventions to address SDoH such as food insecurity, inadequate transportation, and housing insecurity.

This 20th analysis of IPS plans is based on a peer group of fifteen Independent / Provider – Sponsored plans who collectively serve approximately 10.6 million people with Comprehensive products. In addition to the Comprehensive members, these plans also served 253,000 Managed Long Term Services and Supports members. We believe this universe to be quite robust. Participants in this year’s study serve about 52% of all membership in plans served by non-staff model plans of the Alliance of Community Health Plans and 35% of all membership served by commercial members of the Health Plan Alliance. The plans were geographically disbursed, serving 24 states.

Administrative expenses for the Independent / Provider – Sponsored plans increased in 2021 after experiencing a decline in 2020, but the rate of increase remained much lower than two years ago. Total expenses grew by 4.2%, which was higher than 2018 but well below the increase in 2019. The key area Account and Membership Administration, which composes 36% of total expenses, increased by 3.2%, but this was the second slowest rate since 2014.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 960 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation in this set is open to Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

For Blue plans, 2021 reflected trends in membership, the effects of cost management and a redeployment of expenses. Blues experienced a modest decline in costs, the first since 2015. Also, for continuous plans, this was the third year in a row of declines in the rate of growth. Total costs per member per month (PMPM) declined to a median decline of 0.4% from 5.2% in the prior year. The growth in in Account and Membership Administration (representing over 45% of all expenses) fell to 1.7% from 2.7% in 2020.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 950 health plan years. This 24th analysis of Blue Plans is based on a peer group of sixteen Blue Cross Blue Shield Plans who collectively serve approximately 49.1 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 71% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

Accountable Care Organizations participating in the Medicare Shared Program have already progressed through the spectrum of value based care arrangements, with many achieving measurable levels of success. This session addresses the potential to leverage that success further by transitioning to Medicare Advantage participation, including examination of a case study on enabling providers through a multiprogram IPA and ACO infrastructure forward/

During the session Medicare FFS ACO and Medicare Advantage program structures will be overviewed, compared and contrasted. The opportunities available with a collaborative value-based care approach under Medicare Advantage will be examined, with respect to how a standard approach to VBC can achieve success.

The National Hospital Acquired Conditions and Readmissions Summit is the leading forum on current CMS policy implications and reduction strategies for Hospital Acquired Conditions and Readmissions, including the latest in patient safety initiatives and technology-enabled solutions for transitions of care and patient engagement. The Summit will highlight successful hospital strategies and tools, but equally important will feature some of the important new partnerships and collaborations.

Day Two Agenda: Wednesday, May 11, 2022
“Hospital Acquired Conditions during COVID-19 hospitalization in a high-risk national population”
Florian B Mayr Assistant Professor of Critical Care Medicine University of Pittsburgh

“Three-Year Impact Of Stratification In The Medicare Hospital Readmissions Reduction Program”
Karen Joynt Maddox, MD, MPH, Co-Director, Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis

“Factors Associated With Disparities in Hospital Readmission Rates Among Dual Eligibles”
Demetri Goutos, MBA, Research Associate, Center for Outcomes Research and Evaluation, Yale/Yale New Haven Hospital Center

The National Hospital Acquired Conditions and Readmissions Summit is the leading forum on current CMS policy implications and reduction strategies for Hospital Acquired Conditions and Readmissions, including the latest in patient safety initiatives and technology-enabled solutions for transitions of care and patient engagement. The Summit will highlight successful hospital strategies and tools, but equally important will feature some of the important new partnerships and collaborations.

Day One Agenda: Tuesday, May 10, 2022
“CMS National quality strategy, patient safety and overall quality metrics”
Michelle Schreiber, MD, Deputy Director for Quality & Value, CMS, Clinical Standards and Quality

“Outlook from DC: What’s on the Horizon for Medicare Quality Programs”
Sheila Madhani, Vice President, McDermott+Consulting

“Patient engagement and Care in the home: Addressing utilization from the patient perspective”
Caroline Blaum, MD, MS, Senior Research Scientist, NCQA

The ACO REACH Model Team hosted a health equity webinar on Tuesday, April 5, 2022  The ACO REACH Model team highlighted Health Equity provisions added to the ACO REACH Model.

On February 24th, CMMI announced revisions to the Medicare FFS Global and Professional Direct Contracting (GPDC) model, which will now be re-branded as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. As part of this revision, there will be an application window for this program spanning March 7th through April 22nd.

This session will discuss this new program’s requirements and financial components, including how this program compares to the existing GPDC model as well as MSSP. Attendees will develop a deeper understanding of the ACO REACH model, and the pros and cons of joining or staying in the program vs exploring other options.

Please join us as speakers from WakeMed Key Community Care; UC San Diego Health; and MCG Health discuss how providers are leveraging MCG Health solutions for care coordination to develop high-quality care programs in the HealthcareWebSummit event co-sponsored by MCG Health: Value-Based Care and Care Coordination.

• Customer success stories in care coordination and value-based care
• Challenges to delivering value-based care that can be addressed by MCG solutions (today and in the future)
• How MCG solutions for care coordination and value-based care may support the goals of your organization

This webinar focused on the new financial policies featured in the ACO REACH webinar, providing financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model.

Prevailing attitudes about the future suggest that the health care industry is either approaching a new equilibrium or reverting to the pre-pandemic mean—but Advisory Board believes that the future is still unwritten, for the moment. While most health plans were generally stable throughout the pandemic and used excess strategically to make principled (rather than reactive) investments, leaders in other sectors are now finding themselves with their own unique—but time-limited—opportunities to shape that future.

This presentation will explore what health plans need to know about key structural shifts of the peri-pandemic period that may play out in different directions, depending on the actions taken by stakeholders across the industry in the near future. These include new price transparency requirements, value-based payment, physician alignment, virtual care, home-based care, and health equity.

What are the key healthcare business issues and trends for 2022, and how can you best position for them? Attend the Twentieth Annual Future Care Web Summit, which addresses these topics and more.

Noted national healthcare expert speaker Mark Lutes, the Chair of Epstein Becker Green, will address these three pivotal regulatory and policy questions: Where are primary care incentivization and delivery models going? Will digital health innovations find payment success? What will CMS and payor response be to genetic and other breakthrough therapies ?

National thought leader Paul Keckley takes us on a journey through key selected trends impacting such topics as healthcare private equity, inflation and pricing, the value-based agenda and more Paul Keckley is an intense observer of that change, diving deep into the trends, tipping points, intended and unintended consequences to bring clients and opinion leaders the unvarnished truth.

Chris Sukenik, Principal, BDC Advisors will highlight key market dynamics that will reshape the healthcare landscape in 2022 and beyond for payers and providers. Chris is a proven consulting leader and trusted advisor to senior healthcare executives with a focus on provider and payer healthcare markets.

Learning Objectives address in this session:
To recognize and recall the potential impact of major foreseeable trends in US healthcare in 2022
To be able to explain at least one action to mitigate risk and one action to seize opportunities for the participating organization

Anticipated Market Dynamics to be discussed:
A shift in the way digital health is delivered toward decentralization
The increasing role of AI to create insights and improvements to diagnostic capabilities and care pathways
The exponential rise in value-based objectives applied to more modalities in healthcare – Clinical, Operational and Financial

2022 Healthcare Trends  Addressed by Topic:
Provider consolidation
Private branded insurance products
Delayed / deferred care
Physician burden and migration
Managed Medicare

In this session, Milliman experts provide relevant, timely and useful information about the state of the MSSP ACO market. Given that MSSPs represent such a large portion of the Medicare FFS landscape, it is worthwhile to look at the available data for how ACOs have performed and evolved over time. We can then use this data to better understand what MSSP features may be associated with financial success. It is just as important to see what factors are not correlated with success or failure in the program.

In order to provide insights on these drivers, Milliman analyzed CY 2020 experience for MSSP ACOs as reported in CMS 2020 Shared Savings Program Public Use Files, as well as 2015-2019 PUFs, to identify and examine key MSSP trends and patterns in shared savings/loss rates, participation, and other key metrics.

Financial results for 2020 may have been materially impacted by the pandemic as well as CMS’s modifications to MSSP rules and regulations. Due to the potential for skewed results, as well as to highlight potentially longer-term observations, prior year savings outcomes were analyzed as well.

In healthcare, "gaps in care" refers to the gaps that exist between best practices and actual patient care. Closing these gaps is important to deliver value-based care and quality of care. Additionally, care gaps, when not properly managed, can be both harmful and costly. Reporting of open care gaps and closing care gaps is a core component of value-based care between payers and providers.

Health Level Seven International (HL7), the not-for-profit, ANSI-accredited standards developing organization, introduced Fast Healthcare Interoperability Resources (FHIR), to address interoperability challenges as "a new standard for exchanging healthcare information electronically. The HL7 FHIR standard is well-suited to form the basis of real-time API data exchange between applications, devices, and systems. The HL7 Da Vinci Project was born out of the need to accelerate FHIR adoption" to support and integrate value-based care and payment model data exchange.

Join this webinar to learn about leveraging claims and clinical history to inform potential care gaps that can be closed to improve HEDIS/STAR ratings and non-HEDIS measures.

In this session, Milliman experts present their findings that the drivers of recent success are quite different and, in some cases, the opposite of what they were in 2015. With Pathways to Success, CMS endeavored to reshape the MSSP by adjusting incentives, encouraging greater accountability in ACOs, and offering options specific to each ACO’s ability to take on risk. Their analysis gives early indication that these changes are rewarding ACOs for attained efficiency levels, possibly enhancing the attractiveness of the program. Furthermore, the authors also see evidence of at least some correlation between tracks with downside risk and higher gross savings, supporting CMS’s case for accountability as a policy priority, though voluntary track selection may also be playing a role. Lastly, the authors see some indication that ACOs strongly emphasizing primary care are having greater success than their peers.

Epstein Becker Green’s Helaine Fingold and Bob Hearn help stakeholders sort through the No Surprises Act with guidance on compliance and discussion of the issues, implications, and resulting opportunities, in the HealthcareWebSummit event: Making Sense of the No Surprises Act and Interim Final Rules.

In this session, Epstein Becker Green’s Helaine Fingold and Bob Hearn help to make sense of the Act, examine the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces, and discuss specific and “operationalized” guidance to providers, facilities, and health plans on complying with the Act, including its challenging interaction with state balance billing laws. Their insights are based on experience in this arena and are rededicated to deciphering the complex interaction between state law and the new federal law.

As part of the 21st Century Cures Act, the interoperability rule seeks to drive patient access to personal and medical data, and support the ability to share that data, allowing patients more power to coordinate their own healthcare. The rule bolsters the existing trend toward a more patient-focused model, empowering patients to participate more effectively in their own medical care and improve public health services. 

Payer organizations need to able to gather and share data around member costs and coverage, clinical interactions and other data points. All of these efforts aim to prevent information blocking and improve the flow of easy member access to or transfer of data. As payers plan for the future, they should look beyond current system data and consider use cases that may become possible with enriched data sets.

Watch this webinar to learn about the 21st Century Cures Act interoperability and what it means for data exchange for payers. As payers stand up their “Patient Access” APIs, there is an opportunity to look beyond compliance and embrace this new data standard to improve outcomes for their members.

Between 2019 and 2020, administrative cost growth for Medicare-focused plans accelerated from 5.2% to 5.6%, shown in Figure 1. Account and Membership Administration expenses lagged total cost growth, increasing by 1.8% and dropping sharply from last year’s rate of 9.3%. Thirteen plans participated in this year’s Medicare benchmarking study, collectively serving 12.2 million people. 

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 929 health plan years. This 18th analysis of Medicare plans is based on a peer group of 13 plans who collectively serve 12.2 million people. Of the thirteen plans, seven were repeat participants from a year ago. The average plan participating in the Medicare Sherlock Benchmarks this year served 1.2 million people and the median membership was 941,000. The geographic reach extended from coast to coast.

As payers look to uncover every possible recovery opportunity, identifying the proper liable party for payment of health care services is essential. Join this webinar to learn how to maximize the ROI of your subrogation strategy by understanding the key building blocks for success: 

• Breaking down the components of subrogation success

• Understanding both core and ancillary benefits of doing subrogation right

• Appreciating the differences between internal and outsourced subrogation efforts

• How to maximize the ROI of your subrogation program

Speakers: Debra Whaley, Senior Executive Subrogation Analyst, Trustmark Companies; Ryan L. Woody, Partner, Matthiesen, Wickert & Lehrer; Mara Gericke, Director of Subrogation Recovery Operations, Conduent; Moderator: Clive Riddle, President, MCOL

Subrogation is a critical element in ensuring payment integrity. Challenges for improving health plan subrogation recoveries include a multitude of factors such as: complexities in regulatory compliance; a relative “under-the-radar” level of c-suite awareness of subrogation performance issues in some organizations; the difficulty in capturing data identifying claims as subrogation-appropriate; the increased trend rate in accidental injuries and death; and Post-ACA expansion of coverage increasing the volume of potential claims to consider, particularly with the age 19-26 population that experiences a higher rate of accidental injuries.

Yet opportunities exist to meet these subrogation challenges. Advances in analytics provide enhanced capabilities in addressing high volumes of data and identification of potential subrogation claims.

Optimizing the success of health plan subrogation efforts requires a rich understanding of state and ERISA regulations and the skill to recognize the best path to claim resolution.  In this webinar our experts will share their insights on the rules governing healthcare subrogation and their experiences in maximizing results in the current subrogation environment.

Additional Tags: Claims, TPA, Third Party Administrator, Payment Integrity, Slef-Insurance, Self-Funding, Benefits Administration

• Enrollment, Utilization and Financial Data by Plan and by Category
• Trends in Enrollment Changes and Utilization/Financial Ratios
• Highlights of Recent Market Activity

MCOL has compiled key current and historical California Health Plan enrollment, utilization and financial data by plan and by selected categories, and has identified trends in changes in enrollment as well as in utilization and financial ratios. Significant recent market activity has also been highlighted for selected plans. This analysis provides the opportunity to consider the pandemic impact so far on these health plan indicators, and what are the trends and market activities driving the data. MCOL President Clive Riddle provides an interesting tour of the numbers and trends behind the current state of California health plans.

The pandemic has shifted how and where Americans gain access to care, a shift large enough to influence multiple aspects of price and utilization and, thus, medical cost trend. PwC tells us that the aftereffects of the pandemic and the health system’s response to changes and failures observed during the pandemic are expected to drive up spending (inflators) in 2022. At the same time, some positive changes in consumer behavior and provider operating models that occurred during the pandemic are expected to drive down spending (deflators) in 2022.

The impact of the COVID-19 pandemic on healthcare costs has become clearer. For the first time during the 16-year history of the Milliman Medical Index, healthcare costs decreased during the past year (between 2019 and 2020). Eliminated care more than offset the cost of COVID-19 testing and treatments in 2020. But in 2021, Milliman projects healthcare costs to grow again, with the cost of healthcare for a hypothetical family of four insured through an employer PPO standing at $28,256.

This session provides detailed discussion of medical cost trend calculations, projections, components and implications addressed in this year’s release of the PwC Behind the Numbers, and Milliman Medical Index Reports, with time provided for audience Q&A.

Additional Tags: cost, utilization, premium, self-insurance, self-funding, TPA

This analysis is based on the nineteenth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 929 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary.This 19th analysis of IPS plans is based on a peer group of 19 Independent / Provider – Sponsored plans who collectively serve approximately 9.6 million people, not including Managed Long Term Services and Supports and other products.

As payer telehealth policies evolve from short-term approaches in response to the pandemic, to longer-term approaches designed to recognize the opportunities for post-pandemic virtual-care; stakeholders need to be up-to-speed on the current state of telehealth reimbursement and contracting, as well as preparing for the future. In this disruptive environment, stakeholders also need to explore leveraging future opportunities such as remote patient monitoring, as well as understanding the return on investment that can be realized from increasing focus on virtual care.

This session begins with understanding current telehealth billing and coding and revenue cycle considerations, and will then explore opportunities to be successful in value-based and likely future performance-based virtual care arrangements.

Expense growth in 2020 for Blue Cross Blue Shield Plans was sharply lower in 2020 compared with 2019. Total costs per member per month (PMPM) growth declined to a median of 5.2% from 6.6% in the prior year, the slowest growth since 2016. The decline in Account and Membership Administration (representing over 45% of all expenses) was even more dramatic, falling to growth of 2.7% from 6.0% in 2019.

These results are excerpted from the Blue Cross Blue Shield edition of the 2021 Sherlock Benchmarks The Sherlock Benchmarks for Blue Cross Blue Shield Plans provide a window to health plan adaptation to this event and to how the Plans built for the future on this foundation. This 23rd analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve approximately 41.5 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 61% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

Collectively in 2020, the health plan operations of these Plans earned annual premiums plus fees of nearly $130 billion and nearly $230 billion in premium equivalents. The median Plan participating in the Sherlock Benchmarks this year served 2.1 million people. The Plans were geographically disbursed, serving 22 states. Thirteen of this year’s fourteen participants also participated last year.

Democrats in Congress and the states are devising strategies to expand health coverage — through the Affordable Care Act, Medicare, Medicaid and a “public option.” But progress remains halting, at best. Meanwhile, lawmakers in Washington may have to agree on how to control prescription drug prices if they wish to finance their coverage initiatives. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Michelle Andrews, who reported and wrote last month’s KHN-NPR “Bill of the Month” episode about a very expensive sleep study.

A presentation of Medicaid Managed Care Organization Enrollment data and trends for 2021

Join this webinar to learn about the No Surprises Act and what it means for provider data accuracy. As payers are grappling with payments and billing process changes, they might be missing the new rules about provider data accuracy that go into effect in January 2022. 

• New directory accuracy requirements
• What we might expect after January 1, 2022
• How this bill creates risk for payers and the best strategy to mitigate it

Providers move, stop accepting patients and leave insurance networks – causing provider directory inaccuracies. 30% of provider data changes every year and studies found over 45% of provider directory locations had at least one error. Health Plans need to bring their provider data into clearer focus – with greater accuracy - to comply with the new Federal No Surprises Act requiring constant continuous provider directory verification.

Differences in Social Determinants of Health contribute to the stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups, systematically limiting opportunities for members of some groups to be healthy. Interventions targeting SDoH have tremendous potential to narrow disparities across many chronic diseases by removing systemic and unfair barriers to practicing healthy behaviors.

The health and economic crisis stemming from the pandemic has magnified the systemic barriers to health and how they are particularly worse for marginalized groups. Though past and current efforts have focused on addressing health outcomes – racial and geographic health disparities – today’s social climate demands that stakeholders acknowledge how systemic racism and economic inequality are drivers of health inequities, which, in turn, perpetuate disparities.

How can health plans, health systems and other healthcare stakeholders engage to improve health equity through targeted SDoH initiatives? The panel of speakers in this session provide case examples on providing optimal care through the lens of SDoH for black women residing in medically underserved communities. Through tech-enabled and community-based service providers involving transportation, virtual care, and prenatal and postpartum care, these collective uses of service combined with culturally competent providers and technology could have a resounding effect to improve outcomes and reduce global maternal mortality.

CMS hosted a virtual office hour in which presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This session also offered attendees an opportunity to ask follow-up questions.

This session explores the current and future impact of COVID-19 on Alternative Payment Models for providers, examining the current state of APMs, the key effects of COVID-19 on the dynamics involved in provider payments, the impact of COVID-19 on the main types of APMs and the implications for providers considering current or potential risk-based contracting arrangements. 

Telehealth has achieved a new normal of acceptance and prevalence. Virtual care applications of all kinds have become mainstream tools. Many organizations admit that they made as much as five years of progress on telehealth within just a few weeks in 2020.

This webinar will look at where telehealth is at the beginning of 2021 in terms of long-awaited digital transformation and detail the essential steps that our industry needs to take to use these digital solutions to their fullest potential.

• Finding the new normal for telehealth utilization
• How new money and emerging partnerships are changing the telehealth landscape
• Leveraging data to make progress on telehealth reimbursement and quality

What does the remainder of the pandemic, and what does a Post-COVID-19 world hold for healthcare? What are the key healthcare business issues and trends for 2021, and what is the policy outlook under a Biden Administration that will impact you and your organization, and how can you best position for them? Attend the Nineteenth Annual Future Care Web Summit, which addresses these topics and more.

The 90-minute webinar agenda includes:

• Top Health Industry Issues of 2021 and Policy Outlook - Crystal Yednak, Senior Manager, PwC Health Research Institute; and Ingrid Stiver, Senior Manager, PwC Health Research Institute
• State of the health plan in 2021 - Natalie Trebes, Director, Advisory Board   
• The Strategic Pricing Imperative - Chris Sukenik, Principal, BDC Advisors

What is the outlook for Medicare Advantage Supplemental Benefits and Social Determinants of Health Initiatives under the Biden administration in 2021 and beyond? This session examines the Biden health policy agenda; the prognosis for Medicare Advantage Supplemental Benefits and Social Determinant of Health Initiatives during the coming year; developments in the SDOH arms race and what CMS policy can be anticipated during 2021 in this arena.

John Gorman, a nationally recognized health policy expert in areas including Medicare, Medicaid, ACA and SDOH, provides his significant insights for the coming year. John is Founder and Chairman of Nightingale Partners, a Qualified Opportunity Zone Fund and advisory firm connecting capital to payers and care providers to the medically underserved. Nightingale endeavors to improve the quality of care and reduce unnecessary health care expenditures for impactable, high-utilizers through advanced technology, locally-curated social services providers, and innovative financing to address Social Determinants of Health (SDOH). 

The Geographic Direct Contracting Model (also known as the “Model” or “Geo”) is a new payment and care delivery model being tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The Model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries across an entire geographic region. Leveraging best practices and lessons learned from prior Innovation Center models, Geo will enable Direct Contracting Entities (DCEs) to build integrated relationships with healthcare providers and community organizations in a region to better coordinate care and address the clinical and social needs of Medicare beneficiaries.

The COVID-19 pandemic will have a significant impact in all segments of healthcare for a prolonged period. As such, health plans have critical financial decisions to make in the upcoming months with limited data available and wide uncertainty on how the COVID-19 pandemic will transition toward the end of 2020 and into 2021. 

This session explores how COVID-19 may impact a health plan’s medical loss ratio (MLR) requirements in general and provides specific considerations for the Commercial, Medicare Advantage and Medicaid markets at the end of 2020 and into the future.

Dr. McDonald shared updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. In addition, CAPT Hammond and Dr. Kimmons discussed CDC COVID-19 guidance for building operations (HVAC, etc.) and healthy design guidelines for the long-term building design.

We believe health systems must scale to achieve a level of market indispensability characterized by an integrated provider network able to invest in data analytics, bear risk, and offer patient-friendly physical and virtual care settings. But scale doesn’t guarantee relevance. Bigger doesn’t always result in better. Only those health systems that grow while advancing performance by strategically pursuing vertical integration into asset-light delivery mechanisms, exploring new business/product expansion opportunities into nontraditional healthcare services, and ensuring a deliberate and structured approach to scale will be positioned for clinical, strategic, financial, and operational success.

Part of ECG’s series of strategic perspectives on the changing dynamics of the US healthcare system, this webinar explores the relationship between size and performance, benefits of horizontal and vertical integration, and opportunities for health systems to reposition themselves for future success.

During this webinar, participants will learn:

• The Rule of Three and how it can inform health system strategy.
• Opportunities to broaden a health system’s perspective of its potential service offerings to allow for management of an even greater portion of a community’s health and well-being.
• Benefits from transitioning a health system to a more asset-light investment philosophy and options to do so.
• Guiding principles to support enhanced system performance.

In this presentation, revenue cycle experts Brian Harris and Jess Stover will guide attendees through the steps every agency should take to optimize billing and collections workflows. Beginning with best practices and KPI tracking, we’ll examine how department structure and communication strategies are used to eliminate inefficiencies and create strong financial outcomes. Next we’ll take a look at how full or partial outsourcing can enhance productivity and add predictability to your agency’s cashflow. Finally, we’ll consider the anticipated regulatory changes ahead and discuss how agencies can best prepare their billing department for an uncertain future.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

The COVID-19 Vaccination Implementation Planning Update for Rural Stakeholders was presented by CDC subject matter expert, Dr. Amanda Cohn. Dr. Cohn is Chief Medical Officer for the National Center for Immunization and Respiratory Diseases as well as Chief Medical Officer for the Vaccine Task Force of the CDC COVID-19 Response. This session, presented specifically for rural stakeholders, was moderated by Dr. Diane Hall. PowerPoint slides for this video are available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/vaccine-considerations-rural-health.pptx

CMS rule requiring all hospitals to publish detailed information regarding the pricing of their services effective January 1, 2021, has been finalized. Despite strong pushback from the industry, this initiative appears to be moving forward on schedule. What’s more, the industry is unprepared—an HFMA survey found that only 12% of executives believe their organizations are ready to comply with the new requirements. This is important for regulatory compliance reasons, but also because it has implications for how consumers shop for healthcare services and how providers should position themselves in their markets. In this session, ECG’s team of experts explain the rule’s requirements and health systems can best respond.

Learning Objectives

• What the CMS transparency rules are and how they will (or will not) improve transparency
• Near-term tactics for compliance
• Longer-term impact on consumer behavior and reimbursement rates
• Creative pricing strategies and patient-friendly, value-driven payment models

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 894 health plan years over 23 years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform.

So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of ten plans who collectively served 8.4 million people in comprehensive products. Eight of this year’s participants participated in the prior year.

Health plans need to focus on their population health management initiatives. Combining social determinants of health (SDOH) data with existing care management programs can bolster the effectiveness of those programs and help improve health outcomes. Rich Morino, Senior Director, Solutions Consultants, LexisNexis Risk Solutions discusses using Social Determinants of Health (SDOH) data to turbo-charge population health management initiatives in a post-pandemic world, in the HealthcareWebSummit event co-sponsored by LexisNexis Risk Solutions.

Leaning objectives include:

• Identify which members should have their care prioritized post pandemic
• Understand why select members are at risk for poor health outcomes
• Examine risks that can be mitigated by interventions or community/social services

Redundancy, duplication, and waste are pervasive in today’s healthcare delivery system, driving up both operating and capital costs. To achieve economic sustainability and market essentiality, health systems must integrate and rationalize to enhance clinical care, optimize operations, and lower costs, ultimately focusing on the improvement of every aspect of patient care operations.

Part of ECG’s series of strategic perspectives on the changing dynamics of the US healthcare system, this webinar explores four imperatives for healthcare organizations looking to advance their integration and rationalization efforts:

• Capitalize on technology innovation for business tasks.
• Eliminate unwarranted clinical variation.
• Design a platform for delivering and coordinating care across the continuum.
• Implement a capital asset plan that supports integration and rationalization.

ECG’s oncology experts share industry best practices from across the country to support the successful ramp-up of cancer program operations. This session provides practical guidance based on lessons learned from leading institutions, addressing how to position operations to meet the anticipated surge in patient volumes while also continuing to ensure the safety of patients and staff at the center. In this session, we

• Discuss how to optimize performance in a COVID-19 environment.
• Explore strategies to transition patients and staff to alternative settings, as needed.

The CMS CMMI Direct Contracting Model Options team hosted a webinar on September 18, 2020. During this webinar, presenters provided a review of the financial methodology for the Direct Contracting Model Options.

Health systems and provider organizations are experiencing significant financial pressure, exacerbated by the COVID-19 pandemic, while historical market forces continue to create serious challenges. Despite reform efforts that have seen mixed results, the march toward value-based care will go on. The path forward will be arduous, as we believe the current system is too costly, complex, and fragmented to remain viable.

ECG’s We Believe series offers strategic perspectives on the changing dynamics of the US healthcare system. In this webinar, ECG principal Andy Bachrodt discusses the tenuous state and future of the US healthcare provider economic model and what executives must do to guide their organizations toward a sustainable position of financial health.

Key learning objectives for this webinar include the following:

• Review and understand the foundational challenges in the US healthcare delivery and funding model.
• Define ECG’s perspective on the evolution of value-based care and industry readiness for the move to a true population health model.
• Discuss the strategies that support the four key imperatives health systems must address:
  • Own the consumer relationship.
  • Redesign the delivery network for high performance.
  • Optimize operations and cost structure.
  • Optimize revenue structure.
• Share lessons learned from participant organizations and their path forward

Changes to the 2021 Medicare Physician Fee Schedule (MPFS) will have far-reaching implications for provider arrangements nationally. CMS will implement the RVU changes and corresponding conversion factor reimbursement adjustment on January 1, 2021. The E&M code WRVU changes alone will impact provider productivity by upwards of 30% and disrupt medical group budgets across the country, unless adjustments are made. ECG’s experts share five ways to avert losses from these compensation models.

This session will provide the audience with:

• An understanding of the final and proposed changes for the 2021 MPFS.
• Clarity regarding the financial, operational, and contracting implications of the changes.
• A successful playbook for addressing the issues at your organization

The COVID-19 crisis has had a dramatically negative impact on the financial performance of physician practices. Independent practices are ill-suited to address these challenges, and many will not survive the next year. As a result, hospital-physician alignment is likely to accelerate, and executives will need to assess the antitrust considerations of the various alignment options available. In this webinar, ECG and Davis Wright Tremaine experts:

• Examine COVID-19’s impact on physician productivity, including recent month-by-month activity trends.
• Outline various partnership models that health systems and independent physicians may find attractive in this challenging environment.
• Review recent, relevant antitrust cases and explore the key factors leading to antitrust investigations.

ECG consultants Len Henzke and Stuart McClure will be joined by antitrust experts Doug Litvack and David Maas from Davis Wright Tremaine in facilitating this webinar.

In this webinar, BlackTree Clinical Consulting Manager Maureen Kelleher offers a step-by-step guide for establishing a new palliative care program and positioning for long-term success. Covering everything from creating your business plan and staffing requirements to reimbursements and marketing for growth, this comprehensive presentation will provide the tools required for building a successful palliative care program.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

The COVID-19 pandemic has turned the health care industry upside down and accelerated many of the ideas for the future that some thought would take decades to take hold. This session assists attendees in addressing the question: will these changes persist, or will hospitals go back to how they’ve always done business? The speed to decision and execution in this recovery phase is critical. Hospitals cannot go back to their old business models. It most likely is not viable given where health care is heading. As the industry begins to recover from the pandemic, hospital executives should consider how they can maintain their momentum toward operating as a hospital of the future and position their organizations to thrive. 

Discussion includes:

• Implications of how COVID-19 has accelerated future hospital transformation
• The three emerging themes on how hospitals are transforming
• Consideration for what parts of hospital COVID-19 responses should remain part of their new normal
• Steps for those entering the recovery phase of the pandemic toward how to ensure their organizations will thrive

This session will discuss home health industry trends and financial impacts of PDGM primary diagnoses and PDGM comorbidity groups including identifying financial impact of each primary diagnosis group, misconceptions about capturing PDGM comorbidity groups, accurately capturing comorbidity groups, and distinguishing comorbid diagnoses that warrant physician query.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

The Community Health Access and Rural Transformation (CHART) Model team hosted an overview webinar on Tuesday, August 18, 2020 from 1:00 - 2:00 PM EDT. Attendees had the opportunity to hear an overview of the CHART Model, including its objectives, eligible participants and their roles, payment options, and timeline. Following the session, attendees were provided an opportunity to participate in a live Q&A session.

The iron triangle of health care depicts how the three competing priorities of health care delivery – cost, quality, and access – are often interdependent to a fault. Improving any one almost always requires a trade-off with another. Clinical AI offers the promise of improving this equation so that it does not end in a zero-sum game. Attendees to this presentation will learn how a range of data and analytic assets are being combined at the national and account levels to more accurately assess risks and the vulnerability of key populations.

Health Plans continue to be subject to advanced persistent threats from organized hacking groups, and payers need to adopt and update in-depth strategies and comprehensive incident response plans to thwart or mitigate these attacks. These protective countermeasures should be part of the organization’s formalized information security program designed to anticipate, prevent, detect and respond to future similar attacks targeting any organization. 

Attendees to this presentation will learn about current cybersecurity trends impacting health plans, best practices to consider for health plan risk management response preparedness, and the importance of increasing Board and C-Suite visibility and awareness of these issues and responsibilities.

Tune into our first episode of the Avalere Health Essential Voice: Social Determinants of Health (SDOH) series. In this segment, Avalere experts from the Center for Healthcare Transformation and the Health Plans and Providers practice set the stage for how stakeholders are defining SDOH and the impacts of SDOH on health outcomes, specifically when addressing social risks and needs.

Recent public health and economic crises have highlighted long-standing AMC (Academic Medical Center)  challenges. They have also inspired and emboldened leaders to work together to tackle politically sensitive and highly complex initiatives that have been debated for many years. In this session, ECG experts:

• Discuss how COVID-19 has exacerbated existing pain points across AMC mission areas.
• Highlight key diagnostics to rapidly identify opportunities to improve performance.
• Prioritize initiatives and define accountabilities.
• Underscore how AMC component entities can work together to achieve shared objectives.

COVID-19 has overwhelmed hospitals, their emergency rooms, intensive care units and created a huge demand for respirators, personal protective equipment and other resources. However, hospital management and staff can be better prepared for this pandemic or any other extraordinary circumstance that comes their way. Through DNV GL Healthcare’s NIAHO hospital accreditation program, which integrates the ISO 9001 quality management system, providers can create a calm, systematic and highly effective response plan that not only mitigates risks but also ensures that patients receive the best and highest-quality care possible without overwhelming hospital operations and their frontline and management staff.

During this presentation, attendees will:

• Learn how one urban safety net hospital used ISO 9001 and NIAHO to create an effective COVID-19 response
• Learn how to craft their own effective pandemic response using ISO 9001 and NIAHO
• Understand how ISO 9001 and NIAHO can create a clear roadmap to an effective COVID-19 response
• Discuss how the accrediting organization they use to qualify for Medicare and Medicaid participation is absolutely crucial

Discover how Medicare Advantage initiatives are affecting providers and what can be done to overcome the operational challenges they pose. BlackTree Consulting Director Brian Harris and Consulting Manager Samantha Soulas in partnership with Beth Ann Morren of Elara Caring, will present the strategies needed to manage Medicare Advantage contracts and achieve profitability.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

This analysis is based on the twenty-third annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 895 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary. This 18th analysis of Independent / Provider - Sponsored plans is based on a peer group of thirteen plans who collectively serve 8.4 million people. Their median and mean membership is 554,000 and 640,000, respectively.

An ASC with great physician partners, top-notch clinical staff, and substantial surgical volume can still struggle if its payer agreements are poorly negotiated. During this 30-minute webinar, contracting expert Matt Kilton from ECG Management Consultants and billing expert Angela Mattioda from Surgical Notes share their guidance on getting the most out of your payer contracts. They discuss examples and lessons learned from their combined 30 years in the ASC contracting and billing world.

This is a selected session from the Virtual Summit on Health System Recovery from the COVID-19 Pandemic, held June 22-25, 2020. The Nation’s Health System Leaders Engage in a Real-Time Dialogue on Pandemic Recovery and the Future of Health Care in America with over 80 speakers. Six month access to streaming content from the entire Virtual Summit is available for $125 at: https://healthsystemcovidrecovery.com/media-sales/

This session examines the intersection of Value-Based Care and Social Determinants of Health for Payers, Providers and Community-Based Organizations, and will address:

• Factors that Drive Operating Models of Payers, Providers and CBOs
• Payment Models: Reimbursement versus Grants or Contracts
• Measuring Outcomes, Reporting Requirements, and Data Infrastructure in Health and Social Sectors
• Pain Points Encountered at the Negotiating Table
• Successful Models: Common Components & Threads, and a Closer Look at the San Diego Model

Milliman’s Melody Craff, Francesca Hammerstrom, Adam Wallace and Edward Jhu present practical guidance to help organizations analyze the impact of COVID-19 on healthcare cost and utilization trends

This webinar, and Milliman’s accompanying white paper “Frameworks and considerations for COVID-19 related analyses,” present practical guidance to help organizations analyze the impact of COVID-19 on healthcare cost and utilization trends. The intent is to provide initial supportive resources for healthcare organizations, as they navigate dramatic changes in the healthcare landscape.

The COVID-19 pandemic has put tremendous stress on the US healthcare system. In this 60-minute webinar learn how both LexisNexis Risk Solutions and Blue Health Intelligence are contributing innovative solutions that healthcare leaders can use to better predict and prevent public health risk.

Topics Include

• Data for Good: Using data to identify vulnerable populations and care resource gaps
• Leveraging SDOH data, along with provider and claims intelligence to help healthcare organizations sharpen their focus
• Getting ahead of covid-19 using advanced analytics and reporting
• Combining a range of data and analytic assets to more accurately assess risks and key population vulnerabilities

Provides a thorough examination of the legal, regulatory and corporate structural implications, issues, and challenges for healthcare organizations that are exploring and evaluating offering telehealth services.

In this current environment, healthcare organizations not already providing telehealth services are faced with critical decisions regarding developing such capabilities for the populations they serve. However, there are myriad legal and regulatory complexities in doing so, particularly at the state level.

Topics include:

• Key legal and regulatory telehealth issues
• Corporate formation and corporate practice of medicine considerations
• Implications of applicable telehealth modalities to deploy
• Potential regulatory developments in the current environment

Part of the VA PTSD Consultation Program: Lecture Series. The April 2020 webiar: How Mental Health Providers Can Care for Themselves and Support Colleagues During the COVID-19 Virus Outbreak includes discussion of Factors in Recovery From Adversity and Stress and Stress First Aid. 

The Centers for Medicare & Medicaid Services hosted a webinar on Thursday, April 2, 2020 to discuss the Value Based Insurance Design (VBID), Part D Payment Modernization, and Part D Senior Savings models. Attendees received an overview of the models and the CY 2021 application process, and had an opportunity for questions and answers with the Model teams. 

Heather Trafton and Catherine Turbett discuss how Accountable Care Organizations (ACOs) can attain success under challenging risk-based payment models in this special 45-minute HealthcareWebSummit event.

Topics Include:

• Developing strategies that address fundamentals of financial performance in value-based contracts
• Five key accountable care analytics strategies
• MSSP and Next Generation ACO performance results for Arcadia customers
• Arcadia ACOs’ experience and lessons learned

Piedmont Healthcare is a large hospital system in the Atlanta area, four of their hospitals are DNV GL Healthcare certified stroke centers – a designation they have held for the last 5 years. Since the date of certification and with each annual survey, the hospitals have experienced substantial growth through improved delivery of safe and top-notch quality stroke care. Discussion centers on the process of achieving a DNV GL Stroke Program Certification and how certification has positively impacted the Piedmont Healthcare System.

Nightingale Partners’ John Gorman explores Nightingale’s approach and how Opportunity Zone Funds can partner with Medicare Advantage and Medicaid plans to invest in Social Determinants of Health initiatives.

Service line excellence and growth don’t occur organically. They are the result of purposeful planning, and these plans must dovetail with the vision, strategic direction, and strengths of the health system. The transition to value calls for health systems to rethink and redesign care delivery across services lines. But they cannot do it without the support of physicians in those service lines. Comanagement and gainsharing are complementary financial arrangements that facilitate hospital/physician alignment through enhancements in service line performance.

Learning Objectives

• Best practices in gainsharing and comanagement arrangements
• Program development approach
• Funds flow and compensation
• Valuation considerations
• Relevant legal agreements

Service line excellence and growth don’t occur organically. They are the result of purposeful planning, and these plans must dovetail with the vision, strategic direction, and strengths of the health system. The transition to value calls for health systems to rethink and redesign care delivery across services lines. But they cannot do it without the support of physicians in those service lines. Comanagement and gainsharing are complementary financial arrangements that facilitate hospital/physician alignment through enhancements in service line performance.

Learning Objectives

• Best practices in gainsharing and comanagement arrangements
• Program development approach
• Funds flow and compensation
• Valuation considerations
• Relevant legal agreements

While net professional collections across all physicians have remained virtually flat, clinical compensation among teaching physicians has steadily increased. Despite these increases, academic medical centers (AMCs) have not been able to keep up with compensation increases for community hospital providers and face significant recruiting challenges as a result. Additionally, academic organizations encounter serious financial sustainability concerns as they continue to find their resources stretched to subsidize their teaching and research mission. In this webinar, ECG experts will discuss the driving forces behind these trends and offer strategic and tactical approaches to help academic organizations cope.

At the end of this presentation, participants will be able to:

• Describe the physician compensation expense pressures and recruitment challenges faced by AMCs.
• Identify compensation approaches that balance market tensions against financial sustainability.
• List important considerations in incentivizing faculty for their contributions to patient care as well as their teaching and research activities.
• Distinguish best practices to acknowledge value in clinical compensation.
• Recognize opportunities to support market-level compensation for structurally underfunded departments.
• Explain compensation differences between faculty physicians and nonfaculty community physicians in the academic setting

Terri L. Welter and David A. Wofford address the implications of the CMS Price Transparency Rules and the resulting need for creative pricing strategies and patient-friendly value-driven payment models, in this special 45-minute HealthcareWebSummit event.

Topics Include:

• How the CMS transparency rules will (or will not) improve transparency
• Anticipated impact on consumer behavior and reimbursement rates
• The need for creative pricing strategies
• Embracing patient-friendly, value-driven payment models

In 2018, the median loss per physician among hospital-based specialties was more than $200,000. In this part of our webinar series, we will explore how these rising costs, both per physician and in aggregate, have spurred fundamental changes to coverage models and compensation structures as organizations attempt to create cost efficiencies without sacrificing quality and outcomes. Beyond this, we will examine how the influence of advanced home health and telemedicine will increasingly impact coverage-based models.

In this webinar, we will:

» Understand the driving forces behind the rising loss per FTE.

» Discuss how systems are dealing with these losses.

» Explore how advanced practitioners and telemedicine are influencing coverage models.

» Identify how compensation incentives have changed.

» Learn how clinical expectations and the definition of an FTE have changed over time, as well as the impact of this change.

People expect a frictionless experience, especially in health care. Yet, despite spending millions of dollars on experience improvements, plans still lag behind because they aren't investing in things that matter the most for member satisfaction and costly care use.

In our 2019 health care experience survey, we asked over 3,000 individuals about the frictions they experienced while getting care to see which ones impacted costly care use or retention.

This presentation will provide case studies and key insights into where in the customer journey plans should invest to improve satisfaction and lower medical spend.

Stephanie W. Kanwit examines the provisions, complexities, challenges, implications and outcomes of the CMS Hospital Price Transparency Final Rule.

Topics Include:

• The provisions set forth in the CMS Hospital Transparency Final Rule
• The complexities surrounding the scope of the Final Rule
• The challenge of making a hospital’s negotiated rates “consumer friendly”
• Illustrative examples in the application of risk adjustment
• Practical implications and outcomes for hospitals, consumers, and regulators

Many organizations are expanding the APP footprint within their care teams to improve patient access, replace an aging physician workforce, and meet other strategic and business objectives. In doing so, organizations are focusing on operations and compensation for APPs to maximize their investment. In this session, ECG experts explore the limitations and drivers of operations and incentive alignment for APP performance.

The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.

Topics included an overview; a deep dive into the quality, network, and payment policies being tested as part of the hospice benefit component of the Model for CY 2021; and the application process. During the webinar, CMS shared next steps and engagement opportunities as well as a live question and answer (Q&A) session.

What does the coming year and new decade hold for healthcare? What are the key healthcare business issues and trends for 2020 that will impact you and your organization, and how can you best position for them? Attend this web summit event and get 2020 vision for your healthcare organization. The Eighteenth Annual Future Care Web Summit addresses key future trends and also focuses on several important cutting-edge healthcare business topics, including:

• Forces of Change: The Future of Healthcare into 2040
• The Legal, Regulatory and Policy Landscape for 2020
• Social Determinants of Health Program & Policy Developments for 2020
• On-Demand Sessions: Transformation Through Digitally Enabled Care, MSSP Pathways to Success

The Direct Contracting Model Options team hosted a webinar on January 22, 2020 to provide additional information on the Direct Contracting model's payment methodology following the Payment Part 1 Webinar on January 15th. The team presented on additional aspects of the financial model not covered during the Payment Part 1 Webinar, such as its risk adjustment, benchmark methodologies, and quality measures. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.

Employees value choice when it comes to health benefits. When employers facilitate these choices, the method for setting employee premium contributions can create selection bias toward certain options. Selection bias happens when a sicker and more costly population tends to choose one option over another. In order to reduce the selection bias, employers should adjust each option for morbidity. Risk adjustment is used to adjust applicable costs of two or more cohorts of people so all cohorts can be compared as if each had the same morbidity.

Topics Include:

• The concepts of selection bias and risk adjustment
• The implications and justification for applying risk adjustment
• The methodologies involved in setting employer contribution rates and application of risk adjustment
• Illustrative examples in the application of risk adjustment

Additional Tags: Slef-Insurance, Self-Funding, TPA, Actuarial

The Direct Contracting Model Options team hosted a webinar on January 15, 2020 to provide an overview of the Direct Contracting Model's payment methodology. During the session, the Direct Contracting model team presented key aspects of the Direct Contracting financial model, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.

Health care organizations are under increasing pressure to reduce costs, perform successfully under value-based care models, and manage constant industry change and regulatory pressures. Central to effectively managing these pressures is the ability to leverage data to understand and impact quality of care, patient outcomes and the financial health of your organization.

This webinar will explore strategies that health plans and provider organizations can leverage to improve data quality, starting with patient encounter data. Join Optum Advisory Services to learn about how health care organizations are successfully identifying and resolving encounter data quality issues and impacting financial sustainability, including case studies from recently completed projects for Medicare Advantage and Medicaid and insights from payers on their efforts to improve encounter data quality.

As we head into 2020, stakeholder research tells us that:

• High-deductible health plans are waning
• High-performing networks are in
• Highly personalized benefits offerings are a must

To stay ahead of these and other healthcare benefits trends and demands, there is a greater need for near real-time, population-specific health benefits analytics.

Although hospitals are always striving to improve patient safety, they have come under new pressures in recent years to better their performance. Since the Centers for Medicare & Medicaid Services (CMS) began penalizing hospitals for unnecessary readmissions and weighing patient satisfaction scores, it has become imperative for inpatient providers to look at patient safety not as a compartmentalized function, but as a holistic mission involving all facets of hospital management.

As the nation's fastest-growing healthcare accrediting organization, DNV GL Healthcare emphasizes continuous quality improvement. It is always assisting its more than 500 hospital clients in improving patient safety and outcomes. One of the ways to accomplish that is to integrate risk management with patient safety. That may mean weighing the unreimbursed costs of properly sterilizing duodenoscopes versus avoiding infections that may cost more down the line to treat in terms of both money and goodwill. Successfully navigating such decisions can not only make the hospital setting safer, but will also improve the bottom line.

A recent study published in JAMA found that only 15.6% of physicians reported screening for all five social determinant of health factors: food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence.

During this webinar, Alliance for Better Health will talk about how it is working with health systems and payers in alternative payment arrangements, and providing their providers with SDoH data, allowing them to connect patients with community-based organizations to improve care and reduce costs. Topics Include:

• Case Study of Alliance for Better Health Social Determinants of Health (SDoH) Initiatives
• Overview of SDoH Challenges with infrastructure and technology for providers to make referrals to community-based organizations
• How Alliance for Better Health is working with New York health systems and payers in alternative payment arrangements
• How Alliance for Better Health  furnishes providers with SDoH data, allowing them to connect patients with community-based organizations to improve health and reduce

In this webinar, ECG’s team of experts review the findings of ECG’s 13th annual Pediatric Subspecialty Physician Compensation Survey. The session includes our analysis of important pediatric physician and advanced practice provider performance trends from the 2019 survey and how these trends impact children’s hospitals. Included in this webinar is a discussion of market trends related to value-based care and implications for compensation planning as well as overall organization strategies.

Session Objectives

• Share the findings of the 2019 Pediatric Subspecialty Physician Compensation Survey.
• Highlight physician and APP compensation and production trends, including trends in value-based compensation, benefits, work standards, and recruiting.

The ambulatory surgery center (ASC) landscape continues to rapidly evolve, driven by market and legislative forces, patients, payers, and providers. Health systems and hospitals are under pressure from all sides to reduce costs, while changes in government regulations and commercial payer practices reward providers for migrating high‑acuity surgery to the ASC setting. This migration poses a financial threat to health systems, given the significance of surgical revenue. These combined factors motivate the need for ASCs and hospitals to develop and implement a comprehensive ASC strategy.

In this webinar, Naya Kehayes, Principal, and Sean Hartzell, Associate Principal, will discuss the current state of the ASC market, how migration is affecting hospitals’ strategic options, and how hospitals can engage in proactive strategies to survive and thrive in the changing surgical environment.

In this webinar, ECG’s team of experts will review the findings of our 20th annual Physician Compensation Survey. The session will include our analysis of important physician and advanced practice provider performance trends from the 2019 survey, as well as how these trends impact hospitals, health systems, medical groups, and universities/schools of medicine. Included in this webinar will be a discussion of market trends related to value-based care, as well as implications specific to compensation planning and organizational strategies overall.

Session Objectives

• Share the findings of the 2019 Physician Compensation Survey.
• Highlight physician and APP compensation and production trends, including trends in value-based compensation, benefits, work standards, and recruiting.

• Framework for new Medicare Advantage supplemental benefit flexibility
• What MA plans are doing in 2020
• How to best to seize these new opportunities
• Exploring target populations and an array of potential supplemental benefits
• Challenges and accountability associated with new supplemental benefit flexibility
• How Special Needs Plans play an important role

This is a selected session from Twentieth Annual Pharmaceutical and Medical Device Compliance Congress held November 6 - 8, 2019 in Washington, DC with over 120 speakers, and sponsored by Pharmaceutical Compliance Forum. The Pharmaceutical and Medical Device Compliance Congress is the oldest and largest gathering of pharma and device compliance professionals and in-house counsel who come together annually to discuss best practices in legal and regulatory compliance. A Flash Drive Archive or Six Month Online Streaming Access of the entire Congress is available for $195 at:  https://2019.pharmacongress.com/multimedia-sales/

• Avalere research findings on payer and life science OBCs
• Perceived challenges with OBCs
• OBC considerations for new/existing products, and therapeutic areas of focus
• OBC cost savings expectations timelines
• Potential usage of ancillary services under OBCs
• Methods to measure value and financial incentives

This analysis is based on the seventeenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of more than 858 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of twelve plans who collectively serve 10.3 million people in comprehensive products. Seven of this year’s participants participated in the prior year.

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

Insights and aspects of security management and the security vulnerability analysis (SVA) as this is applied under the National Integrated Accreditation for Healthcare (NIAHO) requirements and NFPA 99.

Milliman shares a historical view of the Employer Stop Loss (ESL) market, including portfolio characteristics, underwriting measures, pricing measures, historical results, and product terms offered. Milliman will also address the considerations and implications for health plans evaluating ESL market opportunities.

• The employer stop-loss market opportunity for health plans
• A  historical view of the employer stop-loss market
• Employer stop-loss market characteristics, measures, results and products
• Considerations and implications for health plans evaluating employer stop-loss market opportunities

Additional tags: Self-Insurance, Self-Funding, Reinsurance, TPA

Insights drawn from years of experience in administering Reference Based Pricing (RBP) plans to talk about it's challenges and benefits, as well as key strategies for successfully implementing and administering RBP plans. The session will include case studies of 2 employer groups that switched from a traditional PPO structure to an RBP plan.

Additional Tags: Self-Funding, Self-Insurance, TPA, contracting

Several of the organizations who collaborated on the Guiding Principles for the Ethical Use of Social Determinants of Health provide an overview of the guiding principles, bring clarity to what the industry views as the appropriate use of SDOH, and offer examples of how SDOH can and should be leveraged to help patients achieve optimal health outcomes and wellness.

This is a selected session from the Seventh National Physician Advisor and Utilization Review Boot Camp held July 29 - 31, 2019 in Washington, DC with almost 20 speakers. The conference, in partnership with Day Egusquiza and AR Systems, Inc., addressed Medicare Advantage: Building Blocks of Contracting, Provider Sponsored MA Plans, and the Ongoing Denial Challenges, plus the pre-conference: "The Basics: Medicare 101, P2P 101, CDI 101 and Denials/Appeals 101." A Flash Drive Archive or Six Month Online Streaming Access of the entire conference is available for $195 at:  https://racsummit.com/multimedia-sales/

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

How hospitals can change the accreditation process from an ordeal to a learning experience capable of transforming their institution and improving quality of care, identification of potential tools and strategies for identifying and addressing quality of care issues, and how NIAHO and ISO 9001 are tools of empowerment for hospital managers.

Examine a framework for integrating social determinant of health data into population health analytics, consider application of time-dependent survival modeling in a study to predict survival of patients in hospice, and explore a case study that addresses how much data is enough to build an accurate deep learning model.

This is a selected session from the Tenth National Accountable Care Organization (ACO) Summit, collocated with MACRA Summit IV and Bundled Payment Summit IX, held June 17 - 19, 2019 In Washington, DC with over 90 speakers. The ACO Summit is considered the leading forum on Accountable Care Organizations (ACOs) and related delivery system and payment reform. A Flash Drive Archive or Six Month Online Streaming Access of the collocated Summits is available for $195 at: https://www.acosummit.com/media-sales/
 

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, over 855 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Blue Cross Blue Shield plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary

This 21st analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve 36.7 million people, excluding Host, specialty and other products. We believe this universe to be quite robust. Participants in this year’s study serve 52% of all Blue membership, excluding those served by publicly-traded firms. Collectively in 2018, the health plan operations of these Plans earned annual premiums plus fees of $106.7 billion

A discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.

To learn what MCOs and MA plans are doing to address social needs among their enrollees, the Deloitte Center for Government Insights and the Deloitte Center for Health Solutions interviewed executives and leaders from 14 MCO and MA plans across the country. This project builds upon a previous study by the Deloitte Center for Health Solutions that surveyed a nationally representative sample of hospitals and health systems to learn about their current and future SDoH investments.

Exploration of how new digital services and products can make care affordable and effective for Medicaid and underserved populations - as a laboratory for innovation that will ultimately shape care for everyone.

Confidence in an organization's sterile processing departments and processes can be accomplished and the risk of infection from improperly processed instruments can be reduced, if not eliminated if protocols are followed in a way that is a good fit for a hospital’s management structure and corporate culture.

What will the health plan of tomorrow look like? How will traditional health plans transform, and what choices do leaders need to make now to survive the forthcoming disruption? To begin answering these questions, the Deloitte Center for Health Solutions conducted crowd-sourcing research with 28 health care, policy, and technology experts. Over four days, these experts presented and discussed use cases for the next innovation cycle with a focus on four key areas: customer centricity; innovation; collaboration; and operational excellence.

Milliman shares several data mining tactics that they have seen successful ACOs adopt to effectively guide strategies to reduce medically unnecessary services and in turn reduce the ACO’s total population costs.

This is a selected session from the Nineteenth Population Health Colloquium, held March 18 - 20, 2019 in Philadelphia, PA with over 60 speakers. The Jefferson College of Population Health is the exclusive Academic Partner for the Colloquium. The Colloquium addresses practicing population health, the implications of socioeconomic disparities, transformation of care delivery to meet the specific needs of each community, advances in technology, data analytics and precision medicine, with national and regional thought leaders examining industry trends and sharing their expert insights, best practices and case studies.  A Flash Drive Archive or Six Month Online Streaming Access of the entire Colloquium is available for $195 at:  https://2019.populationhealthcolloquium.com/multimedia-sales/ 

Discussion of some of the many ways episode analytics can be used by Managed Medicaid plans to drive improved care quality and lower total costs of care, and insights into some of the clinical aspects of episodes of care which are unique to the Medicaid market.

With the MSSP final rule, CMS is offering greater shared savings potential to ACOs participating in the BASIC track and making the BASIC track available to a broader set of ACOs. The effect of these rule changes on specific ACOs will vary significantly depending on an ACO’s size, region, cost and quality performance, and structure. It is critical that ACOs fully consider all of the implications of these rules in order to identify both the risks and the opportunities specific to their organizations.

This is a selected session from the Fourteenth National Value-Based Payment and Pay for Performance Summit, held February 25 - 27, 2019 in Los Angeles, CA with over 80 speakers. The Summit has been the Leading Forum on Pay for Performance, Transparency and Value-Driven Healthcare, co-sponsored by APG and IHA.  A Flash Drive Archive or Six Month Online Streaming Access of the entire Congress is available for $195 at:  https://pfpsummit.com/multimedia-sales/

Edifecs will illustrate how health plans participating in government-sponsored programs (such as Medicare Advantage) can take off the blindfold and improve risk-adjusted revenue accuracy and reduce associated costs with clinical data integration.

This session identifies CareMore Medicaid program innovation strategies, scope and components; reviews CareMore and AmeriGroup program outcomes and results in in Iowa and Tennessee; explores CareMore's approach to comprehensive, relationship-based primary care; and considers how CareMore has fostered collaborative behavioral health.

Explore key healthcare innovations and trends that will be highly impactful on healthcare stakeholder this year; gain a sense of the critical legal, regulatory and policy issues impacting healthcare in 2019; and ascertain the implications of the state of value based care in 2019.

Organizations have evolved to accept a growing number of value-based and global-risk contracts. Across the industry, building compensation models to incentivize physicians is challenging. Further, benchmarks to evaluate physician compensation under risk-based models are lacking, making it difficult to obtain a fair market value (FMV) opinion. A value-based model asks physicians to behave differently, so we should measure performance differently. Most medical groups are inexperienced with this type of arrangement, or they lack the right tools and benchmarks. Set aside your $/WRVU models and benchmark percentiles as this on demand webinar guides you through the journey from volume to value.

This recording’s learning objectives include:

• Understanding the development success factors for risk-based agreements.
• Differentiating the issues associated with FFS models from risk-based models.
• Delineating a framework for evaluating the commercial reasonableness of value-based models.

Manatt Health reviews the role that Medicaid agencies and Medicaid managed care plans are playing in testing SDOH-related interventions and integrating them into their healthcare delivery system—creating a platform for “whole person” care that seamlessly addresses individual physical, behavioral and social needs.

This session provides a discussion of Blue Cross PCMH program scope and components, PCMH capability implementation, PCMH program results, and how the PCMH program fits into the Blue Cross Blue Shield of Michigan value-based reimbursement model.

CoxHealth, a six-hospital system in southwest Missouri, spent years trying to follow industry "best practices" to try and reduce its rate of readmissions, but to no avail. Instead, it created a successful readmission reduction program by closely analyzing its own discharge data, identifying high-risk patients and creating a focused, proactive readmissions reduction program in conjunction with local first responders. The result was a double-digit drop in readmission

This session examines novel payer analytic techniques ranging from retrospective data analysis to predictive modeling, that can help health plans and PBMs leverage their data to identify people at high risk for opioid misuse. The role of emerging technologies including virtual care, digital therapeutics, remote patient monitoring, AI and more are explored.

Explore the implications and impact of ACO experience in Medicare ACO performance, in the Avalere study considering the tenure of ACO services in performance, and as a predictor of success; examine the Dobson DaVanzo & Associates study that found MSSP ACOs generated gross savings of $1.84 billion for Medicare in 2013–2015, nearly double the $954 million estimated by CMS; and consider the opportunities and issues involved from CMS proposed regulations regarding telehealth and other non-face-to-face services.

This session addresses how to evaluate the impact of the fiscal year 2019 Inpatient PPS Final rule on your hospital, with respect to coding, payment calculations, reporting measures, legislative and regulatory issues and the longer range implications of price transparency.

This session provides tips for improving member portal experience and utilization; tools that can be added to the website for additional functionality; and ways financial functionality in the member portal can be used to improve the member experience and provider satisfaction.

Highmark's True Performance is a value-based reimbursement program for Primary Care Physicians (PCPs) focused on affordability and quality of health for Highmark members. The program evaluates PCPs' ability to deliver the right care at the right time and in the most appropriate setting, and rewards PCPs for their performance on quality and cost/utilization measures.

This session will provide insights based on the real experience of University of Maryland Medical Systems Health Plan and how UMMS is working collaboratively with hospitals in and out of their network. Also learn how UMMS is enabling those hospitals to look outside the walls of their facilities, by sharing data and the accompanying analysis.

In this session, McKinsey & Company, will share the potential for episode analytics and highlight some of the many ways health plans leverage this intelligence to improve the quality and efficiency of healthcare. Change Healthcare will then share examples of the episode of care data visualizations being using by health plans to identify opportunities across their businesses to improve costs and care quality.

While there are always uncertainties regarding the outcome of any proposed regulation, a deeper understanding of the Pathways to Success program and its implications is essential for stakeholders to best position themselves going forward. This session provides a summary and analysis of the proposed regulation’s key provisions and discusses how they might impact the MSSP.

Having successfully scaled its Enhanced Personal Health Care program, which rewards primary care providers who succeed in delivering patient-centered, value-based care, Anthem is expanding its work to base specialty care payments on quality and efficiency. Anthem’s approach includes multiple programs across both commercial and government-sponsored business, designed to reward specialists for coordination with primary care, as well as for consistently high-quality, efficient care.

An Avalere study found that Medicare Advantage has a higher proportion of patients with clinical and social risk factors shown to affect health outcomes and cost than FFS Medicare; and that despite a higher proportion of clinical and social risk factors, Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, comparable average costs, and better outcomes.

New Deloitte Center for Health Solutions research explores five key findings from analyses of the financial performance of commercial health plans. Deloitte's study focuses on the fully insured commercial group and commercial individual books of business of US health plans. The study uses financial data reported by insurers to CMS according to statutory accounting principles.

The industry is buzzing with exciting words like Machine Learning, APIs, Blockchain and more. This session helps to understand the promise that these and other technologies hold as it relates to solving one of the industry’s greatest challenges: provider data management. Leveraged appropriately these technologies can help automate efforts, create transparency and reduce friction between health plans and providers.

This session explores application of risk adjustment and predictive modeling through brief case studies involving key topics; examines the potential of enhanced models to identify patients with rising risk; and considers the impact and implications of analyzing prescription data to determine future patient costs and serve as predicators regarding opioid abuse patients.

Bob Goodner, a survey team leader and physical environment specialist for DNV GL Healthcare, will share his insights and discuss the aspects of security management and the SVA as this is applied under the National Integrated Accreditation for Healthcare (NIAHO) requirements and NFPA 99. Synjyn Dodd, System Director of Safety, Security and Emergency Management, Emerus Holdings, and Kelly Proctor, Physical Environment Sector Leader, DNV GL Healthcare will also share their insights.

Topics discussed include:

• Reviewing security measures and protocols for hospitals
• Assessing risks for workplace violence
• Enhancing workplace safety
• Conducting a thorough security vulnerability analysis

The spectrum and prevalence of value-based payment arrangements continues to expand significantly. The financial impact of such initiatives can be in the millions of dollars for hospitals and can materially impact practitioners’ reimbursement. In this changing environment, financial models are essential to understand the impact of value-based arrangements.

Compared to the financial performance of US health plans overall, how have government programs fared over the past few years? New Deloitte Center for Health Solutions research explores six trends in Medicare Advantage and Medicaid managed care. This research focuses on information health plans are required to file with the National Association of Insurance Commissioners (NAIC).

Medicaid coverage continues to face challenges nationally amidst funding uncertainties, and program changes advanced by the Trump administration. At the same time, increased opportunities continue to be advanced for value based solutions in serving the Medicaid population.

This webinar focuses on trends in physician enterprise, including market factors influencing medical group financial performance and trends in benchmarking for integrated health systems. The speakers highlight findings from ECG’s 2017 Medical Group Cost and Infrastructure Survey, which identifies comprehensive operating costs and staffing benchmarks for large multispecialty system–employed and foundation-affiliated medical groups across a range of cost categories, staff functions, and operations. Metrics such as investment per physician and cost per RVU/visit are discussed.

The speakers also present case studies for how medical groups can compare themselves to appropriate market benchmarks in order to identify and prioritize performance improvement initiatives.

Specific learning objectives:

• Trends in ambulatory performance improvement
• Factors to consider when benchmarking medical group staffing and operations
• How medical groups can identify functions or areas for performance improvement within their physician organizations

CMS released Comprehensive Care for Joint Replacement (CJR) model results for Performance Year 1 (episodes with start dates between April 1st and September 30, 2016 and end dates on or before December 31st, 2016.) The CJR model is a mandatory bundled payment model in which 799 participating hospitals from 67 metropolitan statistical areas (MSAs) were originally required to participate. Each episode begins with a lower extremity joint replacement procedure, and completes after 90 days post-discharge. There was no downside risk for Performance Year 1, but future years will include downside risk. Going forward, a recent CMS final rule will allow hospital participation in 33 of the 67 MSAs to become voluntary, which will result in fewer participating hospitals in the program.

What are the key healthcare business issues for 2018 that will impact you and your organization, and how can you best position for them? The Sixteenth Annual Future Care Web Summit addresses key trends and also focuses on several important cutting-edge healthcare business topics.

As the prevalence of commercial value based contracts grows, so too does the variability of a provider's overall compensation. In value based contracting, providers are "measured" on certain performance metrics that will dictate ho much they are ultimately paid. In this environment, risk adjustment plays an integral role in determining the provider's "measurement" of financial performance.

Where are Quality Payment Programs established under MACRA headed in 2018? What is the role that Medicare Advantage and other Medicare and Medicaid managed care programs can play in future years of the QPP, and the criteria that such plans must meet to be considered an Advanced APM? What is the CMS perspective for Medicare Quality Payment Programs in 2018?

The Eighth Annual Accountable Care Web Summit features a 90 minute webinar with three prominent national Accountable Care speakers from Catalyst Health Network, the National Business Group on Health and Milliman that will share their spectrum of knowledge to help ACO stakeholders position themselves for 2018.

Additional Tags: contracting, provider network, self-insurance, self-funding, TPA

Based on the ECG whitepaper, this webinar examines market dynamics that are pushing ambulatory surgery to the forefront of the healthcare delivery. Presenters highlight the ways in which health systems are looking at Ambulatory Surgery Center development and joint ventures as an opportunity to partner with physicians and other organizations to effectively implement an ambulatory surgery strategy.

Medicaid can be overlooked in conversations about value-based strategy, but state initiatives can present major opportunities or challenges for health plans and health care providers. ​Many states have been experimenting with Medicaid alternative payment models (APMs) to try to control spending, improve care, and increase accountability within Medicaid and across the health care system. But have any of these models worked? And how might Medicaid initiatives align with the Medicare Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA) to reinforce value-based care initiatives and drive system-wide change?

As technology, innovation, treatment options and care coordination all continue to advance, the impact and implications of organ and tissue transplant resource utilization becomes even more significant for healthcare stakeholders. Possessing and understanding current intelligence regarding transplant costs, utilization and demographics is critical in this regard.

Reference Pricing is an insurance benefit design that encourages enrollees to favor providers charging low prices for non-emergency “shoppable” surgical procedures, diagnostic tests, and pharmaceuticals. Reference pricing can motivate providers to compete based on price as well as quality, and to pursue cost-reducing innovations.

Additional Tags: Pharmaceutical, contracting, self-insurance, self-funding, TPA

Value-based pharmaceutical contracts, sometimes referred to as risk sharing agreements between pharmaceutical manufacturers and health plans or other purchasers are critical in today’s very complex and costly healthcare marketplace. These agreements allow placement of high-risk, high-cost and often times specialty pharmaceutical products onto purchaser formularies through basing payment on outcomes as opposed to volume metrics.

Additional Tags: PBM, Self-Insurance, Self-Funding, TPA

There has been a great deal of uncertainty in recent months surrounding the use of episode-based payment models at CMS. The voluntary Bundled Payments for Care Improvement (BPCI) models have been operational since 2012, and the mandatory Comprehensive Care for Joint Replacement (CJR) program was implemented in April of 2016 and has hundreds of participants nationally.

The wide spectrum of current stakeholder initiatives to achieve a triple or quadruple aim in healthcare objectives require that the needs and resources involved with chronically ill patients and their families be addressed and supported on the front lines by case managers and social workers.

With the publication of the MACRA final rule in the fall of 2016, CMS gave the healthcare industry a reprieve by allowing providers to use 2017 as a transition year. In June 2018, CMS released its 2018 proposed rule which extends this transition period, but with some important changes. Providers must adjust to avoid a negative payment adjustment and maximize their changes for enhanced earnings. This is particularly the case in complex environments involving multiple tax IDs and a mix of value-based reimbursement methodologies. This webinar is intended for audiences that are already well acquainted with the basic provisions of MACRA and are seeking concrete guidance on how best to respond.

On April 11, 2017, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) considered and made recommendations to HHH regarding the first three application for approval as an Alternative Payment Model (APM) to come before the PTAC. The background and lessons learned by three applicants that day are shared during this interactive webinar: 

• Regarding Project Sonar - Lawrence Kosinski, MD, MBA, AGAF, FACG; Managing Partner, Illinois Gastroenterology Group; President, SonarMD, LLC ; Community Private Practice Councillor, AGA Governing Board; Elgin, IL
• Regarding COPD and Asthma Monitoring Project (CAMP) - Daniel P. Ikeda, MD, FCCP; PMA - Pulmonary Medicine Associates (Pulmonary Medicine, Infectious Disease and Critical Care Consultants Medical Group Inc.); Sacramento, CA 
• Regarding ACS-Brandeis Advanced APM - Frank Opelka, MD, FACS; Medical Director for Quality and Health Policy; American College of Surgeons; Washington, DC
• Moderator - Susan Dentzer; President and Chief Executive Officer, NEHI (The Network for Excellence in Health Innovation); Analyst on Health Policy, The NewsHour; Washington, DC
   

Advanced Strategies in Appropriately Reducing Readmissions in the Context of Bundled Payment Arrangements Case Studies in Cardiac (cardiology and cardiac surgery), Oncology and Orthopedics

Medicaid coverage faces uncertainties nationally as Congress and the Trump administration continue to pursue repeal and replacement of the Affordable Care Act. 

Population Health has gravitated to become a central component of the delivery of healthcare in the 21st century, and takes on particular importance given the evolution towards value based care. It is critical for leaders, clinicians and staff of healthcare organizations to have a vision going forward on how to best incorporate population health into their approach - sharing from insights, innovations, best practices, strategies and experiences from national leaders involved with population health.

With the first performance year for the new Merit-Based Incentive Payment System (MIPS) underway, eligible clinicians must strategize payment implications under the program.

Today’s health care executive is considering many strategies to drive value. How can bundled payments and post-acute care fit into an organization’s future plans? 

The Medicare Access and CHIP Reauthorization Act (MACRA) makes significant changes to the Medicare payment system by introducing a quality-based payment model. 

In this webinar, a framework and metrics for measuring SNF performance is discussed, followed by an exploration of SNF performance levels across the United States in order to provide a quantitative assessment of the opportunity to reduce spending for SNF services through steerage of patients to more cost-efficient SNFs.

Milliman reviews their RAPS to EDS transition study and discuss transition problems and how Medicare Advantage organizations should respond.

Sessions include: Key Healthcare Legal, Regulatory and Policy Issues for 2017; The Employer Role in Healthcare Transformation 2017; and Top Ten Trends for Healthcare Marketing 2017

A state of the art examination of the consumer driven landscape going forward from two national consumerism experts.

Detailed research findings relating to the impact and implications of narrow networks on health plans premiums with respect to the public marketplaces.

Results from Deloitte’s 2016 Survey of US Health Care Consumers and Deloitte's study on Realizing the potential of telehealth report on trends in telehealth and consumer interest; with a discussion of the regulatory landscape; and the potential barriers, opportunities, and enablers for telehealth in the coming years.

Sessions include: Five Common Pitfalls in Commercial ACO Shared Risk Arrangements; The Aledade ACO Perspective; and ACOs, Risk, and Paradigm Shifts

In this webinar, ECG’s team of experts will review findings of ECG’s 17th annual Physician Compensation Survey. The session will include our analysis of important physician and advanced practice clinician performance trends from the 2016 survey. A particular focus of this webinar will be on market trends related to value-based provider compensation planning and how those plans integrate with overall organization strategies. As healthcare reimbursement transitions from volume- to value-based, it is essential that physician compensation plans also evolve to ensure organizational success under changing financial incentives.

Discussion of a range of issues and considerations under the final rule implementing Medicare physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”).

Discussion of the risk sharing pricing environment and payment methodologies, the process involved in building your managed care pricing strategy at a service line level as well as across an aligned provider network, and the impact of physician integration on different risk models and payer contracting strategy.

The speakers share their health system population health insights and experiences.

This session builds on the Health Plan Alliance's perspective of the shared experiences, opportunities and challenges faced today by provider sponsored health plans and their integrated delivery systems.

This presentation will review the findings and implications from the survey of executives from hospital/health systems, health plans, biopharmaceutical companies, and medical technology companies, regarding awareness, preparedness, and perceptions about MACRA.

This session will position stakeholders for 2017 and beyond by providing a deeper understanding of the current Medicare environment; an examination of the intricacies of the challenges facing Medicare Advantage plans and networks - especially provider sponsored and regional plans and networks

Explore the dynamics of how MACRA will impact all parts of the healthcare market; the key concepts surrounding how MACRA will impact provider reimbursement; and specific strategies for how both providers, health systems, and health plans can leverage MACRA to its fullest effect to further organizational goals and reimbursement.

A brief overview of the proposed rule, timing for the final rule, and implementation timelines will be discussed, and Implications of the MIPS scoring proposal will be addressed.

An overview of Bright Health's vision, insights, perspectives, experiences, strategies and initiatives as they face the challenges of a start up health plan setting its sights on national presence in this era of healthcare transformation.

A discussion of the state of rural ACOs and their lessons learned, drawing on Caravan Health experience.

A discussion regarding applying risk adjustment to value based payment models.

Sessions include: Five Health Care Trends that will Impact Your Population Health Strategy; Capturing Triple Aim Value Across the Care Continuum in Value-Based Programs ; and Telemedicine and the long-tail problem in healthcare.

A case study in the Delaware Valley ACO's evolving approach.

This session provides an overview of CPC+ program details and examines the new model's implications, strategies and issues for stakeholders.

This session explores the crucial role of diagnosis coding by focusing on the role of certain variables—including carrier size, market share, and market size—on the ACA risk adjustment formula.

This session examines the current bundled payments environment and what successful organizations are doing to position themselves in the new era of payment reform and value-based care.

PwC research and insights on the private exchange value proposition, and the evolution of private exchanges

How and why patient complexity is reshaping care delivery.

A case study of innovation in care for the Medicaid population hrough innovative technology and other initiatives combined with a highly efficient, patient-centered, team-based model of care.

Sessions include: Top Healthcare Trends and Issues for 2016; Key Healthcare Legal, Regulatory and Policy Issues for 2016; and Reference Pricing - Coming soon to a health plan near you?

Sessions include: The Evolution of Accountable Care in 2016 and Beyond; Preparing For Direct Employers Contracts: The Next Business Curve for ACOs; and Eight Essential Keys to Successful ACO Contracting.

In this webinar, ECG’s team of experts will review the findings of ECG’s 9th annual Pediatric Subspecialty Physician Compensation Survey. The session will include our analysis of important physician and advanced practice clinician performance trends from the 2015 survey. A particular focus of this webinar will be on market trends related to value-based provider compensation planning and how those plans integrate with overall organizational strategies. As healthcare reimbursement transitions from volume to value, it is essential that physician compensation plans also evolve to ensure organizational success under changing financial incentives.

ECG’s surveys focus on provider performance trends, including compensation, production, and benefits by specialty; compensation plan design and metrics; recruiting efforts and signing bonuses; CPT code physician profiling; and many other key performance metrics. The 2015 ECG surveys include data from 134 physician specialties and 15 advanced practice provider specialties from more than 110 physician organizations, representing more than 32,000 practitioners. Together, this data contributed to produce our most comprehensive reports to date.

A macro and micro examination of California's Health Insurance Exchange and Market.

A discussion on how Payors can avoid certain problems associated with narrow networks and give themselves a clear competitive advantage by designing high-performing health networks using three criteria.

A discussion of the UMass Memorial ACO case study that other Accountable Care Organizations can consider as they address their specific post acute care issues and approach.

This session examines balancing the constructive use of lifestyle and behavioral data and analytics to slow certain chronic illnesses in their tracks, while making sure that data is not misused.

An examinaation of the myriad of legal, regulatory and ethical considerations that must be addressed in order for healthcare stakeholders to properly leverage Big Data in healthcare, and adopt best practices in data mining.

Components and implications of reference pricing, current use of reference pricing in the U.S., and how reference pricing can be structured on a more widespread basis

Findings from the Deloitte Center for Health Solutions Survey of US Health Care Consumers, and sharing of perspectives, insights and potential stakeholder strategies regarding Public Health Exchanges and Consumer Engagement.

Presentations include: Analysis of Medicaid Managed Care Administrative Costs; The Colorado State Innovation Model, a Case Study; and Fostering Medicaid Accountable Care Organization Development in New Jersey

This presentation provides an outline of ECG Management Consultant's perspective on the significance of health plan consolidation on provider organizations, and the steps they are recommending that their clients take in preparation.

This session will explore demographic changes, readmissions reduction challenges, work force and caregiver issues and successful intervention approaches involved with SCAN Health Plan initiatives to reduce readmissions.

During this session, case examples will be provided detailing how technology has been employed at one health network to facilitate the development of patient-centered medical homes; and telehealth use cases in medical home settings, addressing different modes of telehealth transmission and platforms.

During this presentation, an overview will be given of the key features of the CCJR model. Examples of possible savings opportunities will be provided, and participants will learn how they can estimate the potential effect CCJR will have on their practice pattern and revenue cycle.

This session will address the relevant details of the Medicaid Managed Care Proposed Rule, as well as highlight key implications of the major provisions for stakeholders, and what overall level of revisions might be expected with issuance of the Final Rule.

This session will discuss in detail PwC research findings, expand on individual factors that will "deflate" and inflate components of the medical cost trend for 2016, and address strategic implications for health plans, providers, employers, consumers and other stakeholders.

This session addresses Treasury Department new guidelines for not-for-profit hospitals on how and when to offer financial assistance, and upcoming IRS changes in reporting requirements and scrutiny of both community benefits and patient financial assistance.

Atrius Health's ACO case experience, results, challenges, opportunities, insights, and perspectives as a platform for their Medicare population health strategy.

Discussion of a comprehensive Dual Eligibles study that provides insights into how clinical, sociodemographic and community resource characteristics impact health outcomes and Medicare Advantage (MA) plan Five-Star ratings.

A discussion of applying the principles of population health to improve the health of a large employee population and illustrate the value of a population health driven approach to practicing physicians.

Sessions will include: Population Health Management: Innovations in Risk Adjustment and Predictive Modeling; Risk Adjustment and Shared Savings Agreements; and Connecting Predictive Modeling and End-Users: the Last Mile Problem.

Ths session examines research on the current and historical number of ACOs and covered beneficiaries for Medicare and Commercial categories, geographical representation and access to coverage, along with other Accountable Care data and further insights.

A presentation on Capital BlueCross' Accountable Care approach - discussing their medical value strategy; an overview and history of Capital BlueCross’ value-based programs; detailing their Accountable Care Arrangements model; and sharing data regarding their program outcomes and results.

A discussion of the scope of the controlled substance abuse epidemic and a variety of methods to detect misuse and abuse; the Prime CS Score study, its implications, and opportunities for stakeholders to lightly manage or aggressively manage the problem.

Sessions include: Tools for Managing and Monitoring Population Health for Health Plans and Hospitals; Expanding Access to Diabetes Self-Management Education: The Economic Case; and Integrating Behavioral Health: Essential for Population Health.

Patient Engagement Systems' Benjamin Littenberg, MD, CMO and National Kidney Foundation's Joseph A. Vassalotti, MD, discuss Chronic Kidney Disease & the Primary Care Practitioner: Early Screening and Prevention for the At-Risk Patient. This presentation was an on-demand session as part of the 2015 Population Health Web Summit.

An in-depth look at forward-thinking diabetes management approaches some companies are taking, and ways other employers might integrate innovative elements into their own programs.

An examination of the GRACE Team Care Approach in Managing High-Risk Medicare Populations.

A discussion of the specifics of the provisions that participating ACOs under the Next Generation model will be subject to, as well as further-reaching implications for all ACO stakeholders with respect to the impact the new model will have on the Medicare ACO program as a whole, and the entire Accountable Care movement.

Research findings and lessons learned from a three-year evaluation of a pilot program conducted between 2009 and 2012 with more than 28,000 AARP Medicare Supplement Plan beneficiaries insured through UnitedHealthcare.

A presentation on CareSource's innovative persona approach that has transformed their care management for acuity based care coordination using cluster analysis to yield outputs of clinical personas.

A discussion of the National Rural Accountable Care Consortium's 2014 experience of their initial rural ACO, was well as their approach and initiatives going forward.

Results from the Private Exchange Evaluation Collaborative's survey, based on the responses of 446 employers, regarding private exchanges as a strategy for full-time active and retirees, and a national assessment that specifically captures the experience of early adopters of both private exchanges for active employees as well as retirees.

Three expert perspectives on the California Healthcare Environment in 2015.

Sessions include: Top Health Industry Issues for 2015; Key Healthcare Legal, Regulatory and Policy Issues for 2015; and ICD-10 as a Strategic Enabler in 2015.

A discussion of Humana's approach to value-based reimbursement, which involves analyzing practice readiness for participation in value-based reimbursement programs, and determining where appropriate practices might fit along the Accountable Care Continuum.

Milliman insights on key health plan issues pre and post the Supreme Court King v. Burwell decision.

Three prominent Accountable Care speakers share their organizational experience, insights, strategic perspectives and operational knowledge, including presentations on the Providence-Swedish ACO experience with employer driven Accountable Care; Accountable Anesthesia Organizations; and ACO legal, regulatory, strategic and operational hurdles for physicians to navigate.

Betsy Imholz of Consumers Union and Michael O'Neil with Healthcare Bluebook discuss the future of price transparency.

In-depth session on Medicare Bundled Payment PAC Utilization Benchmarking.

Applicable enrollment trends and the outlook for public and private health insurance exchanges.

Lessons learned for ACOs in Maryland.

PwC research, insights and perspectives regarding the continued evolution towards private exchanges including defined contribution approaches.

In-depth session on ACA Plan Sponsor Roadmap regarding Current and Upcoming Compliance Challenges

Issues and considerations that stakeholders need to address regarding ACO consolidation and antitrust issues in the marketplace.

Sessions include: Transforming Medicaid - Lessons Learned; Innovations and the Future of Medicaid Managed Care Contracting; and Medicaid Accountable Care Organization Development and Initiatives.

In-depth session addressing Best Practices in Managing Advanced Illness through Population Health Management.

Three national experts will share their experience, insights and strategies and initiatives in reducing preventable readmissions, including: a discussion on the PACT program; engaging Emergency Departments and Urgent Care for care transitions; and the next phase of hospital readmission research.

An in-depth session on the strategies for success for employer sponsored population health programs.

Employer 2015 medical cost trends and implications for stakeholders

Oliver Wyman research of ACOs at this juncture provides keen insight into the state of Accountable Care at this tipping point. Their research examines the current and historical number of ACOs and covered beneficiaries for Medicare and Commercial categories, geographical representation and access to coverage, along with other Accountable Care data and insights.

Implications of DSH changes for hospitals by area, with details of the mechanics of the new DSH and Uncompensated Care payments, and issues specific to Medicare Advantage plans.

The changing world of reimbursement and the use of quality measurements in provider contracts.

Cigna's Collaborative Care Strategy and results from their collaborative Accountable Care initiatives.

Stakeholder considerations for large employers involving fully-insured group plans as well as private exchange evaluation.

Topics addressed include: (1) predictive analytics research into evaluation of provider efficiency in order to advance techniques for value based provider payments; (2) ways hospitals have used analytics for staffing optimization; and (3) predictive analytics applied to users of a health behavior change program in order to predict future engagement.

Topics include: partnering and creating a culture of health with local employers; ROI analysis and methodology; and decision areas in population health.

The best of consumer engagement innovation during the past 12 months, that organizations should embrace as they move forward; and strategies and insights for healthcare organizations managing their CX journey into the future.

SCAN's initiatives to improve outcomes through patient engagement for their Medicare plan population

Research findings, and implications for stakeholders seeking to improve patient medication adherence and reduce overall costs

Additional Tags: PBM, Self-insurance, self-funding, TPA

Learn about the requirements for a successful multi-stakeholder cooperative care model to reduce readmissions, including Collaboration and Clinical Outreach and Care; Business Sustainability; and Employee Communications and Outreach.

Topics discussed include: How new ACA enrollees are being absorbed by ACOs and other provider networks; How health plans are dealing with enrollment administrative issues; How California compares to the rest of the country; Changes to the safety net; and The challenges ahead.

Results, lessons learned, challenges and implications of WESTMED's and UnitedHealth Network's ongoing Accountable Care collaboration.

Innovative research findings, and implications for stakeholders in the new public and private health insurance exchange environment

Tenet's Accountable Care initiatives supported by Conifer Health Solutions, and the implications of these initiatives.

Insights and perspectives on the top health industry issues for 2014; results and stakeholder implications from the 2014 Segal Health Plan Cost Trend Survey; and a discussion of collaborations between health systems as the strategic impetus for the formation of clinically integrated networks.

Known regulatory and market changes impacting estimates, and techniques and approaches for adjusting morbidity assumptions in the absence of claims data, so that plans can take advantage of data sources to gain some perspective into future pricing

Sessions include: The Journey to Physician Gain-Sharing Success; Legal Issues Arising Out of the Operation and Expansion of ACOs; and Actuarial Perspectives on ACO Provider Payment Rates.

Key research findings from two respective studies regarding healthcare social media activity.

Northeast Business Group on Health report based on a collaborative examination by 15 executives from large employers and health plans and highlighting approaches employers are taking to tackle the high cost and serious health issues stemming from obesity, and the keys to making programs more effective in the future.

PwC's HRI Health Exchange research and assessment of stakeholder positioning and recommended strategies going forward at the "opening bell" juncture for public Health Insurance Exchanges.

Discussion of the American Psychiatric Foundation's Partnership for Workplace Mental Health initiative regarding their free worksite education program that enables employers to raise awareness about depression and increase help-seeking behaviors.

Insights, perspectives and detailed research findings from ReviveHealth's Exchange Rates Survey, and the implications for stakeholders

The Kentucky Health Cooperative shares insights, perspectives and experiences on their organizational development, challenges, marketplace environment and key issues going forward.

Results and implications of SAI Global's Health Insurance Compliance Benchmark Study.

Sessions include: Avoid Readmissions through Collaboration - The ARC Initiative; Reducing Readmissions at UCLA: A Collaborative Approach; and Readmission Rates and the Robotic Operating Room Computerized Checklist.

Booz research and perspectives on the unfolding environment, employer segmentation, strategic considerations and stakeholder implications regarding payor participation in private exchanges.

Employer 2014 medical cost trends and implications for stakeholders.

Critical marketplace insights, perspectives and strategies for healthcare organizations to shift from a B2B to B2C model.

Sessions include: Predictive Modeling Opportunities, Issues and Implications from Richer Data Streams via EHR and Other Sources; Medication Adherence Interventions: using predictive modeling and risk stratification to target and improve program efficiency; Protons Don't Smoke - A unified theory for biologic science - in the context of big data in healthcare.

How WellSpan Health successfully transitioned a virtual SuperUtilizer Pilot to a dedicated Ambulatory Intensive Care Unit model, and perspectives on other SuperUtilizer programs and state initiatives.

Detailed provisions and stakeholder implications of CMS FFE guidance.

HealthPartners' strategies, initiatives, results and perspectives for success in the readmissions arena.

Key financial and operational considerations for providers to evaluate participation in exchanges.

Aetna initiatives, experiences and perspectivesto improve the coordination of care for Medicare Advantage members.

This session connects the dots between the issues of Medication Adherence, Readmissions Management and Predictive Analytics; providing insight into the correlation between medication adherence and readmissions; the application of predictive models for medication adherence; and the implications for improving outcomes, efficiencies and performance in a variety of care settings.

Detailed study results and an in-depth exploration of the Diabetes Health Plan case experience, performance and structure.

Essential Health Benefit and State Benchmark Plan requirements, guidelines and process, and findings from Milliman's analysis of state variability in benefits.

Descriptions of the currently uninsured population, where they may be getting coverage under different scenarios, their health status, the impact to Medicaid plans and the Exchanges, and how to design risk adjustment to reflect their unique characteristics.

Sessions include: The race to 2014 - health reform and the 30 million newly insured; Employer Health Benefit Trends for 2013; and 2013: The ACO Surprise

Sessions include: Evolving Toward the Accountable Future: Aetna's Accountable Care Vision and Collaborations; Cigna National Collaborative Accountable Care Strategies and Initiatives; and How to avoid the mistakes of the 2010s - pitfalls of risk-based contracts, the importance of data and how to strategize to be a successful ACO

Expert discussion and analysis of the policy and regulatory implications of the 2012 elections, with time allotted for questions and answers.

Marketplace intelligence, insights and perspectives based on a Booz research including a study of more than 500 employers and 300 consumers regarding interest in private exchanges.

Detailed results from Healthcore's hallmark PCMH research findings and experiences.

Will Fox of Milliman overviews the concepts and issues involved with Transparent Cost Networks including provider pricing and contracting and consumer selection, and how the Networks could work. This presentation was made as part of the 2012 Consumerism Web Summit.

This session presents detailed findings and analysis of PwC's 2011 HIX report, Change the channel: Health insurance exchanges expand choice and competition. It outlines the key strategic considerations for insurers as they gear up for participation in health insurance exchanges, including the impact of various exchange models on their business. Each state has flexibility in how to design and operate an exchange, which could mean dozens of variations in exchange models across the country. The differences could make some exchanges profitable for some insurers but not for others, and insurers will need to decide which ones they will enter. Join PwC's Serena Foong and Shannon Smith as they discuss PwC's HIX report in depth, address strategic considerations for stakeholders, and tackle your specific HIX questions.

This lecture highlights the pivotal role of testing in HIV prevention and treatment, presented as part of CDC HIV/AIDS 30 Years: Commemoration Activities.

A discussion of the legal, regulatory, policy, fiscal and operational implications for ACOs, their sponsors and other stakeholders regarding the Medicare Shared Savings Program Proposed Rule:

A presentation on 2010 HSA (Health Savings Accounts) market statistics and trends, made during the 2011 consumerism Web Summit

The 2010 Accountable Care Web Summit included three faculty presentations:

• Piedmont Physicians Group Accountable Care Pilot Program - James C. Sams, MD, Medical Director, Piedmont Physicians Group
• The ACO Legal and Regulatory Environment: An Update for 2011 - Doug Hastings, Chair of the Board of Directors, Epstein Becker & Green, P.C.
• ACO Payment and Contracting Issues for 2011 - Terri L. Welter, Principal, ECG Management Consultants, Inc.