Monday, January 22, 2018

Registration & Continental Breakfast


Chairman’s Welcome & Opening Remarks

Payment Model Innovations

Health care providers will increasingly experience the need for comprehending the "value" to them of value-based reimbursement. For this to occur, it will be crucial for providers to develop a fully integrated perspective of several, or many, disparate payment initiatives, including bundled payments, total cost of care arrangements with gain-sharing or risk-sharing, comprehensive primary care reimbursement, quality and efficiency incentive programs, and pricing transparency (just for starters).

By integrating the collective impacts of each of these initiatives and methodologies, a provider can determine the ultimate value to them, rather than evaluating them in isolation.

Attendees will:

  • Gain an understanding of the proliferation of value-based payment strategies and tactics.
  • Recognize how these separate components to reimbursement can be integrated to create a cohesive view of total reimbursement from a third-party payer.

Richard O'Donnell,Vice President, Provider Contracting,Priority Health

Adam Giroux,Director Value-based Reimbursement Strategies,Priority Health


Panel Discussion: Seamless Transitioning & Transparency Between Fee-for- Service and Pay- For-Value

Understand the interaction and transition between FFS and P4V

  • How will all parties pay or get paid?
  • Evaluating and getting used to paying for cost avoidance
  • Assessing your potential business partner(s)
  • Ensuring a win-win (-win- win) partnershipm


Lili Brillstein,Director, Episodes of Care, Market Innovations,Horizon Blue Cross Blue Shield of New Jersey


Matt Flora,Director – EBI Medical Informatics, Enterprise Business Intelligence,Arkansas Blue Cross and Blue Shield

Jennifer Winchester,Senior Director, Provider Network Innovations and Partnerships, BlueCross BlueShield of South Carolina

Michael Manna, Executive Director, Healthcare Solutions, J.P. Morgan


Networking Refreshment Break


Mandatory, Voluntary Episodes/Bundles: What’s Happening?

  • Understand the difference between mandatory and voluntary episodes/bundles
  • What does it mean now that CMS has abandoned mandatory bundles?
  • What’s the future of episodes/bundles?
  • What do you need to know?  What do you need to do?

Lili Brillstein,Director, Episodes of Care, Market Innovations,Horizon Blue Cross Blue Shield of New Jersey


Role of Bundled Payments within Hospital System Population Health Strategy

This session will address the convergence adoption of Bundled Payments and compares and contrasts the motivating drivers and critical success factors based on the initiator ( CMS, hospital system, physicians, commercial payers, employers) This session also will stress the importance of inclusion of Bundles in a Hospital System's overarching population health strategy that will recognize the nuances of each model and ensure consistency in patients' continuum of care coordination best practices, alignment of quality metrics and agreement on efficiencies targets.

Lauren McDevitt, Episode Payment Model Director, Bon Secours


Optimizing Payments in the Unbundled Outpatient World

Fee for service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

  • The Fee for service model is here to stay
  • wRVU and providers' productivity as a measure 
  • Patient care and the impact of the FFS model 
  • Identify key business processes that can improve quality of care and revenue

Khaled Kadry,Director of Revenue Cycle,Columbia University Medical Center


Networking Lunch

Next Generation Transparency to Enhance Member/Provider Payment Experiences

Increasing Opportunity for Data Sharing, Transparency and Building Long-term Trust with Providers

  • Maximizing Shared Savings Plans
  • Facilitating Better Care Quality and Clinical Outcomes at a Lower Cost
  • Leveraging Data Across the Network to Stratify Risk and Maximize Resources
  • Sharing Data with Providers About Their Clinical and Financial Performance and How it Compares to Other Organizations
  • Offering Data Options Across the Spectrum of Risk
  • Establishing Value-based Goals and Aligning Incentives
  • Incorporating Pharmacy into the Equation

Michael Ruiz,Vice President, Provider Relations & Contracting,UCare


Making the Member-Patient Financial Experience Seamless!

Learn from UPMC Health Plan on how they enhanced the financial experience for their members and patients. Hear highlights on how they have leveraged being part of an Integrated Delivery and Finance System. Solutions will be shared on cost transparency, claims payment, premium billing payment, and member/patient satisfaction.

Anne Palmerine,Associate Vice President, Customer Engagement & Enrollment Services,UPMC Health Plan

Linda Zang,Assistant Treasurer,UPMC


How St. Luke’s and Select Health are Digitizing EOB’s into a Self-Pay Portal to Improve Yield and Experience

This session will review how St. Luke's Health System and Select Health has partnered to co-develop processes in order to improve the overall member/patient experience. This effort includes the addition of Select Health EOBs into St. Luke’s Bill Pay so patients can reconcile balances, make payments or develop payment plans in a single platform.

Michael Rawdan, Ph.D., MBA,System Senior Director of Revenue Cycle & Patient Experience,St. Luke’s Health System


Networking Refreshment Break


HSAs, HRAs, SSAs – Solutions for Smoother Payment Flows

Robin Wright-King,Director of Consumer Directed Health Product and Strategy, Blue Cross Blue Shield of Massachusetts


Panel Discussion: Price Transparency: A Win-Win for Providers, Payors and Patients


Khaled Kadry,Director of Revenue Cycle,Columbia University Medical Center

Richard O'Donnell,Vice President, Provider Contracting,Priority Health

Michael Ruiz,Vice President, Provider Relations & Contracting,UCare


Discover how New York Presbyterian Hospital Focuses on the Pharmacy Financial Life Cycle To Realize Over $2M In Additional Revenue Annually

Mary Eileen Bezman, Revenue Manager Pharmacy, New York Presbyterian Hospital

Data, Compliance & Infrastructure

From Policy to Bottom Line: Improving Revenue Cycle Performance with Use of Operating Rules for Healthcare Transactions

There is widespread consensus that administrative costs in healthcare are excessive. An industry-wide transition to replace manual processes with electronic, real-time transactions is ongoing to reduce the cost of doing business in healthcare and meaningfully impact efficiency, productivity, and data quality. The nonprofit CAQH CORE is a key driver of this transition as the HHS-designated operating rule authoring entity.

Health plans are currently required to use transaction standards and operating rules when exchanging administrative data with providers. To date, operating rules addressing eligibility, claim status, electronic remittance advice (ERA), and electronic funds transfers (EFTs) are federally mandated and rules for claims and prior authorization are industry driven. These transaction standards and operating rules can significantly improve revenue cycle performance through real time transaction, delivery of more robust patient financial information, easier reassociation of EFTs and ERAs, and a common infrastructure between trading partners. Furthermore, specific CORE-defined Business Scenarios for the uniform use of Claims Adjustment Reason Codes (CARCs) and the Remittance Advice Remark Codes (RARCs) increase the ability to auto-post and better understand adjustments and denials reported in the remittance advice which reduces manual follow up.

The purpose of this session is to:

  • Build awareness of the HIPAA administrative simplification provisions, new voluntary operating rules for claims and prior authorization, and how operating rules and standards can improve revenue cycle performance.
  • Understand why coordination between health plans, providers and vendors is critical to reap full administrative simplification benefits.
  • Share real world examples of how industry is benefiting from the use of operating rules for administrative healthcare transactions and key action steps to ensure maximum gains.

Robert Bowman,Associate Director,CAQH CORE


Networking Reception

Tuesday, January 23, 2018

Continental Breakfast


Chairman’s Remarks


Protecting Healthcare Payors from Ever Increasing Data Breaches and Payment Fraud

The healthcare industry is one of the primary targets for data breaches. According to the Identity Theft Resource Center (ITRC), 36 percent of all breaches and 44 percent of all records compromised were healthcare-related in 2016. This is because a single stolen healthcare record is worth $50 on the cyber black market, more than 10 times the value of a social security number ($0.43), making the healthcare system a prime target for fraud.

To help protect healthcare payors against breaches and fraud, this session will:

  • Educate on payments fraud and breach trends, and how and why hackers target unprotected healthcare payors
  • Explain the technologies, such as EMV chip technology, mobile payments, and online risk-based ecurity solutions, that are available today and how to implement them to protect health organizations from becoming a victim
  • Provide best practices to prevent future payments fraud or data breaches

Randy Vanderhoof,Executive Director,Secure Technology Alliance


Networking Refreshment Break


Panel Discussion: Operationalizing Value Based Payments


Mark D. Wagner, Director, Provider Reimbursement Operations, Excellus BlueCross BlueShield

Michael Manna, Executive Director, Healthcare Solutions, J.P. Morgan

Emerging Technologies in Expediting Payments

Opportunities to Enhance Payor/Provider Transactions to Accelerate the Movement to Real-time Payment Processing

June St. John, SVP, CTP,Healthcare Product Manager,Wells Fargo


Emerging Technologies, including Blockchain, and Treasury Solutions for the Healthcare Industry

Learn about how the adoption of new payment methods, such as Real-Time Payments, Same Day ACH and tokenized payments, is increasing value, speed and transparency for payers, providers and patients, and how growing research and development opportunities using blockchain technologies are securing methods for sharing claims data, electronic medical records and expansive clinical information.

This session will be a discussion on some of the most innovative trends in technology impacting Treasury today. Each segment will help you to understand what the technology is, how it works and how it could help your business.

Valerie Rodgers,Vice President, Healthcare Product Manager, Global Product Management: Healthcare Segment,BNY Mellon Treasury Services


Close of Conference