Saturday, April 5, 2014
11:00 a.m. – 12:15 p.m.
Starting a Provider-Sponsored Health Plan through Partnerships [More Info]
Ashok Rai, MD, President and Chief Executive Officer, Prevea Health; and Craig E. Samitt, MD, MBA, Executive Vice President, HealthCare Partners
Presenters will explain why a collaborative approach to health coverage is a benefit to local business and the community. They will introduce the real ACO, and describe how a coordinated network can provide profitability back into your local community, and share how to establish the partnership, including governance, financial arrangements, and brand development. They will also share their process of applying to be included onto the federal insurance exchange, their unique sales strategy, which combines health plan offerings with wellness solutions, and how they identify direct marketing solutions that appeal to business decision makers. |
Upon completion of this activity, participants should be able to understand the steps required to start a provider-sponsored health plan in their own state. |
Robert E. Matthews, Vice President for Quality, PriMed Physicians and President and Chief Executive Officer, MediSync; and Douglas Romer, MD, Family Practice Physician and Chairman of the Board, PriMed Physicians
Most medical groups’ revenues have been based solely on volumes of services provided. As medical groups are contemplating or actually engaging in the shift to value-based revenue, leaders must plan and execute a massive change in their group infrastructure, operational practices, and culture. This presentation will feature some of the key elements in the change strategy from the perspective of PriMed Physicians, a group that has been undertaking this transition for a decade. |
Upon completion of this activity, participants should be able to identify and define five major areas of change that must occur in a major organizational transformation; understand the elements of “change management,” especially as they apply to medical groups; and understand the need for physician leaders to simultaneously have both a “big picture” perspective of the changes that they are planning and a detailed list of change projects. |
Grace Terrell, MD, MMM, Chief Executive Officer, Cornerstone Health Care, PA
This presentation explores the management challenges and health information infrastructure requirements of transforming a large group practice to an innovative population health management hub taking on accountability for costs, quality of care, and patient loyalty. |
Upon completion of this activity, participants should be able to define the challenges facing large ambulatory group practices attempting transformation from volume to value-based revenue models; list the components of an integrated health information infrastructure required to support transformation to accountable care for a patient population; and appraise a group practice’s readiness to embark upon practice transformation. |
Jean Tealey, RN, MSN, Director of Nursing, and Susan Terry, MD, Medical Director, University of Utah Health Care Community Clinics; and Alisha Richins, RN, BSN, Ambulatory Nurse Educator, University of Utah Health Care
Eighty percent of all hypertension patients with their condition under control. That was the goal embraced by the University of Utah Healthcare as they took the plunge into AMGF’s Measure Up/Pressure DownTM national campaign focused on controlling the nation’s high blood pressure. Hear best practice strategies on how the group was able to move the needle by implementing training regimens for team members involved in direct patient care, developing prevention, engagement and self-management programs, and engaging their physicians in the primary and specialty care settings. |
Upon completion of this activity, participants should be able to describe the purpose of the MU/PD campaign; describe implementation strategies for planks 1, 5, & 8; and explain the pneumonic BP STARS as well as how to use this as a staff education and engagement strategy. |
Cindy DeCoursin, MHSA, FACMPE, Chief Operations Officer, Richard C. Naftalis, MBA, MD, FAANS, FACS, Chair, Physician Specialist Affairs Committee, and Pam Zippi, Director of Marketing, Baylor Healthcare System/HealthTexas Provider Network
This presentation will discuss HTPN’s referral strategy and our advances made in implementing referral policies and procedures that work to facilitate acceptance of the referral process throughout the entire network of physicians. One of the group’s neurosurgeons will share his view on the seven habits for a highly effective referral. |
Upon completion of this activity, participants should be able to develop a centralized Referral Coordination program that increases in-network referrals and allows for referral tracking; utilize the EHR to enter and track referral orders, understand how in-network referrals improve overall care coordination; create a healthy “referral environment” through published Service Standards between primary and specialty care physicians; and describe how protocols at the primary care level can help PCP’s better manage patients and lead to higher quality referrals to specialists. |
Helen Portalatin, RN, MSN, FNP-C, Director, CARETEAM Program, and Betty Jessup, RN, BSN, Crystal Run Healthcare LLP
This interactive presentation will demonstrate the benefits and savings opportunities of transitional care. Various evidence-based models will be reviewed as a framework for building a transitional care program. Specific protocols for transitional care home visits, care management, and telemonitoring will be shared. Case studies and outcome data will be reviewed, including descriptive statistics of home visits, and the impact that these interventions have had on our organization’s admissions and readmissions, ER utilization, and cost of care. |
Upon completion of this activity, participants should be able to understand the impact that reducing hospital admissions and readmissions can have on bending the cost curve; demonstrate the use of claims data to tailor clinical programs that advance the triple aim; understand evidence-based models of transitional care and utilize these programs to customize a transitional care program for their own organization; discuss how to integrate population management, home visits, and telemonitoring to impact hospitalizations, ER visits and cost of care; and identify the unique challenges of improving transitions to and from skilled nursing facilities. |
Parag Agnihotri, MD, Medical Director Continuum of Care, and Janet Appel, RN, MSN, Director of Population Health, Sharp Rees-Stealy Medical Group
Successful embedded, clinic- based disease management programs achieve greater efficiency, patient centered engagement, increased satisfaction, and improved outcomes. This presentation will describe a value-based team practice redesign which works across the continuum of care and focuses on physician communication and patient engagement towards healthier living. |
Upon completion of this activity, participants should be able to find effective ways to mobilize clinical teams towards patient engagement in order to manage chronic conditions and improve the health outcomes for their population. |
Robert A. Probe, MD, Professor and Chair, Department of Orthopedic Surgery and Chairman, Hospital Board, and Andrejs E. Avots-Avotins, MD, PhD, Chairman, Board of Directors, Scott & White Healthcare
Scott & White will present their process for expanding Advanced Practice Providers in their medical model and practices. They will show their burning platform for change, why key changes in governance were needed, and how this helped create better care for patients. They will also show key differences in their model. |
Upon completion of this activity, participants should be able to embrace and develop APP’s. |
James S. Zacharias, MBA, CMPE, Chief Executive Officer, St. Francis - Columbus Clinic, PC; and Aimee Greeter, MPH, Senior Manager, Coker Group
As hospitals and physician groups continue to evolve in response to the accountable care reimbursement paradigm, quality measurements are becoming a larger component of the total payment received from both government and private insurers. This session will address five specific ways to increase the total revenue “pie” through demonstrating quality. |
Upon completion of this activity, participants should be able to identify five different quality incentives existent within the healthcare industry today; explain ways to effectively respond to established quality incentives; understand how to continue to maximize fee-for-service reimbursement along with quality payments; discuss the value proposition for both physicians and hospitals/health systems; and engage in open dialogue about current situations within their own healthcare entity relative to value-based reimbursement and apply tools, ideas and resources presented. |
John T. Randolph, Vice President and Chief Compliance Officer, UMass Memorial Health Care; Daniel Carlat, MD, Director, Prescription Project, The Pew Charitable Trusts; and Tara Shewchuk, Vice President, Ethics and Compliance, Medtronic, Inc.
On March 31, 2014, drug and device manufacturers must submit reports to the federal government detailing payments to all U.S. physicians and teaching hospitals, and this information will be publically published on September 30, 2014. Case studies will be shared to describe the publicity institutions can expect. |
Upon completion of this activity, participants should be able to discuss how the Open Payments registry can cause negative publicity for health care institutions; apply effective policies from case studies of leading health care institutions to your organization; and list specific conflict of interest policies that may work for your institution. |
Saturday, April 5, 2014
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Merger Synergies: What’s Real? [More Info]
Robert Pryor, MD, MBA, CPE, FAAP, FCCM, FCCP, President and Chief Executive Officer, Scott & White Healthcare; and Joel Allison, FACHE, MS, President and Chief Executive Officer, Baylor Healthcare System/HealthTexas Provider Network
Less than nine months after closing, the leaders from Baylor and Scott & White will present answers to questions you might ask about the merger. Some prognosticators predicted a larger merger like Baylor-Scott & White would fail miserably. Some predicted billions of dollars of synergies. They will present what is real and reflect on what worked and why. |
Upon completion of this activity, participants should be able to determine how much of predicted synergies are real; understand how similar mergers might affect their professional practices; and apply these lessons learned to help their practices. |
Jennifer Coleman, RN, MSM, BSBA, BSN, Nurse Manager, Department of Internal Medicine, Fred DeGrandis, Jr., MPA, Administrator, Department of Internal Medicine, Andrea Sikon, MD, FACP, Chair, Department of Internal Medicine, and Mary Thibeault, MSL, Project Manager, Medicine Institute, Cleveland Clinic
Successes and challenges encountered in a primary care practice transformation process are highlighted along with techniques used to mitigate these challenges and lessons learned. Participants will offer their own best practices related to managing change and collaborate to develop a shared playbook on how to overcome these common challenges. |
Upon completion of this activity, participants should be able to describe Patient Centered Medical Home value-based care practice transformation efforts; identify commonly experienced challenges that are encountered during practice transformation efforts; and explore techniques used to mitigate challenges in practice transformation. |
Philip M. Oravetz, MD, Medical Director, Accountable Care, Ochsner Health System; and Brad M. Boyd, Vice President, Sales & Marketing, Culbert Healthcare Solutions
This presentation reviews action
taken by a large health system to develop an EHR extension offering for affiliated practices and community
physicians to improve the exchange of patient information in an effort to decrease the costs of delivering
patient care while improving the overall quality of care.
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Upon completion of this activity, participants should be able to guide their organizations through a structured process to examine potential benefits or disadvantages to extending Electronic Health Records to affiliated practices and community physicians; describe a comprehensive strategy process that included the active involvement of key decision makers in a large health system to recruit and overcome apprehension from physicians in a rural community; and outline an EHR roll-out approach, financial plan, and staffing/resource requirements. |
Bernadette Loftus, MD, Associate Executive Director for the Mid-Atlantic States, Kaiser Permanente
Kaiser Permanente Mid-Atlantic States has rapidly become a top national performer in quality. By establishing clear targets, accountabilities, processes, reports, and oversight, they have achieved dramatic gains in quality across race, virtually eliminating racial disparities in the health care provided. |
Upon completion of this activity, participants should be able to gain actionable ideas to eliminate racial disparities in health care. |
Angela Lin, MD, Assistant Medical Director, and Steven A. Mitnick MD, MBA, Chief Medical Officer, Gould Medical Group; Katherine T. Manuel, Chief Operating Officer, Sutter Gould Medical Foundation, Sutter Health Central Valley Region; and Thomas N. Atkins, MD, MMM, FAAFP, FACPE, CPE, Medical Director Urgent Care Services, Sutter Medical Group
Medication safety is a major patient safety activity that every medical group longs to achieve. In this presentation, two Sutter Health-affiliated medical groups describe the collaborative redesign of process and procedures based on the Care Team model. The speakers will discuss performance dashboards, medical group incentives, and policy developments to achieve EHR-medication list accuracy. The physician leaders and executives will discuss their experiences of uncovering underlying cultural blind spots, biases and the strategies to bridge the divide between primary care, specialist, and surgical physicians. |
Upon completion of this activity, participants should be able to identify training and knowledge gaps among the Care Team members—medical assistants, nurses, physicians—and establish training programs to bridge the gaps; identify the gaps of technical support in the EHR to accomplish the objective of an accurate medication list; identify the gaps in office procedures Medication List Management and build a coherent process and policy to which the organization as a whole adheres; design and construct a metrics dashboard to monitor Medication Reconciliation performance granular to the level of each patient encounter; leverage external and peer influence to advocate a Culture of Safety; and use the GMG-SGMF Medication Reconciliation toolkit to assess the EHR-process readiness in their offices. |
Karen Lloyd, PhD, LP, Sr. Director, Behavioral Health Strategy & Operations, and Arthur Wineman, MD, Regional Assistant Medical Director, Primary Care, HealthPartners
Primary care collaborated with behavioral health to develop an approach to proactively manage care of patients who have behavioral health conditions; provide easy access to urgent and routine behavioral health and chemical dependency services; and develop screening and management guides for providers for selected behavioral health and alcohol misuse conditions. |
Upon the completion of this activity, participants should be able to focus on and improve access and health outcomes for patients at the highest risk; and establish and embed practical and effective workflows into their system. |
Marty Murray, Vice President, Administrative Services, and Robert Breakey, MD, Division Head and Chairman of the Board, IHA
This presentation will provide insights into IHA’s journey to move from an automated phone system to live answering of phone calls. IHA receives just over 1 million phone calls a year. Presenters will share the process and tools developed and utilized to achieve significant improvement in patient, provider, and staff satisfaction. |
Upon completion of this activity, participants should be able to identify operational opportunity areas by utilizing Patient, Provider, and Staff Satisfaction Surveys and testimonials; understand the key steps to implementing a phone improvement plan; organize and utilize “pilots” to test improvement plan ideas; develop work plans and tools to accomplish improvement goals; and utilize outcome data to spur on continued improvement. |
Meyers Stallings, MBA, Associate Director, Vanderbilt Access Services, and Paul Schmitz, MLAS, Director Capacity Management Department, Vanderbilt Access Services, Vanderbilt University Medical Group
In the past four years VUMG has made substantial access services improvements, including new patient wait time, call management, and physician template capacity. Initiating a custom access toolkit with transparent data reporting at the individual and institutional level is one approach helping change the internal dialogue and allowing execution of action plans. |
Upon completion of this activity, participants should be able to discuss the barriers and challenges related to implementing patient access initiatives; engage with fellow attendees and the presenter(s) to identify best practices regarding developing metrics, changing culture, and earning buy-in from physician leaders; outline the core components of Vanderbilt University Medical Center’s three-pronged approach for improving patient access performance; and evaluate the findings and critical success factors for supporting access programs within their own practice/organization. |
Joseph Moscola, MBA, PA-C, Senior Vice President and Executive Director, Ambulatory Services, and Nicholas Stefanizzi, Director, Management Services, Ambulatory Services, Physician and Ambulatory Network Services, North Shore-LIJ Health System
The North Shore-LIJ Medical Group has leveraged the lessons learned from successful operations throughout Hurricane Sandy to further advance its preparedness capability, ensure the health and safety of our patients, employees, and physicians, and redefine the model for emergency preparedness and business continuity in ambulatory care. |
Upon completion of this activity, participants should be able to recognize the challenges inherent in sustaining emergency operations across a large and diverse ambulatory care network and the opportunity to advance preparedness capability; identify critical elements of Ambulatory Emergency Preparedness and Business Continuity Planning; leverage the lessons learned during Hurricane Sandy to proactively identify gaps in existing emergency preparedness and business continuity plans; understand the tools, processes, policies, and procedures necessary to support emergency operations across a large ambulatory network; adopt the best practices developed by the North Shore-LIJ Medical Group to support emergency preparedness and business continuity plans; and understand the critical role practice recovery plays in supporting the delivery of care in areas hardest hit by a particular incident. |
Fred McQueary, MD, MMM, CPE, Senior Vice President of Clinical Integration, and Fred Ford, Senior Vice President of Ambulatory Care, Mercy Clinic; and Brad Vaudrey, Principal, Sullivan, Cotter, and Associates, Inc.
Mercy’s physician compensation structure addresses the next generation of revenue and reimbursement. The plan is designed to pay average market compensation for clinical work and performance, while rewarding physicians with above average market compensation for success of the enterprise. Ultimately, participants will gain an understanding of the fundamental compensation principles and consistent, yet adaptable design parameters used to guide the creation of the common physician compensation structure. |
Upon completion of this activity, participants should be able to understand the value in providing a patient focused, activity based compensation plan that yields equitable dividends to physicians for performance on quality, safety, service, overall system financial performance, and transformational change; describe the principles and design parameters used to develop the compensation plan; outline the steps taken to develop a common compensation structure across the organization that meets our organizational goals and maintains above- average compensation for the integrated physicians; and explain the risks and rewards of the transition to a compensation plan. |