2012 Healthcare Advantage Conference
 
Wednesday, May 9
Breakfast Session
7:00 - 8:00 AM

How Will Children’s Hospitals Position for Value in Health Reform Era?  
Presenter: Dr. Bill Bithoney, Clinical Leader & Pediatrician, Thomson Reuters
Presenter: David Gray, Reform Practice Leader, Thomson Reuters
Presenter: Linda MacCracken, Vice President Product Management, Thomson Reuters

 
For Children’s health service providers (both stand alone Children’s Hospitals and Hospital Based-Children’s Hospitals) the key to navigating health reform will be a balance between maintaining specialized and high quality care in a changing payment environment. Caught in a policy debate between excellence and specialization vs. expense for care of chronic and acute patients, what are the options?  Come talk with peers and Thomson Reuters leaders about:
 
• How the shift to population health management creates both opportunities and challenges for pediatrics.
• Understand the potential impact of payment reform on pediatric hospitals and how to navigate taking on risk.
• How branding will play a critical role in reaching and engaging target patients, donors, and supporters.



Wednesday, May 9
Rotating Sessions
10:30 - 11:45 AM
 
Rotating Sessions #1
10:30 - 11:00 AM 
 
Worksite Health Promotion/Disease Prevent Programs – Impact, ROI, and Challenges
Presenter: Ron Z. Goetzel, Ph.D., Research Professor and Director Institute for Health and Productivity Studies Rollins School of Public Health, Emory University Vice President, Consulting and Applied Research Analytic Consulting and Research Services, Thomson Reuters

Level: Basic/Intermediate/Advanced


For decades, proponents of worksite health promotion programs have struggled to collect and report research documenting the health and financial impact of these programs. Do these programs work? Do they improve workers’ health? Do they save money? This session will review recent scientific evidence that worksite health promotion and disease prevention programs can reduce employees’ health risks and produce a positive return on investment (ROI) for employers. However challenges arise in designing, implementing, and evaluating effective programs.
 

Value-based Insurance Design: Next Generation

Presenter: Teresa B. Gibson, Ph.D., Senior Director, Health Outcomes, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

This session will provide an overview of the history of value-based insurance design (VBID), review published evidence to date, and discuss provisions of the Affordable Care Act that can affect VBID strategies going forward. Participants will be introduced to ‘next-generation’ VBID strategies and learn how our team can assist in assessing opportunities.

 

This session will provide an overview of the history of value-based insurance design (VBID), review published evidence to date, and discuss provisions of the Affordable Care Act that can affect VBID strategies going forward. Participants will be introduced to ‘next-generation’ VBID strategies and learn how our team can assist in assessing opportunities.

 

Regional Variations in Quality and Cost of Hospital Services

Presenter: Bill Marder, Senior Vice President Analytic Consulting & Research Services, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

How big are regional variations in quality and cost of hospital services? This session focuses on analysis of data from the Healthcare Cost and Utilization Project (HCUP) funded by the Agency for Healthcare Research and Quality.

 

Payment Reform: Planning for Bundled Payments

Presenter: David Gray, Practice Leader, Payment Reform, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

Hospitals, health plans, and even some employers are contemplating payment for bundles of services like total knee replacement rather than fee-for-service for the components of the bundle. This session gives an overview of how we use our MarketScan data and Treatment Pathways to help those planning for and negotiating around bundled services.

 

Treatment Pathways Overview

Presenter: Stella Chang, Director, Analytic Consulting & Research Services, Thomson Reuters

Level: Basic/Intermediate/Advanced

 
Treatment Pathways is a user-friendly analytic tool for assessing the costs and outcomes of different treatments for patients with a given clinical problem. The tool is being increasingly used for understanding patterns of care, where patients adhere to care guidelines, and for designing service bundles under bundled payments. This session will provide a brief overview and glimpse of the product.
 
Rotating Sessions #2
11:15 - 11:45 AM

 

Worksite Health Promotion/Disease Prevent Programs – Impact, ROI, and Challenges
Presenter: Ron Z. Goetzel, Ph.D., Research Professor and Director Institute for Health and Productivity Studies Rollins School of Public Health, Emory University Vice President, Consulting and Applied Research Analytic Consulting and Research Services, Thomson Reuters
Level: Basic/Intermediate/Advanced

 

For decades, proponents of worksite health promotion programs have struggled to collect and report research documenting the health and financial impact of these programs. Do these programs work? Do they improve workers’ health? Do they save money? This session will review recent scientific evidence that worksite health promotion and disease prevention programs can reduce employees’ health risks and produce a positive return on investment (ROI) for employers. However challenges arise in designing, implementing, and evaluating effective programs.

 

Value-based Insurance Design: Next Generation

Presenter: Teresa B. Gibson, Ph.D., Senior Director, Health Outcomes, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

This session will provide an overview of the history of value-based insurance design (VBID), review published evidence to date, and discuss provisions of the Affordable Care Act that can affect VBID strategies going forward. Participants will be introduced to ‘next-generation’ VBID strategies and learn how our team can assist in assessing opportunities.

 

Regional Variations in Quality and Cost of Hospital Services

Presenter: Bill Marder, Senior Vice President Analytic Consulting & Research Services, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

How big are regional variations in quality and cost of hospital services? This session focuses on analysis of data from the Healthcare Cost and Utilization Project (HCUP) funded by the Agency for Healthcare Research and Quality.

 

Payment Reform: Planning for Bundled Payments

Presenter: David Gray, Practice Leader, Payment Reform, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

Hospitals, health plans, and even some employers are contemplating payment for bundles of services like total knee replacement rather than fee-for-service for the components of the bundle. This session gives an overview of how we use our MarketScan data and Treatment Pathways to help those planning for and negotiating around bundled services.

 

Treatment Pathways Overview

Presenter: Stella Chang, Director, Analytic Consulting & Research Services, Thomson Reuters

Level: Basic/Intermediate/Advanced

 

Treatment Pathways is a user-friendly analytic tool for assessing the costs and outcomes of different treatments for patients with a given clinical problem. The tool is being increasingly used for understanding patterns of care, where patients adhere to care guidelines, and for designing service bundles under bundled payments. This session will provide a brief overview and glimpse of the product.

Wednesday, May 9
1:15 – 2:30 PM

Responding to Tomorrow Today: Profiling the Competition and Developing Strategies for Success
Presenter: Whitney Robinson, MPH, Senior Planning Associate, Emory Healthcare
Presenter: Keeli Johnson, Senior Planning Associate, Emory Healthcare
Related Tool: Market ExpertÒ
Level: Intermediate

To survive and thrive amid a changing healthcare environment, providers must position themselves by understanding competition and market dynamics while devising the right mix of hospital, physician, and ancillary strategies. Emory will explore developing comprehensive competitor profiles using little known publicly available data to gain insight into competition and market dynamics. Attendees will learn how to develop multi-pronged market strategies to position your organizations for success.

Utilizing Benchmarking and Daily Productivity Data to Manage Labor Staffing
Presenter: Kenneth Hurr, MBA, Senior Business Analyst, Memorial Hermann Healthcare System
Related Tool: ActionOIÒ
Level: Intermediate

Since labor is a hospital’s single biggest asset and cost, achieving optimal staffing level will increase a hospital’s productivity and financial viability. This session will show you how to achieve this goal by incorporating all three variables: national benchmarking, internal benchmarking, and daily productivity.

Clinical Integration: Connecting the Dots
Presenter: Gloria Velez -Barone, MSN, ARNP. Director Service Line Development, Parrish Medical Center
Presenter: Christopher Manion, Medical Director Florida Health, Parrish Medical Center
Related Tool: CareDiscoveryÔ
Level: Intermediate

During the past decade, hospitals have faced unprecedented challenges. Care must be provided to an aging population with multiple chronic diseases during one of the most difficult economic eras. This care must be provided while improving the value to care provided. Value is the critical balance between cost and the quality of care rendered. This presentation will highlight the efforts of the Clinical Alignment Team at Parrish Medical Center in implementing Clinical Integration initiatives.

Harnessing Plan Design to Improve Care and Reduce Costs
Presenter: Eric Bishop, Vice President Finance, Administration, Fresenius
Related Tool: Analytic Consulting
Level: Intermediate

Fresenius realized that ER copay changes inadvertently resulted in decreased office visits, increased ER use, and higher costs. To identify how to address this plan design flaw, Fresenius analyzed five years of cost and use experience compared to MarketScan® benchmarks. They analyzed clinical and productivity data by business to develop strategies to reduce costs, improve care, and identify health and productivity issues. Fresenius will discuss its solution to adverse-care patterns caused by plan design.

Over 200 Fresenius utilization and cost measures were compared to MarketScan benchmarks for 2007 through 2011 data. Cost, clinical, and productivity data were analyzed by Business Unit and strategies developed to reduce costs, improve care, identify health and productivity issues, and recognize adverse care patterns caused by plan design.

Healthcare Disparities: The Burden of Knowledge
Presenter: K. Andrew Crighton, MD, Vice President and Chief Medical Officer, Prudential Financial, Inc.
Presenter: Jody Amodeo, Vice President Analytics, Consulting and Research Services, Thomson Reuters
Presenter: Stella Chang, Director, Information Assets, Thomson Reuters
Related Tool: Analytic Consulting

True to its commitment to improve health and well-being in every part of the organization, Prudential set out to evaluate health disparities among its employee population. In this session, Andy Crighton will present how Prudential, supported by Thomson Reuters MarketScan® data, developed a set of core measures, segmented the employee population, and created a framework to measure progress on an ongoing basis.

In-sourcing Care Coordination: Strategies and Tools for Success
Presenter: Laura Correale, Director Quality Improvement and Informatics, The Ohio State University Health Plan
Presenter: Bruce Wall, Medical Director, The Ohio State University Health Plan
Related Tool: Analytic Consulting
Level: Basic/Intermediate

OSU Health Plan includes employees of The Ohio State University and their covered dependents.  After careful consideration, they decided to in-source their care coordination program.  They developed an Opportunity Score, utilizing predictive tools, to identify individuals most appropriate for targeted intervention.  To target individuals for outreach, OSU Health Plan used Diagnosis codes along with the Advantage SuiteÔ to identify patients with gaps in care.  They also identified monitoring mechanisms to refine both their predictive tools and outreach methods.

Maximize Direct Mail Effectiveness
Presenter: Tom Comes, Director, Marketing and Public Relations, Borgess Health
Related Tool: crmViewÒ
Level: Advanced

This presentation will use not only demographic information found in HouseholdView segmentation, but psychographic data to reveal an “X factor” common in individuals with a high rate of clinical utilization. We'll show you how to use this information along with conventional targeting methods to maximize direct mail effectiveness.

How We Leverage Market Intelligence
Presenter: Scott Schroeder, BS, MBA, Director, Strategic Information Resources, OhioHealth
Related Tool: Market ExpertÒ
Level: Basic

OhioHealth’s leadership designated enhancing its market intelligence as a critical project for the organization. This presentation will follow OhioHealth's ongoing journey to enhance its market intelligence capabilities, including deploying robust data systems (i.e., Market Expert®), creating actionable reports, raising organizational awareness of market intelligence, and building smart systems to disseminate intelligence.
 
Population Stratification: Finding the Sickest of the Sick
Presenter: Jennifer Hoenstine, Director of Medical Economics, XLHealth
Presenter: Hope Miller, Director of Advanced Illness, XLHealth
Related Tool: Advantage SuiteÔ
Level: Intermediate
 
Our presentation will demonstrate how Thomson Reuters business intelligence and predictive models were used to stratify members into different risk levels for care-management interventions. We will share the value of appropriate leveling and the outcomes from both member quality improvement and company profitability perspectives.
 
Achieving Measurable Improvements in Employee Health Risk
Presenter: Keith Cox, Senior Accountant, The State of Alabama State Employees' Insurance Board
Related Tool: Employee Wellness
Level: Basic
 
The Alabama State Employees' Insurance Board (SEIB) is in the third year of its wellness program and continues to achieve measureable results. They have successfully engaged employees and educated them on their health risks. Keith Cox will describe the program and metrics of success. He will also share lessons learned from the SEIB health plans that includes state employees, local government units, and a high-risk pool.
 
VHA Bundled Payment Simulation Project
Presenter: Peggy L. Naas, MD, MBA, Vice President, Physicians Strategies, VHA
Presenter: Anne Fischer, Director of Healthcare Analytics, Thomson Reuters
Related Tool: MarketScan®
Level: Basic/Intermediate
 
VHA convened 15 member hospitals to participate in a knee replacement bundled payment simulation.  Using commercial claims data from the Thomson Reuters MarketScan® Research Database, VHA and Thomson Reuters profiled components of knee replacement payment bundles and gathered input from clinicians and hospital service-line ledaers to arrive at a standard bundle definition.  Empirical data illuminated care delivery decision branch points.  Participant hospitals received a calculator that enables them to simulate the potential financial risk and opportunity from care redesign as they contemplate entering local bundled payment engagements.
 
Turning Data Into Information to Drive Performance Improvement at Ministry Health Care
Presenter: Andrew Weier, MA, BS, Director, Quality and Strategic Analysis, Ministry Saint Joseph’s Hospital
Presenter: Jessica Rabida, Business Intelligence Analyst, Ministry Saint Joseph’s Hospital
Presenter: Kelly Fohrenkamm, Ministry Saint Joseph’s Hospital
Related Tool: CareDiscoveryTM Quality Measures
Level: Intermediate
 
Learn how Ministry Health Care turned mounds of static data into dynamic information by incorporating unique solutions for value-based purchasing, core measures, and Meaningful Use. Through the partnership with Thomson Reuters, Ministry Health Care allows staff to see how their hospital/system is doing on quality and customer services measures through weekly uploads, meets Meaningful Use clinical quality reporting objectives, and estimates the financial impact of value-based purchasing.
 
What You Need to Know: Detecting and Eliminating Waste and Fraud
Presenter: Jean MacQuarrie, Vice President, Thomson Reuters
Presenter: Mark Gillespie, Senior Director, Thomson Reuters
Presenter: David Nelson, Senior Director, Thomson Reuters
Related Tool: Program Integrity/Fraud, Waste and Abuse
Level: Basic/Intermediate/Advanced
 
This workshop will feature Thomson Reuters research on the drivers of waste, fraud, and abuse in the U.S. and practical approaches to eliminating fraud and waste. Presenters will review fraud trends, schemes, solutions, methodologies, key algorithms, and technical and analytic approaches with a focus on what works in the payer world. Emphasis will be placed on the prevention and detection of patterns at an early stage to stop inappropriate billings.
 
PI Perspective: Building and Managing an Effective Program Integrity Infrastructure
Presenter: David Spath, Data Analysis Unit Manager, Maryland Office of Inspector General
Presenter: Jina Hughes, Program Integrity Manager, Indiana Office of Medicaid Policy and Planning
Related Tool: J-SURS
Level: Basic 
 
This session will focus on building and maintaining a successful Program Integrity infrastructure.  David Spath, Maryland OIG, will provide his perspective on maintaining a SUR unit that has been in place for many years.  He will share with you the changes and improvements made to increase the overall sucess and effectiveness of the unit as they fight fraud, waste, and abuse.  Jina Hughs will share her recent experiences as she has worked to create a new infrastructure for the State of Indiana's Program Integrity unit.

Wednesday, May 9
2:45 – 4:00 PM

Taming the Specialty Pharmacy Monster
Presenter: Robin Love, Manager, Benefits Administration, Marathon Petroleum Corporation
Presenter: Ryan Peterson, Director, Client Services, Thomson Reuters
Related Tool: Pharmacy Benefit Strategy Consulting
Level: Intermediate

In 2010, Marathon implemented a benefit design change requiring members to purchase specific specialty drugs through their pharmacy benefit manager rather than their medical plan. With this change, Marathon expected to achieve improved pricing for specialty medications and overall cost reduction. However early results indicated an alarming trend in specialty drug costs. This session will reveal the results of the Thomson Reuters analysis of the factors driving specialty pharmacy trend and an objective valuation of the specialty pharmacy initiative.

Seven-year Trends in Employee Health Habits From a Comprehensive Workplace Health Promotion Program
Presenter: Mary Yarbrough, MD, MPH, FACOEM, Associate Professor of Medicine, Director Faculty and Staff Health and Wellness, Director Center for Occupational and Environmental Medicine, Vanderbilt
Presenter: Ron Goetzel, Vice President - Consulting and Applied Research, Thomson Reuters and Emory University Institute for Health and Productivity Studies
Related Tool: Population Health/Employee Wellness
Level: Basic/Intermediate/Advanced

Vanderbilt University established a voluntary, incentive-based worksite wellness program to improve the health status of its employees. To evaluate the effects of the program, they analyzed changes in employee health risk profiles over a seven-year period. Health improvement measures included physical activity, smoking, and seat belt usage. Vanderbilt will share the details of this rigorous evaluation of results achievable in a worksite program.
 
Developing and Deploying a High-performance Physician Network
Presenter: William Halvey, Manager of BI, AvMed Health Plans
Presenter: Barb Fernandez, Lead Business Intelligence Analyst, AvMed Health Plans
Related Tool: Advantage SuiteÔ
Level: Intermediate

For AvMed to more effectively serve its Medicare population, it is necessary to sway that population to more cost-efficient and high-quality physicians. To determine those high-performing physicians in the network though, AvMed had a critical need for data points to effectively define and quantify cost efficiency and high quality. In January 2012, AvMed Halth Plans will successfully implement a High Performance Network (HPN) for the second year. Cost savings that resulted from the implementation of the 2011 HPN is $1.7 million.
 
Identifying Fraud and Abuse Using Procedure Utilization Analysis
Presenter: Larry Overbaugh, Senior Consultant, SC Department of Health and Human Services
Related Tool: DataProbe®
Level: Intermediate/Advanced

SCDHHS has had great success identifying fraud and abuse using two procedure utilization algorithms in DataProbe®.  This session will give in-depth detail on those algorithms and show how they were used to identify outlier providers.
 
Profiling Medicaid's Aged, Blind and Disabled Population 
Presenter: Daphanie Keit, Manager, Office Fiscal Planning and Analysis, Georgia Department of Community Health
Related Tool: Advantage SuiteÔ and Consulting Services
Level: Intermediate

Description coming soon

Solution Update: Planning and Marketing
Join Thomson Reuters experts as they highlight key issues impacting hospital planners and marketers and discuss how our products and services address these issues.

Solution Update: Operational and Financial
Hear the latest updates about ActionOI® and learn how you can leverage our solutions to become more efficient and improve financial performance.

Solution Update: CareDiscoveryÔ
Hear the latest updates about CareDiscovery and learn how you can leverage the new enhanced solution to become more efficient and improve performance.

Solution Update: Quality Reporting: CareDiscoveryÔ Quality Measures and Meaningful Use
Hear the latest updates about CareDiscoveryÔ Quality Measures, plus learn more about Meaningful Use quality reporting and compare the two reporting programs.