A crop of new health care companies delivers predictably better health outcomes at lower cost than conventional approaches in high value niches of clinical, financial, and administrative risk. Purchasers using a combination of these firms can reasonably expect (often, with guarantees) a 20% reduction in spending in Year 1 and a 40% reduction by Year 3.
This workshop brings together purchasers, benefits advisers, and solutions providers to discuss the dynamics, barriers, and potential within this sector. Topics will include:
- Identification and vetting of high-performance
- Scalability and financial guarantees of performance as litmus test issues
- Why the legacy health care sector has been so resistant to high-performance service offerings
- Why these high-performance organizations will find one another and come together
- How "making an offer an employer can't refuse" is the way forward
Institute CEO and Group Cofounder, Health Rosetta; Author: The CEO’s Guide to Restoring the American Dream
Attend this workshop and learn the ABC's of the drug contracting process, starting with the manufacturer. Learn how discounts, formularies, and rebates work and take control of your drug spend. Leverage strategies used by the pharma supply chain in your favor rather than the other way around.
- Learn how pharma brings drugs to market
- Identify specialty drugs which are the new 'brand'
- Understand drugs trials and how that data is used today in decision making
- Gain insight on orphan drugs
- Examine how organizations like NCCN create guidelines that become practice
- Find answers to the following questions and more:
- How can you take control of your contracting process?
- What can you do differently to bend the cost curve?
- What does the next generation of outcome-focused contracting look like?
Individual health care risk management programs will inevitably give way to "platforms" that integrate a range of solutions to high value cost drivers and barriers to quality. This advanced session will explore the cumulative quality and cost impacts available when high performance solutions are brought to bear under a single organizational or contractual umbrella.
The first half of this workshop will describe the challenges and results of a collaborative management effort by an on-site clinic company, and a musculoskeletal disorder management company, across several sites. The project relies on advanced analytics, worksite primary care, musculoskeletal management, and other capabilities, and provides a glimpse of the efficiencies and effectiveness readily available to employers willing to genuinely think outside the box. In the second half of the workshop, Adam Russo from The Phia Group, focused on efficient employer health plan management, will detail how to control health plan costs and protect plan assets through:
- Comprehensive cost containment consulting services
- Legal expertise
- Plan document drafting
- Subrogation and overpayment recovery
- Reference-based re-pricing
- Claim negotiation
- Plan defense
This case-based MasterClass explores the drama and trauma of daily management, including resistance to change. Discuss critical success factors that transform professionals into more effective leaders, who in turn distinguish their organizations as industry frontrunners. Understand pre-conditions for higher productivity and performance – more speed and lower cost – based on theory and practical examples. A unique highlight of the workshop is a case discussion about healthier leadership and our responsibilities to ourselves, to others, and to our change initiatives.
- Engage in a provocative case discussion that challenges participants’ decision-making process
- Explore several enablers that transform individuals into leaders who create a unique and adaptable competitive advantage
- Understand the tie-in between these pre-conditions for change and the ability to successfully launch, lead, and realize value from change initiatives.
This live activity is eligible for 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity and 3.0 contact hours through the Florida Board of Nursing, Provider # 50-94.
Faculty, Harvard University; Former Associate Dean
Harvard University School of Public Health
Distinguished Professor of Innovation and Change
Tianjin University of Finance and Economics (China)
This workshop explores new models of collaboration that address health system sustainability. Across the world, states and cities face huge health and social care challenges in an environment of increased patient expectations and economic challenges. Solutions require concerted action, imaginative policies, and innovative partnerships harnessing academic, industry, government, health, and social care resources to discover, develop, and deliver accelerated health care innovation. In this workshop, attendees explore, debate, and discuss optimal models of collaboration.
- Hear innovative health system and industry perspective
- Development of a health innovation district in Greater Manchester, the first fully devolved and integrated health and social care system in the UK
- Progress and lessons-learned in forging new strategies and partnerships to tackle local and global challenges of financial sustainability
- Industry case study
- Open discussion and debate of optimal models of collaboration
This workshop paves the way for a wider European and worldwide perspective on health system sustainability at the World Health Care Congress (Europe) in Manchester, UK on March 5-7, 2019.
This workshop showcases five high-performance health care organizations that excel in clinical, financial, and administrative risk management. Learn how these organizations deliver improved health outcomes while curbing costs. Examine direct contracting models that are scalable, significantly reducing financial burden while optimizing care delivery.
- Discuss an approach to allergy management that provides effective, disease-modifying care at half the cost of conventional methods
- Gain strategies to use a primary care platform to manage downstream risk, drive appropriate care, and more importantly, disrupt inappropriate care
- Explore a pharmacy benefit management approach that is transparent and delivers 15%-25% below typical PBM cost
- Assess a claims review process that typically recovers 5%-10% of total health care spend
- Learn how outpatient surgery centers provide transparent pricing at a fraction of typical cost, and shake up the market in the process
Status quo employee benefits agencies produce status quo results: “less bad” annual premium increases. It is time for advisers to start delivering real bottom-line results to employers: lower health care costs with better benefits. Leading benefits advisers are putting their compensation at risk to guarantee bottom-line results and are working with the C-Suite to manage the health care supply chain and lower health care costs.
In this workshop discover proven strategies from Nelson Griswold, the industry’s top innovation consultant, and some of these next gen benefits advisers who are revolutionizing the benefits industry:
- Learn the three steps to transform into a next-generation benefits firm
- Discover the success secrets of three Employee Benefit Advisers of the Year who have become next-generation benefits advisers
- Hear directly from an adviser who in a single year doubled his firm’s revenue organically to $5 Million; another who won 15 straight letters of record for mid-market groups; and one from a small agency who took a 3,000-life group from a Top-3 national broker
- Discuss proven strategy and lessons-learned:
- Why taking fees instead of commission is so critical with the C-Suite
- How to have the conversation with your client about moving to fees
- Moving to performance-based compensation: How does it work?
- How to get access to the CEO/CFO and how to speak to them in the language of the C-Suite
- The two strategies that can take business from almost any Status Quo broker
- Why self-funding is necessary to lower the cost of health care
- The two often-fatal mistakes brokers make with self-funding
- Why “managing the health care supply chain” changes everything in employee benefits
- What is “supply chain management” and how do you make it work?
- Five key cost-containment strategies that are guaranteed to lower costs
President, Bottom Line Solutions, Inc.; Author, DO or DIE: Reinventing Your Benefits Agency for Post-Reform Success
- Explore a data-driven approach to community health
- Case study of how a 10-hospital health system and community partners are improving outcomes
- Discuss the groundwork for a successful partnership
- Connect individuals with additional means to access both clinical and non-clinical services
- Understand how the partnership uses a population health approach and leverages data pre- and post-service
- Use data to understand ROI
- Develop a long-term follow up program via data
- Discuss critical data points to collect including common metrics and changes in self-efficacy
- How do changes indicate the value of the program?
- Reframing Change: Connecting Systems and Organizational Level Change to Person Centered Holistic Practice
- Discuss a state government’s approach to incorporating Social Determinants of Health
- Connect Social Determinants of Health to a framework for organizational and practice change
- Understand key principles of the Charting the LifeCourse framework and how they can be applied to change efforts
- Explore how the framework is being used to blend population health and individual health
Senior Director of Marketing and Product Development
Chesapeake Regional Information System for our Patients (CRISP)
Former Secretary, Kansas Department of Health and Environment; Former State Health Officer, Former Medicaid Director
State of Kansas
Director of individual Advocacy and Family Support, Institute for Human Development
University of Missouri-Kansas City
Wonder whether your wellness program delivers savings and results? Want to make sure you are choosing programs with the highest impact and best savings? In this workshop, find answers to the above questions and walk away with:
- Useful, practical tools to discern high-value from hype
- Scientific methods to assess a vendor’s ROI promises
- Confidence to make great choices for your wellness programs
Understand population health metrics, how measures work, and the role of measure stewards. Learn from case studies, engage in small group discussions, and gain strategies to maximize savings.
This activity, has been approved for 2.75 HR (General) recertification credit hours toward aPHR™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Please make note of the activity ID number on your recertification application form. For more information about certification or recertification, please visit the HR Certification Institute website at www.hrci.org
With the global health care market expanding, and health care consuming a growing proportion of the GDP in most countries, discussions about health care are consuming a larger share of popular attention and media coverage. Those responsible for paying for health care, managing its delivery and determining policies to assure quality and outcomes have been caught up in these debates, discussions and public arguments.
Politics and rhetoric aside, there is much that countries, jurisdictions, providers and regions can learn from each other about how best to manage the transition from volume-based, fee-for-service care to value-based health care. Consumers traveling for medical services from one location to another – “medical travelers” – may be paving the way for an international exchange of ideas that will ultimately benefit insurance companies, intermediaries managing care, providers delivering care and governments overseeing health care. The markets have moved faster than the legacy systems which are responsible for funding, managing and delivering healthcare.
This Masterclass provides insights into these topics: Hosted by:
- Medical travel and tourism market review
- Employer funded medical travel
- U.S.providers and medical travel
- Legal issues: Liability and jurisdiction
- Marketing medical travel
- Data-driven discussion of how a large employer has radically improved employee health and reversed chronic illness
- Exploration of a healthy eating program – How has it evolved? What is the next generation?
- The importance of top-down leadership to create sustainable change
co-Founder and Chief Executive Officer, Whole Foods Market; Author, The Whole Foods Diet: The Lifesaving Plan for Health and Longevity; Founder, Whole Planet Foundation
- Rationale for posting prices and background
- Categories of buyers: those who care and those who don’t care about cost
- Industry shortcomings in fulfilling the promise of price transparency
- Good news of price competition is spreading
- Strategies that meet evolving consumer needs and hold the potential to drastically reduce systemic costs
- Population health initiatives that emphasize consumer views and feedback to revamp care
- Connected health – Technology enabling targeted care for costly patients when and where they need it
- The power of behavior change – Apply feedback and let the consumer lead
President and Chief Executive Officer
President, Healthcare Operations
Chief Behavioral Officer
- Cross-sector views of persistent and systemic challenges in U.S. health care and how those trickle down and impact individuals
- Opportunities for business leaders from payer, employer, pharma, and other stakeholder groups to collaborate and realize better outcomes
- Barriers to aligning incentives around determinants of health
- Innovation from beyond our borders – replicable examples of excellence
President and Chief Executive Officer
Current Board of Director and Former Chairman National Association of Chain Drug Stores (NACDS);
Chief Operating Officer
Executive Vice President and Chief Medical Officer
Chief Medical Officer
UPMC Health Plan
- Understand the benefits of integrating Molecular Markers into a cost-effective and comprehensive evaluation of thyroid nodules
- Overcome clinical challenges including “indeterminate” results for more streamlined testing and patient care
- Understand evidence supporting the use of Next Generation Sequencing (NGS) markers applied to indeterminate thyroid cytology
- Identify which patients are a match for this testing and understand the impact on clinical management and outcomes
- Understand the cost-effectiveness of NGS applied to thyroid nodule evaluation
- Understand how lowering prescription costs for consumers creates a significant savings opportunity for health plans and employers
- Explore case study implementation and savings results
- Understand analytics that simplify pharmacy choices and make costly medication regimens affordable
- How does the tool integrate with your existing programs?
- Provide real-time, cost-saving choices to members and employees
- Customize according to benefit plan; stay in plan, consider tier
- Explore the impact on member and employee behavior
- The growing Medicare Advantage opportunity for US health systems and health plans
- Why US health systems are entering the market at an unprecedented rate
- The challenges of winning in MA
- Key capabilities necessary to succeed
- Options for entering the MA market
Director, Business Development
- Discuss strategies to reduce and control specialty drug costs
- Ensure safe use of specialty drugs
- Align dispensing quantity with FDA-approved dosage guidelines
- Implement prior authorization and step therapy to monitor drug use
- Leverage cost-effective contracts to minimize unnecessary spend
- Align medical policies with drug manufacturer requirements to maximize savings
Senior Vice President and General Manager
HealthSmart Rx Solutions
The importance of automation in health care has increased dramatically. Despite more demand for value-based care, improved patient outcomes, regulations, global competition, pricing pressure and the need for more precision medicines, the U.S. market is poised for a technology transition that will aid future business; it is already a major contributor to the growth of AI in health care. In this sessions attendees explore critical questions like:
- Where are we now and what’s next? Gain an in-depth understanding of what AI means in health care.
- How do we overcome extra challenges including regulatory barriers, interoperability with legacy hospital IT systems, and serious limitations on access to crucial medical data needed to build powerful health-focused algorithms in the first place?
- How do we move forward and make Artificial Intelligence more scalable and cost-efficient?
Vice President, Health Care
VP, Medicaid Business/Program Delivery
An increasingly digital marketing environment has brought with it the ability for rapid, unpredicted changes and the need for quick trajectory shifts. See how to use the information you have in a more robust database, or how to get the data you might still need, to prepare contingency plans for swift changes.
- Leverage clean, comprehensive data to keep marketing campaigns responsive, agile, and ready to adjust in an unpredictable market
- Evaluate the benefits of utilizing hyper-local consumer segmentation and multiple data sources to drive organizational innovation
- Review the importance of continued training and conditioning in-house to ensure your team stays flexible
- Examine what data points have changed since 2017 and why this matters for 2018 and beyond
Founder and CEO
Carrot Health, Inc.
- Discuss the current health care environment and shift to value-based care
- Gain insight on financial risk arrangements including upside and downside
- Explore strategies to avoid unnecessary treatment, minimize costs, and achieve quality metrics
- Examine value- and outcomes-based contracts to manage specialty drug costs and improve patient outcomes
- What’s ahead? Examine payers’ increased responsibility to create healthy populations
Executive Vice President, Strategy and Communications, Chief Strategy Officer
Capital District Physicians Health Plan, Inc. (CDPHP®)
- Develop a holistic approach to the redesign of care delivery using these strategies and other examples
- Maximize outcomes with remote patient monitoring tools
- Invest in primary care and implement team-based models
- Improve access by utilizing advanced practitioners
- Identify, manage, and minimize clinical variation to bend the cost curve
- Deploy new technology to power population health activities
- Explore natural language processing to read free text and unstructured data for better clinical decision support
- Investigate the potential of predictive modeling and data analytics to drive intelligent strategic decisions
- Collaborate to create healthier communities upstream
Vice President, Payer & Network Strategies, Adventist Health; President, Adventist Health Managed Care; President and Chief Executive Officer, Adventist Health Plan, Inc.
Executive Vice President and Chief Medical and Scientific Officer; President, Health Services Division
- Augment care of a population by appropriately using advance practice and RN nurses in the workforce staffing plan
- Important to get the “right mix”
- Address the millennial generation workforce’s needs
- Promote the culture of teamwork and develop ways that care coordination teams can work together to achieve outcomes
- Deploy team-based models (“cross-collaboration”) across the care continuum and spread to affiliated hospitals
- Manage transitions of care to prevent readmissions, e.g. nurse navigators
- Manage lower acuity patients in a retail clinic or urgent care center
Nursing Director, Emergency Services and Resource Management, VCU Health; Adjunct Faculty, School of Nursing, Virginia Commonwealth University
Family Nurse Practitioner, Wheeling Health Right;
President, American Association of Nurse Practitioners (AANP)
- Explore obstacles, risks, and opportunities in Medicaid innovation
- Examine how states manage uncertainty and address unique needs to improve policy and care delivery through waivers
- Will DSHP and DSRIP waivers be phased out? How will the framework for waiver evaluation change?
- Will waiver approvals embolden more states to seek similar changes?
- Do CMS actions help or hinder innovation?
- Discuss evolution of the Medicaid scorecard and it’s use to measure the impact of payment reform
Deputy Secretary for Medical Assistance, Division of Medical Assistance
North Carolina Department of Health and Human Services
Thought Leader TBA
- Address connectivity and integration challenges when blending multiple data sources: Claims, EHR, patient-generated health, and pharmacy
- Support workforces and cultures that value data analysis and actionable insights for population health management
- Change physician behavior and care pathways for quality outcomes
- Understand the role data analytics plays to mature a population health management services organization
- Take a vendor agnostic approach to data integration to ensure buy-in and collaboration
- Address the non-clinical aspects of a population’s health to remove barriers to health care
- Proactively identify rising risk members and develop programs in coordination with community organizations to provide services they lack
- Implement strategies to short-circuit opioid addiction by leveraging pharmacogenomics data