1:00 pm

Providers are responsible for treating the whole patient. A staff trained to recognize and respond to the social and environmental challenges patients may face, in addition to their medical needs, leads to better patient outcomes. In this workshop, learn skills to improve your staff’s understanding and ability to address patients’ social determinants of health.

Discuss Staff Needs to Become More Aware of Non-Clinical Factors Impacting a Patient’s Health and Wellbeing

  • Identify ways to develop a culturally competent staff
  • Promote an increased awareness of patient challenges
  • Learn how to change the patient-provider conversation to gain important social information through techniques such as motivational interviewing, teach back, and patient decision support
  • Develop a standardized SDOH screening tool and metrics

Create Strategies that Enable Staff to Design Interventions and Leverage Community Partnerships and Resources

  • Ensure a knowledge of community resources available to patients
  • Create plans to foster an atmosphere of engagement, community partnership, and education within your organization
  • Work with members of the care team to integrate the community health worker into care coordination strategies
Desha Dickson
Desha Dickson, MS
Associate Vice President, Community Wellness
Reading Hospital Tower Health

Tanieka Mason
Tanieka Mason, MPH
Data Manager
Reading Hospital Tower Health

1:00 pm

Whether you and your organization are new to value-based care or have been a Pioneer ACO or participated in BPCI Classic from the very beginning, it can be a daunting task to following along with the intricacies of value-based care. Decoding the different types of collaborative organizations, payment models, and arrangements is key to determining the best way to enter and succeed in a value-based health care world. Dive into the different aspects of value-based care and gain insight into the opportunities and pitfalls available to health care organizations.

Examine the Benefits and Drawbacks of Various Advanced Alternative Payment Models

  • BPCI Advanced – Bundled Payments for Care Improvement Advanced Model
  • CPC+ - Comprehensive Primary Care Plus
  • Next Generation ACO Model
  • CJR – Comprehensive Care for Joint Replacement

Integrate Advanced APM Approaches to Strengthen Coordination throughout the Care Continuum

  • Explore both the downside risks and potential financial gains of specific payment models
  • Discuss the cost of implementing care redesign changes, operational, and administrative functions under an Advanced APM
  • Align payment model strategies to deliver patient-centered, longitudinal, and coordinated care and explore the advantages and limitations of different value-based organizational structures (for example: CINs, IPAs, IDNs)
Joseph Egan
Joseph Egan
Director of Operations, Value-Based Programs
Tenet Healthcare

Joshua M. Liao
Joshua M. Liao, MD, MSc, FACP
Associate Medical Director, Contracting and Value-Based Care Director UW Medicine Value and Systems Science Lab
University of Washington Medicine

CPE Credits: 3.6
Field of Study: Regulatory Ethics

1:00 pm

Establishing new models of care with Case Managers positioned as integral patient advocates is necessary within the current value-based care environment. The most vulnerable populations with challenging medical needs and behavioral conditions require a collaborative team to support treatment, rehabilitation, and sustainable recovery. During this workshop, learn how an integrated case management approach can improve access for complex patients, stabilize conditions, and reduce trips the ED.

Discover the Value of the Integrated Care Management Approach

  • Discuss best practices to support a patient-centered approach for care coordination and transitions
  • Examine ways this approach benefits complex populations to reduce ED visits and readmissions
  • Learn how to meet regulatory and accreditation requirements for CMS and NCQA

Expand Case Managers’ Skill Sets to Holistically Address the Whole Person

  • Understand the case management role as part of a multi-disciplinary partnership to improve patient outcomes
  • Address medical, behavioral, and social challenges impacting patient health outcomes
  • Target and address complex health conditions and co-morbidities to reduce readmissions

Put Integrated Case Management in Practice

  • Review case study results to show how comprehensive risk assessments were used to develop effective care plans effective care planning
    • Walk through both adult and pediatric case demonstrations
Rebecca Perez
Rebecca Perez, BSN, RN, CCM
Director, Product Development
Case Management Society of America Foundation

1:00 pm

Congratulations, you’ve just been awarded a generous grant from hospital leadership or the government to develop an innovative digital health program to combat one of the biggest health issues facing your region! Now what? A successful remote patient monitoring program involves much more than picking a tool and collecting data. Without a plan for infrastructure, implementation, and results, you will not get the most out of your time, money, and effort and you will lose the opportunity to achieve desired results. This workshop is designed to instruct how to develop a program from the ground up to achieve the best possible outcomes and set you up to build upon the program for the future.

Set a Strong Foundation to Achieve Goals

  • Identify clinical focus areas that provide the best opportunity for improved outcomes
  • Define specific and achievable goals and a realistic timeframe for completion of the RPM program
  • Assess human and technological resources to ensure the infrastructure can support the program

Choose the Right Vendor for Your Needs

  • Determine the correct type of tool necessary to provide the measurement you need
  • Examine interoperability with existing digital health programs and technological infrastructure
  • Discuss ancillary services such as delivery, upkeep, and cleaning

Collect and Present Findings to Encourage Growth

  • Bring together data and results into a cohesive and easy to understand format
  • Shape the presentation of results for the intended audience
  • Determine a plan to grow and scale your RPM program and adjust the objectives accordingly
John Aldridge
John Aldridge
Co-Founder, Vice President, Sales

Melissa Jordan
Melissa Jordan, RN
Director Clinical Quality & Education,
Advocate-Aurora Health

Allison Thebado
Allison Thebado
Solutions Consultant,

4:15 pm
Diwen Chen
Diwen Chen
Executive Director, Payment Innovation & Accountable Care
Dignity Health

4:30 pm

America’s Physician Groups is the leading organization for physician education, advocacy, and health care news and information. APG’s model supports clinicians to operate through a patient-centered, comprehensive care lens. In this Keynote Address, explore the key principles to expanding access to patient-centered care across the health care continuum.

  • Elevate standards of care coordination to ensure access to high-quality health care services
  • Share best practices and innovation in care management to best manage unnecessary hospital utilization
  • Utilize technology and population health to enhance value-based care
Amy Nguyen Howell
Amy Nguyen Howell, MD, MBA, FAAFP
Chief Medical Officer
America's Physician Groups