8:30 am

Hear firsthand about CMMI’s value-based initiatives and the best practices that are working in the current system.

  • Assess provider accountability, current innovative payment and delivery initiatives, and a greater focus on at-risk primary care models
  • Discuss where innovation is happening and how an organization can participate and speed the adoption of best practices
  • Examine the future of data sharing and collaboration across the care continuum
Sanjay Doddamani
Sanjay Doddamani, MD, MBA
Senior Physician Advisor, Center for Medicare and Medicaid Innovation (CMMI)
Centers for Medicare and Medicaid Services (invited)

10:00 am

Leading payer organizations lend insight into their goals for value-based contractual partnerships with providers and manufacturers.

  • Explore how payers perceive value and the quality and outcome metrics they want to incentivize for reimbursement
  • Hear examples of the successes and challenges faced as payers, providers, and manufacturers participate in more value-based contracts

Moderator:

John Doyle
John Doyle, PhD
Vice President, Global Healthcare Innovation Lead
PFIZER

Panelists:

Anthony Nguyen
Anthony Nguyen, MD
Senior Vice President, Population Health Management
UnitedHealthcare

William Shrank
William Shrank, MD, MSHS
Senior Vice President, Chief Medical Officer
Humana

11:00 am

Population health leaders from leading organizations engage in a revealing discussion on the challenges and issues they confronted while designing and implementing successful APMs.

  • Discuss favorable market conditions, partnership development, and collaboration strategies
  • Learn why a health system or medical group chose these models, including:
    • Medicare ACO
    • Medicare Advantage
    • Commercial shared-risk arrangements
    • Bundled/Episode-based payments
    • Direct-to-Employer contracting
  • Hear about challenges faced and steps to mitigate issues during implementation
  • Discuss what’s next for the evolution of chosen models

Moderator:

Amy Mullins
Amy Mullins, MD, CPE, FAAFP
Medical Director, Quality and Payment
American Academy of Family Physicians

Panelists:

Mark Gwynne
Mark Gwynne, DO
President and Executive Medical Director
UNC Health Alliance and UNC Senior Alliance

Derek Novak
Derek Novak, MBA
President, Population Health Services Organization
MercyOne (Formerly Mercy ACO)

Devdutta Sangvai
Devdutta Sangvai, MD, MBA
Vice President, Population Health Management
Duke University Health System

12:00 pm
1:15 pm
Rob Philo
Rob Philo
Vice President, Market Access
Veloxis Pharmaceuticals

1:30 pm

Value-based contracts (compared to traditional rebates and discounts) require highly complex negotiations on price, selection of outcomes, and the agreement on legal terms between all stakeholders in order for an agreement to be reached.

  • Understand how to create a product value story to communicate your product’s effectiveness to the payer and provider communities
  • Examine value based contracting terms, conditions, and metrics necessary to implement a successful value-based strategy
  • Align the internal objectives of HEOR, Managed Markets, Market Access, and Accounts teams to achieve a streamlined approach to designing a value-based contract
Bernie Good
Bernie Good
Director, Value-Based Purchasing
UPMC Health Plan

Jeff Henderson
Jeff Henderson
Vice President, Head of Market Access and Government Affairs
Sobi

2:15 pm

The proposed rule to exclude safe harbor protection for contracted rebates in Part D plans and Medicaid Managed Care Organizations will likely eliminate rebates; however, outcomes-based contracts were identified as an important mechanism for linking payment to clinical outcomes and will continue in a post-rebate world.

  • Discuss how rebates flow between manufacturers, PBMs, payers, and patients
  • Understand how policies around alternative rebate models will either support or impact value-based contracts and indication-specific pricing agreements
  • Explore alternative options for rebate models, point of sale rebates for patients, and upfront discounts
Celia S. Segel
Celia S. Segel, MPP
Director of CER Policy Development
Institute for Clinical and Economic Review

3:00 pm

Due to the high list prices for cell and gene therapies, payers are seeking more risk-based agreements and evidence around the long-term value of these products.

  • Describe types of arrangements being agreed upon for cell and gene therapies, and components that could be applied to other types of agreements
  • Explore where price reporting and other legal implications must be considered
  • Identify common challenges faced in contract development due to the unique characteristics of these disease states
Kevin Cast
Kevin Cast
Partner
Archbow Consulting

4:15 pm

Explore the role of data in value-based contracting with payers and opportunities to drive consensus on data metrics and requirements within a risk-sharing agreement.

  • Identify emerging data metrics that payers are seeking when contracting with manufacturers
  • Discuss how payers and manufacturers are cooperating to share data
Martin Marciniak
Martin Marciniak
Vice President, US Medical Affairs, Customer Engagement, Value, Evidence and Outcomes
GSK

5:00 pm

Scientific evidence of a product’s ability to improve patient outcomes and effectiveness in real-world settings must be shown through real-world data, and/or in the case of a launch, convincing clinical data. Share ways to develop a real world evidence strategy to demonstrate product value to payers.

  • Explore the data and metrics that payers are looking for when contracting with manufacturers
  • Discuss how to incorporate real world and clinical data to outcome measures in value-based contracts
Christopher (Chris) Boone
Christopher (Chris) Boone, PhD, FACHE, FHIMSS
Vice President, Global Medical Epidemiology & Big Data Analysis Lead
Pfizer



Contact


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