3rd Annual Value-Based Network and Contract Management Summit

HHS has set explicit goals to tie 50% of all Medicare payments to alternative payment models, such as ACOs, and 90% of all payments to quality or value by 2018 through the Value Based Purchasing and Hospital Readmissions Reduction Programs.

• Review the legislative mandate and targets
• Examine the challenges systems will have in the next three years to make progress and why it’s important to take steps now to improve primary care-specialty interaction, care management and integration of behavioral health
• Discuss pragmatic solutions and recommendations for implementation

As providers assume more risk, build capability, and add services that have been traditionally part of the insurer’s domain, it is important to understand the impact on the market, contracting, and future relations.

• Examine how market dynamics are changing due to an evolving ACO marketplace
• Describe workgroup topics, including definitions and measurement of progress, and steps to accelerate progress on effective payment reform
• Discuss implications for contracting and future relations

Some providers feel that ACOs have a short half-life and are taking steps to become licensed insurers. Experience managing a Medicare population in an MSSP is a foundation to develop a Medicare Advantage (MA) plan. Understand how this path enables an ACO to eliminate TPA and other costs and realize savings to pass on to the patients, physicians, and the community.

• Understand the organization’s strategy and developmental steps
• Discuss innovative partnerships for full-risk and infrastructure to manage utilization
• Assess potential changes to the market – Explore the impact on hospital-physician alignment and existing relationships with insurers

In April 2015, the repeal of the SGR payment formula and passage of the Medicare Access and CHIP Reauthorization Act (MACRA) changed how Medicare pays physicians going forward. Under MACRA, every provider is required to choose participation in one of two value-based payment tracks in 2018. Organizations must prepare for impending changes including those prompted by MACRA.

• Improve your understanding of the statute and timeline for implementation
• Prepare for updates to existing programs and understand how they will be affected and folded into the new statute
• Understand the importance of building or honing capabilities now for monitoring and analyzing quality performance
• Assess the impact MACRA may have on commercially-driven, risk-based contracting and network development

One of the biggest challenges in ACO and network development is measurement and reconciliation of hundreds of different value-based quality indicators for reporting. Moreover, not all measures are created equal and have the same relevance or legitimacy driving toward the same targets. As organizations take on more risk, predictability and consistency in how they’ll be measured is needed.

• Learn how to address the quality metrics issue with physicians and work around the flaws in the system
• Hear about successful approaches to manage and align different payer quality measures
• Anticipate the impact of initiatives designed to streamline measurement such as IOM Core Metrics and a 2016 CMS-Private Insurer core measure initiative that’s in development

The partners you choose and the way you approach the transformation of care delivery has a big impact on success. With the right partners, an organization can take on the challenges of an ACO and effectively manage quality in an open, effective, and collegial fashion. In this session, explore approaches to partnerships, including how to:

• Develop an appreciation of your potential partner’s capabilities for population health management from a clinical and administrative perspective
• Assess the long-term value of a partnership for participation in more complex and upcoming value-based contracts
• Overcome legal obstacles when non-affiliated health system ACO partners approach commercial payers to contract for risk

Bundled payment use is growing in both the public and private sectors. Although there are no concrete reports as to the widespread quality impact or derived savings, bundled payments have real potential to improve care coordination and reduce costs. Hear case examples from a provider that expanded a CMMI bundled payment initiative beyond the hospital – how they did it and why it’s succeeding.

• Identify factors to consider that would help determine if your organization is well-equipped to participate in a bundled payment arrangement
• Discuss how participating in payment bundles impacts population health management in the MSSP
• Translate experience and lessons learned in the Medicare program to contracting on bundled payments with commercial insurers

These roundtables provide the opportunity to discuss current challenges and opportunities for professionals engaged in value-based contracting and ACOs. Attendees choose one of the below topic areas to address with peers, led by a roundtable facilitator.

*Join us for a book signing with William J. DeMarco, author of Performance-Based Medicine: Creating the High Performance Network to Optimize Managed Care Relationships

To purchase your copy before the event to bring with you to have signed, please click here.