Summit Chairman:

Mike McCallister
President and CEO
Humana

Consumer-Driven Healthcare – Analysis of Successful Product Design and Financial Incentives

The focus on consumer-driven healthcare is important, but should not detract from a critical discussion on how all the players -- consumers, providers, employers and health plans -- must work together to achieve high quality, affordable healthcare.

• Consumers' role will evolve as healthcare information becomes more accessible and actionable
• Employers will demand more of employees while employees demand greater value for their healthcare dollar
• Health plans and providers must work together in new ways to impact quality and affordability
• Consumer education – Decision support and health education tools to increase accountability and change behavior
• Implementing appropriate financial incentives for consumers and providers
• Operational challenges of implementing multiple benefit designs and auto-adjudication
• Backlash on provider quality reporting and shifting the burden of collection onto providers
• Managing the shift to a retail market and adapting your business model
• Applying strategy to operational goals – Product development, enrollment, customer service, chronic care management
• Development of BCBS of Florida’s “Platform for Affordable Choices”

Moderator:

Gary D. Ahlquist
Senior Vice President and Managing Partner
Global Health and Insurance
Booz Allen Hamilton

Panelists:

Charles Berg
Chief Executive Officer
Oxford Health Plans

Doug Kronenberg
Chief Strategy Officer
Lumenos

Roger C. Holstein
Chief Executive Officer
WebMD Corporation

Vincent E. Kerr, M.D.
EVP, Network and Clinical Strategies
United HealthCare

Networking Break
congressional ballroom

Sponsored by:

Top Ten Issues Facing Health Plans and Insurers in 2004

• Fundamental cost drivers and pressures facing health plans
• Improving health outcomes
• Pending legislation and regulation in election year 2004
• Consumerism and employer demands
• Successful strategies employed by the most progressive health plans to maintain competitive positioning
• Addressing the problem of the uninsured

Peter R. Kongstvedt, M.D.
FACP, Vice President
Cap Gemini Ernst & Young, LLC

Panelists:

Sam Ho, M.D.
Senior VP and CMO
PacifiCare Health Plans

W. Allen Schaffer, M.D., F.A.C.P.
Senior Vice President, Chief Medical Officer
CIGNA HealthCare

Reed V. Tuckson, M.D.
Senior Vice President, Consumer Health and Medical Care Advancement
United HealthCare

Transforming Care Delivery – Transparency, Performance-Based Contracting and Re-Engineering

Wellpoint Case Study – Aligning Quality Measures and Physician Incentives
WellPoint is a proponent of sharing quality metrics with its contracted physicians on the premise that physicians have a strong interest in accessing quality data. In an effort to assess and increase physician participation and support of evidence-based quality metrics, WellPoint is testing new models for sharing quality data with physicians and structuring financial incentive programs to reward quality care.

• The business case for quality metrics - How to structure programs on quality measures and financial incentives
• HMO Vs. PPO quality incentive plans
• Next generation of quality incentive programs
  Case Study – HealthPartners’ Redesign to Improve Outcomes
• Strategic redesign of care delivery
• Building a safer, modern delivery platform for providers
• Implementing evidence-based care with hospitals and physician groups
• Engaging consumers directly and using technology to change behavior
• Measuring, reporting and rewarding improved outcomes

Woodrow A. Myers Jr., M.D., MBA
Executive Vice President and Chief Medical Officer
WellPoint

George Isham, M.D., MS
Medical Director and Chief Health Officer
HealthPartners

The Business Case for Disease Management

An expansive and unique approach to help its members who have a chronic disease was started by Blue Cross Blue Shield of Minnesota in 2002. The CEO and CMO will candidly discuss the decision-making process and results of their outcomes-based program.

• Improving the five dimensions of outcomes
• Critical success factors in a population-based approach to disease management
• ROI: the good, bad, and the ugly
• Case study from Blue Cross Blue Shield of Minnesota – “bending the trend”

Moderator:

Robert Stone
President, Disease Management Association of America;
Executive Vice President, American Healthways

Speakers:

William Gold, M.D.
Chief Medical Officer
Blue Cross Blue Shield of Minnesota

Mark Banks, M.D.
CEO
Blue Cross Blue Shield of Minnesota

Strategic Approaches to New Business and Product Development to Meet Employer Demands

• Diversification strategies to maintain consistent growth
• Strategic responses to reduce costs and improve quality
• New product development to improve competitive positioning (including tiered networks, consumer-driven products)
• Product architecture approach – Create and roll out new products quickly, more cheaply and pilot products easily

Moderator:

George Bennett
Chairman and CEO
Health Dialog

Speaker:

Nancy L. Leaming
President and CEO
Tufts Health Plan

Strategies for Connectivity and IT: Improving Operations and Reducing Costs

Highmark Case Study

• Payer-provider connectivity with the University of Pittsburgh Medical Center and physician offices -- Reducing transaction and administrative costs
• Investing in provider systems to improve revenue cycle management, care management, IT infrastructure and to develop an electronic medical record
• Develop and measure metrics for a ROI

Health Technology Center

• Connectivity works – Regional experiments that demonstrate the impact of connectivity
• Investment strategies for IT in operations and provider network communications
• Building coherent IT strategies for outsourced and in-house disease management
• Understanding the impact of emerging clinical technologies on IT requirements

Panel discussion topics

• IT investment spending -- How much to spend, balancing investment vs. ROI and how to project the payoff
• Designing flexible systems to enable product innovation and launch
• The outsourcing decision – which systems are better managed by a vendor vs. internally?

Moderator:

Mary E. Edwards
Vice President
Cap Gemini Ernst & Young

Panelists:

Molly J. Coye, M.D., MPH
Chief Executive Officer
Health Technology Center

Jim Klingensmith
Executive Vice President, Health Services
Highmark, Inc.

Charles D. Baker, Jr.
President & CEO
Harvard Pilgrim Health Care