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Health Datapalooza - Creating a Virtuous Cycle: Design and Curate a Risk-Ready Network

Date post: 13-Feb-2017
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OWNING RISK IS TOUGH, BUT IT’S WHERE THE ACTION’S AT Once upon a time plans had large group commercial populations with years of consistency and providers simply delivered services for a fee. But government programs like Medicare Advantage, Marketplace / Exchange and Medicaid, have populations changing every year, or even every month and providers managing a population's health over time. Changing populations and dynamic payment models may make it tough to predict and achieve member outcomes in a financially sustainable way precisely when providers are getting in the game to take on risk. Public health data are providing solid case studies of achieving member health and happiness with sustainable financial models for all players in this new game. If you are managing risk, considering taking on risk, or investing in or providing products or services to anyone bearing risk, camp out in these sessions to learn how to use public data and internal resources to: § Effectively leverage analytic approaches to manage risk § Accurately assess risks and project costs § Effectively align providers and incentivize care delivery CREATING A VIRTUOUS CYCLE: DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE FROM FEE FOR SERVICE AND CREATE VALUE-BASED WINS FOR BOTH PAYERS AND PROVIDERS USING CMS BENCHMARK DATA Value Proposition: Designing and Curating a Pay-for-Value Ready Network Moderator: Joshua Rosenthal , Co-Founder and Chief Scientific Officer at RowdMap, Inc. Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer at Health Care Service Corporation “The value propositionsfor public data either disintermediateor innovateowning risk – either way they can’t beignored.” Session Participants Joshua Rosenthal, PhD, Co-Founder and Chief Scientific Officer at RowdMap, Inc. Jonathan Blum, EVP at CareFist and Former Principal Deputy Administrator at CMS Sachin Jain, MD, Chief Medical Officer and Chief Operating Officer at CareMore Steve Ondra, MD, Chief Medical Officer at Health Care Service Corporation Chair & Vice Chair Kavita Patel, MD, Brookings Institute and Former Director of Policy, The White House Niall Brennan, Chief Data Officer, CMS
Transcript

OWNINGRISKISTOUGH,BUTIT’SWHERETHEACTION’SAT

Onceuponatimeplanshad large groupcommercial populationswithyearsofconsistencyandproviders simplydelivered services forafee. Butgovernment programs likeMedicareAdvantage, Marketplace /Exchange andMedicaid, havepopulationschangingevery year, orevenevery monthandprovidersmanaging apopulation'shealthover time.

Changingpopulationsanddynamicpayment modelsmay make it toughtopredictandachievemember outcomes ina financially sustainableway preciselywhenprovidersare getting inthegame totake onrisk.

Publichealthdataareprovidingsolidcasestudiesofachieving member healthandhappinesswithsustainable financialmodels forallplayers inthisnewgame.

Ifyouare managing risk,considering takingonrisk,orinvesting inorprovidingproductsorservices toanyonebearing risk, campoutinthesesessionstolearnhowtousepublicdataandinternal resourcesto:

§ Effectively leverageanalyticapproachestomanagerisk

§ Accuratelyassessrisksandprojectcosts

§ Effectively alignprovidersandincentivizecaredelivery

CREATINGAVIRTUOUSCYCLE:DESIGNINGNETWORKSTOMITIGATENO-VALUECAREFROMFEEFORSERVICEANDCREATEVALUE-BASEDWINSFORBOTHPAYERSANDPROVIDERSUSINGCMSBENCHMARKDATAValueProposition:DesigningandCuratingaPay-for-ValueReadyNetwork

Moderator:JoshuaRosenthal,Co-FounderandChiefScientificOfficeratRowdMap,Inc.

Panelists:JonathanBlum,EVPatCareFirstBlueCrossBlueShield andFormerPrincipleDeputyAdministratoratCentersforMedicareandMedicaidServices;Sachin Jain,ChiefMedicalOfficer&ChiefOperatingOfficeratCareMore;SteveOndra,ChiefMedicalOfficeratHealthCareServiceCorporation

“Thevaluepropositionsforpublicdataeitherdisintermediateorinnovateowningrisk– eitherwaytheycan’tbeignored.”

Session Participants

Joshua Rosenthal, PhD, Co-Founder and Chief Scientific Officer at RowdMap, Inc.

Jonathan Blum, EVP at CareFist and Former Principal Deputy Administrator at CMS

Sachin Jain, MD, Chief Medical Officer and Chief Operating Officer at CareMore

Steve Ondra, MD, Chief Medical Officer at Health Care Service Corporation

Chair & Vice Chair

Kavita Patel, MD, Brookings Institute and Former Director of Policy, The White House

Niall Brennan, Chief Data Officer, CMS

CREATINGAVIRTUOUSCYCLE:DESIGNINGNETWORKSTOMITIGATE NO-VALUECAREFROMFEE FORSERVICEANDCREATEVALUE-BASEDWINSFORBOTHPAYERSANDPROVIDERSUSINGCMSBENCHMARKDATA

ValueProposition: DesigningandCurating aPay-for-Value ReadyNetwork

Moderator: Joshua Rosenthal, Co-Founder andChief Scientific Officer atRowdMap, Inc.

Panelists: Jonathan Blum, EVPatCareFirst Blue Cross BlueShield andFormer PrincipleDeputyAdministrator atCenters for MedicareandMedicaid Services;Sachin Jain, ChiefMedicalOfficer &Chief Operating Officer atCareMore; SteveOndra, Chief MedicalOfficeratHealthCare ServiceCorporation

Description:

High-performing networks arenotenough tosucceed invaluebasedarrangements andclassictriple aimmeasures missamajor keytosuccess:reducing low-value care.30centsofeverydollar paid goestolow-value care, orprocedures andprescriptions thatdonotproduce anyadditional positive outcomes.

Low-value careaccounts for roughly3%ofGDPanddrove billing inFee-for-Serviceeconomic arrangements.

Thekeytosucceeding invaluebasedprograms andriskarrangements isidentifying andreducing low-valuecare.

Newlyreleased CMSdataallows anyonetodetermine designandcurate anetwork ofproviders tosucceed invaluebasedprograms.

Join thissessiontoseereal-world, operational examples ofavirtuous cycleswhere payersandproviders successfully reduce lowvalueservicesandsharethepositive results.

No-ValueCare(30%)

NecessaryUtilization(70%)

CareThatDoesn’tProduceBetterOutcomes$850BillionUnnecessarySpendin2014

(InstituteofMedicine)

LowValueCareDrivesBillinginFeeforService“#1Weakness ofFFSPaymentSystemIsExcessUseofLowValueServices”Dr.PatrickConway,ChiefMedicalOfficer, CMS


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