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
