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Day One Thursday, December 4, 2008

7:15 Conference Registration & Morning Coffee

8:00 Chairperson’s Opening Remarks

8:15 Applying Accountability and Incentives: Driving Meaningful Change

The Business Health Care Group is a vehicle for collective voice and action of the business community as it relates to improving the cost of healthcare. This involves developing initiatives to address behavior change of key stakeholders – providers, consumers, employers/plan sponsors and the administrator. However, this group takes a different stance on P4P. They believe that consumers need education, information, guidance and incentives to use the most valued provider. Education modules are used to provide information on how to be a better healthcare consumer. Pricing and quality of information (based on availability), guidance through Humana’s Personal Nurse and incentives for using providers that are identified as providing the best value, wellness and prevention initiatives all are aimed at improving accountability of the consumer and healthcare providers. The session focuses on:

  • Examining initiatives aimed at improving value in healthcare

  • The results of the Business Health Care Group’s work

  • Future focus to achieve behavior change

Dianne Kiehl Executive Director BUSINESS HEALTH CARE GROUP



Accessing the Impact of P4P on Health Plans: Who Will Cover

the Costs

The increased movement of P4P programs is prevalent in the United States. The service differs from other forms of payment plans. The payment plan relies on how a physician performs. For instance, providers are rewarded for meeting a set of goals prior to the delivery of healthcare services. Moreover, over 100 health plans across the United States are involved with P4P or undergoing pilot studies. With this new, pricey implementation, individuals wonder where all the finances are coming from. Many health plans point out their success with P4P, but this issue is something that is on everyone’s mind.

This panel engages the audience, debates the issues and offers a critical look at practical and forward-thinking solutions, including:

  • Strategic tactics used to identify the costs of a P4P program initially

  • The issues to date, including health plans falling into traps where they do not

have the finances to pay for services in a P4P program

  • Provider perspectives

  • What works and what should be identified in future P4P programs

Paul Thompson Vice President of Healthcare Cost and Quality Transparency Initiatives CIGNA HEALTHCARE

Cortney Larson, MBA, MHSA Director of Provider Relations PUBLIC EMPLOYEES HEALTH PROGRAM

Michael Madden, MD Medical Director HIGHMARK

Chris Brehm Provider Information and Credentialing Director CAREFIRST

10:00 Networking Break & Refreshments

10:30 Value-Based Benefit Design: An Innovative Strategy That Links Quality and Cost

Value-based benefit design is increasingly a strategy employers are using to improve health and lower costs by minimizing out-of-pocket costs for high value services in a defined patient population. This presentation will discuss the employers’ perspective on this new approach to benefit design.

The session will provide attendees with:

  • Introduction to value-based benefit design (VBBD)

  • Description of how VBBD supports an integrated health management framework

  • Examples of the medical impact of VBBD

  • Recommendations for a VBBD implementation approach Laurel Pickering, MPH Executive Director NEW YORK BUSINESS GROUP ON HEALTH

11:15 Next Generation P4P Programs: Tools & Techniques to Measure Performance, Improve Efficiency & Reward for Quality

As the healthcare panorama continues to shift, payers and providers are developing new models for healthcare delivery. P4P is a key trend that offers advantages to payers, providers and consumers. However, several issues challenge the successful implementation of P4P strategies. This includes collecting solid performance data, identifying reliable and feasible performance measures, indexes and metrics which are acceptable to providers. This session examines:

  • Defining performance measures

  • Identifying baseline, critical activities, and required metrics to be measured

  • Establishing mutually beneficial performance goals or standards

  • Implementing efficient solutions with reward for quality

Ravi Shankar Vice President of Performance Improvement AMERIGROUP

12:00 Using and Improving Evidence for P4P and Benefit Design

The experiments in P4P and value-based benefit design show a widespread belief that changing provider and consumer incentives can improve provider performance and employee health. To be successful, such efforts need strong measures, tools and data for diagnosing problems and tracking change. They also need solid evidence on what strategies work, when, for whom, and under what circumstances.

This presentation focuses on the evidence base for such efforts: what evidence do we need, what do we know now, and how can we learn from the current experiments to better inform later ones? It also examines tools that purchasers can use to target and shape their efforts, especially around measuring and mapping levels of potentially preventable hospitalizations among employees and their families. Topics include:

  • Evaluating measures, data and tools available to target and track improvement

  • Targeting the Preventable Hospitalization Cost Mapping Tool with benefit redesign

  • Critically examining the current state of P4P and focusing on what can be done to make it better

  • Implementing steps to go from incentivizing improvement to achieving improvement

Irene Fraser, PhD Director of the Center for Delivery, Organization, and Markets AGENCY FOR HEALTHCARE RESEARCH & QUALITY

12:45 Networking Luncheon


TO REGISTER: Call: 800-647-7600 or 781-939-2500 Fax: 781-939-2543

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