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2:00 p.m. – 5:15 p.m AFTERNOON TRACKS

TRACK A: Medical Management

2:00 Population-Based Payments: A Mechanism for Returning the Responsibility for Patient Outcomes, Medical Management, and Equitable Compensation Back to Local Physicians

Payors and providers grapple with the deployment of evidence-based medicine. Essentially, a redefined focus on patient safety initiatives and a growing number of P4P programs have led payors and providers to evaluate the cost and benefits of their initiatives.

Payors want to quantify the economic value derived from program payouts, and providers are questioning the adequacy of their “reward” relative to practice time, administrative expense and effort.

By returning the responsibility for patient outcomes, medical management, and equitable compensation back to local physicians through population-based payment arrangements, payors, providers and members all see the benefit. This session examines:

  • Creating clinically integrated physician practices

  • An actionable process for establishing population-based payment arrangements

  • Establishing clinical initiatives and evidence-based quality metrics which promote patient safety

Jeff Danilo President US HEALTHCARE SOLUTIONS Former Senior Vice President and Head of Core Network Management AETNA US HEALTHCARE

2:45 Creating Physician Group Incentive Programs

It is important for physicians and providers to be a cohesive unit. The collaboration and investment of physicians is necessary every step of the way in design and implementation for success. The incentives within the scope of the measure must be managed by the physician. Finally, the program must be flexible, based on the changing needs of the various stakeholders (i.e., the plan, physicians, state agencies, members). The session examines:

  • Understanding what you can achieve through a P4P program with your physician groups

  • Defining the measures most relevant to your various stakeholders and which will be a strong foundation to base your P4P program

  • Building physician investment at the all phases of the program

  • Supporting physicians to be successful in P4P

Maurice Sahar Associate Executive Director, Quality Management METROPLUS HEALTH PLAN

3:30 Networking Break & Refreshments

3:45 Designing the Best Strategies and Practices for the Medical Home

The medical home’s personal physician leads a team of individuals who collectively take responsibility for the ongoing care of the patient. Healthcare is coordinated with the hospitals, sub-specialists, nursing homes and home health agencies and the patient’s community-based services. However, what is missing from the medical home perspective is how P4P influences this concept. This new topic in the healthcare industry is drawing attention from numerous healthcare leaders. The session focuses on:

TRACK B: Contract & Network Management

2:00 Revealing the Benefits of Performance-Based Contracting

The healthcare environment puts pressure on payors and providers, and they are expected to work as a cohesive unit to assure that healthcare services provide the highest amount of quality. At times, this can be very difficult and leads to both parties being fragmented and frustrated. Additionally, the healthcare system is further complicated with new benefit plans and products. In the past, health plans have been experimenting with P4P and other quality improvement programs. Some programs have been successful, and others have not. The session focuses on:

  • Revealing the key factors necessary in designing a performance-based contracting plan

  • Evaluating the benefits of implementing a performance-based contracting

  • Critically examining key components for performance-based contracting

Augustine Manocchia, MD Chief Medical Officer BLUE CROSS BLUE SHIELD OF RHODE ISLAND

2:45 Designing a P4P Program to Improve Quality & Reduce Costs

Harvard Pilgrim Health Plan developed and implemented a successful P4P program that focuses on improving quality and reducing costs. For over six years, incentives, such as using generic drugs, use of electronically available medical records, and diabetes outcome measures have been the catalysts for P4P. From their direct experience, it is important to understand what steps Harvard Pilgrim Health Plan took to make the program a success. The session examines:

  • Fundamentals in designing a P4P program structured for your company

  • Evaluating different strategies and tactics necessary for a P4P program

  • Focusing on clinical outcomes and the infrastructure necessary to support

the effort

Richard Weisblatt, MD Vice President, Network Services HARVARD PILGRIM HEALTH CARE

3:30 Networking Break & Refreshments

3:45 Medical Home Programs and Incentivization

Physician pay-for-performance incentives and Centers for Medicare pilot programs continue to strive for improvement in quality and removal of risk. Medical Home programs are being tested by payors and CMS to actually drive fundamental behavior changes. Prevent chronic and catastrophic patient episodes by instilling preventative care and effective disease and case management. Family practitioners and primary care givers are asking for multi-payor collaboration and incentives to realize an improved outcome for patients. Some cynics call the Medical Home programs nothing more than “back to the future” by instilling pcp gatekeeper programs and limiting of specialist interactions. Proponents point out that the current medical processes are failing to keep the chronic patient from “crashing” in an emergent setting. Learn what payors and providers will need to be successful.

  • Understanding what is a Medical Home

  • Defining the parties needed to build a successful Medical Home

  • Preventing failures of gatekeeper models from the 1980’s, and exploring new

reimbursement/contracting alternatives

e-mail: info@worldrg.com www.worldrg.com/p4p


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