2018 Network Contracting Forum
October 25-26, 2018 * Loews Sapphire Falls Resort * Orlando, FL

2018 Network Contracting Forum

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About the Conference

Network contracting is currently facing unprecedented challenges, as well as opportunities. It has become an imperative for payers, as well as providers, to respond to these challenges by making changes to their network contracting strategy, as well as taking advantage of the opportunities that currently arise within network management. The market has seen numerous changes within the relationship between providers and payers, and new techniques have been introduced to operate within this market – this
has greatly impacted how payers approach network contracting. Specifically, we are now operating within a market where new regulations are being introduced for Medicaid and Medicare, and new technologies and solutions have been released to better enhance provider contracting and management. Furthermore, declining budgets are demanding new approaches to how we do network contracting, and to how new opportunities can become profitable for a payer. As the cost of doing business continues to rise and when every dollar is more important than ever, healthcare payers, as well as providers, are in greater need of solutions to lower costs and increase efficiency. By implementing cutting-edge network contracting solutions, many organizations have been able to achieve these goals.

This conference will guide you in the right direction – in addition to focusing on traditional, yet current, issues such as developing a strategic and transparent approach, this conference stands out in that it recognizes the need to effectively incorporate innovative network contracting strategies. We are bringing together leaders and innovators to share their insights and offer tested solutions on how to streamline the network contracting process. You will learn what others in your industry are doing to be prepared for the challenges that lie ahead.

Who Should Attend?

From Health Plans/Hospitals/Health Systems:

  • CEO
  • CFO
  • COO
  • Network Contracting
  • Managed Care
  • Provider Relations
  • Network Management
  • Network Development
  • Provider Contracting
  • Finance
  • Compliance
  • Claims Management
  • Auditing
  • Contract Administration
  • Reimbursement
  • Patient Financial Services
  • Medical Director
  • Revenue Cycle Management
  • Government Relations
  • Payor Relations
  • VP of Finance

Also of Interest to:

Vendors; Consultants; Solution Providers; Law Firms offering services in the healthcare industry and network contracting process.

Conference Agenda

Day One – Thursday, October 25, 2018

7:15am
Conference Registration & Morning Breakfast

8:00am
Chairperson’s Opening Remarks

8:15am
Reality Check: System Readiness and Physician Alignment in Value-Based Reimbursement
This presentation will discuss the current state of large health systems, including hospitals and physician networks, in terms of their readiness for, and life-stage in, value-based contracting. Key points will include: What does it mean to get ready/be ready for value-based care? How do you align physicians, as well as hospitals, who have competing interests? What constitutes meaningful “provider engagement”?

Vince McVittie
Executive Director
Signature Care Management

Lisa B. Wagamon
System Vice President, Managed Care
SSM Health

9:05am
New AMA RAND Research on the Impact of New Payment Models on Physician Practices
In 2015, the AMA and RAND documented that new payment models were changing ways physician practices delivered care and organized across different markets, practice sizes and specialties. Learn the latest findings of the just released follow up study on the same physician practices conducted by AMA and RAND in 2018.

Carol Vargo, MHS
Director, Physician Practice Sustainability Strategy Group
The American Medical Association

9:55am
Networking Break & Refreshments

10:25am
Innovative Network Contracting Strategies to Establish Effective Partnerships with Large Primary Care Practices and Multispecialty Groups
This session will focus on how to establish effective partnerships with large primary care practices and multispecialty groups through innovative network contracting strategies.

Kevin Egge
Vice President of Provider Relations and Contracting
Blue Cross Blue Shield Louisiana

11:15am
Provider Contracting: The Transition from Volume to Value
This presentation will focus on changing primary care contracting strategy from fee for volume to value. We will discuss concepts related to practice readiness, member quality, data transparency and population health all while maintaining a focus on the quadruple aim.

Michael Sweeney
Vice President, Reimbursement, Contracting and Provider Relations
UPMC Health Plan

12:05pm
Luncheon for All Attendees & Speakers

1:05pm
Population Health MSOs & IPAs… Keys to Value Based Contracting Success
This presentation will focus on the important roles of population health MSO and independent physicians in Medicare, Medicaid and commercial value-based programs. We will discuss how PCP-led networks (IPAs/CINs) fit, particularly those that are aligned with like-minded Preferred Provider Networks of specialists and acute/post-acute providers. Additionally, we will cover the critical role (oft-overlooked) of a robust population health MSO (clinical and technology platform), such as analytics, technology tools, clinical care coordination/management, business management/operations, network development/quality, and risk contracting/management.

Ralph Tang
President, MD/VA IPA
WellCare Health Plans/Collaborative Health Systems

1:55pm
Examining Strategies to Create and Manage High Performing Networks
This session will examine strategies on creating and managing high performance networks. Topics to be discussed will include:

- Tiered versus narrowed
- Incorporating service category or specialty network designs
- Analytics to support provider stratification
- How alternative payment models fit within the strategy
- Managing the disruption
- Operational considerations

Akil McClay
Director, Alternative Payment Model Operations
Trinity Health

2:45pm
Networking Break & Refreshments

3:15pm
Opportunities to Establish Partnerships with IDNs to Streamline Care Coordination
Integrated health systems have taken in multiple paths in addressing the needs for patients they serve needing specialty pharmacy care. This session will explore one health system’s approach in transforming the “traditional” specialty pharmacy patient, provider, and manufacturer experience, to one of population health, standardization of care pathways, transparency, and accountability. The resulting service serves as the platform for new opportunities to more “deeply” integrate care delivery and outcomes for manufacturers, providers, payers, and other partners in patient care.

John C. Robicsek
Assistant Vice President
Strategy, Business, and Program Development
Specialty Pharmacy Service
Division of Pharmacy Services
Atrium Health

4:05pm
Understanding and Solving the Complexities in Medicaid Provider Network Contracting: Provider Perspective
This session will discuss some of the complexities surrounding provider network management, participation, and contracting as it pertains to Medicaid. Topics to be discussed will include:

- Effectively selecting provider partners to optimize network management, network adequacy and vale based targets
- Creating operational efficiency through cross-departmental collaboration
- Developing Medicaid value-based contract relationships that drive performance and quality care
- Reliance of state on Payor knowledge/expertise
- Bankruptcy of payors, settlements, etc.
- Narrowing networks to establish the right Medicaid medical home
- HEDIS – why payors and providers should make this a part of any VBC contract
- Managing provider/payor performance and expectations

John R. Swanson
Vice President, Managed Care Contracting
Ann & Robert H. Lurie Children’s Hospital of Chicago

5:00pm
End of Day One

Day Two – Friday, October 26, 2018

7:15am
Morning Breakfast

8:00am
Chair’s Recap of Day One

8:15am
Creating and Implementing Innovative Pay-For-Performance Programs in Provider Contracting to Improve Quality and Manage Costs
Innovative incentive programs are vital in maintaining provider relationships. This session will present strategies on developing such incentive programs and implementing them with success. Learn about how pay-for-performance can create an overall improvement in quality, and provided an opportunity to better manage costs for the population. Additional topics to be discussed will include:

- Incorporating quality and efficiency data transparency into your network contracting and claims management
- Implications of data-sharing, value-based or risk-shared contracts
- Data demands of providers
- Consolidating and normalizing data files from multiple payers

Sean Burns
Vice President Payment and Network Infrastructure
Highmark Blue Cross Blue Shield

9:00am
Optimizing Value-Based Network Contracting Through Effective Shared Savings and Care Coordination Strategies
This session will examine how to effectively optimize value-based network contracting through effective shared savings and care coordination strategies. Learn what works, lessons learned and successes. Topics to be discussed will include:

- Defining the structural components of the network
- Discussing the contracting and reimbursement models that were utilized to support the strategy
- Exploring the approaches to encourage individual providers to accept and support value-based arrangements
- Cooperating with governmental value-based payment initiatives
- Data sharing transparency

Carl Lund
Vice President, Value Based Arrangements
EmblemHealth

09:45m
Networking Break & Refreshments

10:15am
Keys to a Successful Shared Savings Population Management Program
This session will focus on best practices that can be used to set up successful shared savings programs between payers, providers and members.

- Defining and agreeing upon key terms
- Data Sharing – complete transparency
- Collaborative Solutions
- Engaging members and providers

Cortney Larson
Director, Provider Relations
PEHP Health & Benefits

11:00am
Supplier Diversity & Total Health
This session will include a review of innovative contracting strategy with certified diverse suppliers (minority, woman, LGBTQ and Veteran) and how this program creates an economic impact in underserved communities in an effort to bridge the healthcare disparities gap. This presentation will focus on three areas: 1) Supplier Diversity Program Overview, 2) Total Health which is primarily solving for socio-economic factors which impact an individual’s health outcomes, and 3) Shared Agenda which illustrates good corporate citizen business practices and how collectively we can help solve healthcare disparities in the United States.

Jonathan S. Van Etten
Executive Director
Co-Chair KP Pride
Kaiser Permanente National Provider Contracting

11:45am
Leveraging Claims Data to Build and Refine Clinically Integrated Networks: A Health System Perspective
This session will discuss the challenges associated with evaluating providers based on limited claims information for populations attributed to our clinically integrated networks (CIN). How we assess prospective providers for inclusion in our CINs based on claims analysis and other sources of information. Additionally, understanding the performance of network providers using claims analysis to identify those for which intervention might be appropriate.

Scott J. Malan
Director, Individual Products and Network Development
Trinity Health

12:30pm
Conference Concludes

Workshop – Day One – Thursday, October 25, 2018

05:15pm – 7:15pm
How to Navigate Both Sides of the Value Contracting Maze

- Determining the “value” in the value based contract
o Payer vs. provider
o Measuring market share and share of customer
o Timelines and transition points
o Population/payer segments
 Medicare vs. self insured vs. commercial vs. Medicaid

- Calculating the risks of value based contracts
o Gain/risk sharing
o Risks that are influenced vs. controlled vs. uncontrolled
o Incremental vs. global risk, volume, costs

- Understand the other perspective

- Determine BATNA (best alternative to negotiated agreement)

Mike Barrett
Founder
Cura Health Management

Featured Speakers

Vince McVittie

Vince McVittie

Executive Director

Signature Care Management

Lisa B. Wagamon

Lisa B. Wagamon

System Vice President, Managed Care

SSM Health

Carol Vargo, MHS

Carol Vargo, MHS

Director, Physician Practice Sustainability Strategy Group

The American Medical Association

Kevin Egge

Kevin Egge

Vice President of Provider Relations and Contracting

Blue Cross Blue Shield Louisiana

Michael Sweeney

Michael Sweeney

Vice President, Reimbursement, Contracting and Provider Relations

UPMC Health Plan

Ralph Tang

Ralph Tang

President, IPA MSO and Senior Vice President, Commercial Market Development

Universal American Collaborative Health Systems

Akil McClay

Akil McClay

Director, Alternative Payment Model Operations

Trinity Health

John C. Robicsek

John C. Robicsek

Assistant Vice President, Strategy, Business, and Program Development, Specialty Pharmacy Service, Division of Pharmacy Services

Atrium Health

John R. Swanson

John R. Swanson

Vice President, Managed Care Contracting

Ann & Robert H. Lurie Children’s Hospital of Chicago

Sean Burns

Sean Burns

Vice President Payment and Network Infrastructure

Highmark Blue Cross Blue Shield

Cortney Larson

Cortney Larson

Director, Provider Relations

PEHP Health & Benefits

Jonathan S. Van Etten

Jonathan S. Van Etten

Executive Director, Co-Chair KP Pride

Kaiser Permanente National Provider Contracting

Michael Olsen

Michael Olsen

Senior Director, Network Strategy and Contracting

Beth Israel Deaconess Care Organization

 Mike Barrett

Mike Barrett

Founder

Cura Health Management

Venue

Loews Sapphire Falls Resort
6601 Adventure Way
Orlando, FL 32819
888-884-7922

“Mention BRI Network to get a discounted rate of $189/night”

Sponsors and Exhibitors

TBA

FAQ

Are there group discounts available?

  • Yes – Register a group of 3 or more at the same time and receive an additional 10% off the registration fee

Are there discounts for Non-Profit/Government Organizations?

  • Yes – please call us at 800-743-8490 for special pricing

What is the cancellation policy?

  • Cancellations received 3 weeks prior to the event will receive a refund minus the administration fee of $185. Cancellation received less than 3 weeks prior to the event will receive a credit to a future event valid for one year.

Can the registration be transferred to a colleague?

  • Yes – please email us in writing at info@brinetwork.com with the colleague’s name and title

Where can I find information on the venue/accommodations?

  • Along with your registration receipt you will receive information on how to make your hotel reservations. You can also visit individual event page for specific hotel information. The conference fee does not include the cost of accommodations.

What is the suggested dress code?

  • Business casual. Meeting rooms can sometimes be cold so we recommend a sweater or light jacket

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