Bundled Payment Summit
Bundled Payment Summit
Bundled Payment Summit
Bundled Payment Summit
Bundled Payment Summit
Bundled Payment Summit



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Preconference | Day 2


Agenda: Day I
Tuesday, June 17, 2014
7:00 a.m. Registration Commences
OPENING PLENARY SESSION
8:00 a.m.

Welcome and Introductions

Francois de Brantes, MS, MBA
Executive Director, Health Care Incentives Improvement Institute, Newtown, CT (Co-chair)

    Speaker Bio

    As Executive Director of HCI3, Mr. de Brantes is responsible for setting and implementing the strategy of the organization. This includes supervising the implementations of Bridges To Excellence and Prometheus Payment pilots, leading the development of new programs, and designing incentive efforts for employers, health plans and provider organizations.

    Previously, Mr. de Brantes was the Program Leader for various healthcare initiatives at GE Corporate Health Care Programs, responsible for developing the conceptual framework and the implementation of GE's Active Consumer strategy.

    Mr. de Brantes attended the University of Paris IX - Dauphine where he earned a MS in Economics and Finance. After completing his military service as a platoon leader in a Light Cavalry Regiment, he attended the Tuck School of Business Administration at Dartmouth College, where he graduated with an MBA.
8:15 a.m.

Keynote Address

Stephen F. Wiggins, MBA
Founder and Past Chair and Chief Executive Officer, Oxford Health Plans; Founder and Past Chairman and Chief Executive Officer, HealthMarket, Inc., Chairman, Remedy Partners, Darien, CT

    Speaker Bio

    Steve Wiggins is the Managing Director of Essex Woodlands, a health care private equity firm. Prior to Essex, Mr. Wiggins founded Oxford Health Plans, HealthMarket, Health Partners, Intelliclaim, Accessible Space and Remedy Partners. Mr. Wiggins graduated from Macalester College and Harvard Business School.
    Presentation Material (Acrobat)
8:45 a.m.

Challenges and Opportunities of Statewide Bundled Payment Implementations

Lili Brillstein, MPH
Director, Episodes of Care, Horizon Healthcare Innovations; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ

    Speaker Bio

    Lili Brillstein is the Director of Episodes of Care for the Horizon Healthcare Innovations division of Horizon Blue Cross Blue Shield of New Jersey. She is responsible for the overall direction, strategy, design and oversight of the Episodes of Care Program, which currently includes value-based programs in orthopaedics, OB, colonoscopy, and oncology. Lili also plays a leadership role in the advancement of Horizon's PCMH and ACO models.

    Lili's background is in building public health programs, focusing on improving quality and member experience, while reducing overall cost of care. She has more than 25 years of experience working with hospitals, physicians, and in managed care organizations.

    Lili has a Masters in Public Health.
Kimberly Hartsfield, MPA
Senior Manager, The Camden Group; Former Director, Enterprise Business Intelligence-Medical Informatics, Arkansas Blue Cross Blue Shield, Little Rock, AR

    Speaker Bio

    Ms. Hartsfield is a senior manager with The Camden Group. She specializes in hospital operations with a focus on designing and implementing Medicare and commercial bundled payments. She has more than 22 years of experience in the healthcare industry and has frequently presented at national speaking engagements on a variety of topics including value-based payment models and provider cost and quality transparency as well as provider engagement.

    Prior to The Camden Group, Ms. Hartsfield was the director of enterprise business intelligence -medical informatics for Arkansas Blue Cross and Blue Shield. There she was responsible for the implementation of Arkansas Health Care Payment Improvement Initiatives ("ACHPII"), a multi-payer statewide bundled payment initiative, including the development of reporting, methodology, and provider engagement. She also worked on the development and implementation of Accountable Care Organization ("ACOs") arrangements with facilities and provider groups throughout Arkansas and served as a healthcare consultant in both the employer and provider markets.

    Ms. Hartsfield earned her master's degree in public administration and her bachelor's degree from the University of Arkansas, Little Rock.
Jeannie Hubbell, MBA
Director of Payment Innovation, Cigna Healthcare, Franklin, TN

    Speaker Bio

    Jeannie Hubbell is the Director of Value Based Contracting for Cigna Healthcare. Jeannie has over 17 years of health care industry experience with national payors including Cigna, Humana, and Principal. While the majority of her career has been focused on commercial and Medicare network development and contracting, she has also held roles within medical economics and National Account sales. In her current capacity as Director of Value Based Contracting, Jeannie and her team are responsible for designing Cigna's care collaboration programs nationwide, including pay for performance programs, next generation medical home models, and episode of care programs. Jeannie holds a Bachelor of Science degree from Arizona State and an MBA from University of Arizona.
Robert Smith, MBA
Project Director, Colorado Business Group on Health, Denver, CO

    Speaker Bio

    Since 2010, Bob has worked with the Colorado Business Group on Health on piloting payment reform and promoting value-based purchasing in Colorado.

    Over a 40 year career as a healthcare executive, Bob's focus has been strategic planning, business development, and performance-based contracting. He has facilitated various joint ventures, partnerships, and collaborative initiatives between providers and purchasers, working within the community hospital, university medical center, and managed care settings. The health plan he started and ran several years was called "the most successful provider-owned plan in the country" by Modern Healthcare at the end of his tenure as CEO and he has overseen development and management of over 20 IPAs and PHOs.

    Bob holds an MBA from Loyola University of Chicago. He has co-authored two books on healthcare contracting strategies, published numerous healthcare articles, and taught as a faculty member of the American College of Healthcare Executives for 15 years. Since 2007 he has served as a member of the St. Vrain Valley School District Board of Education.
David Nuzum, MBA
Principal, McKinsey & Company, New York, NY (Moderator)

    Speaker Bio

    David Nuzum is a Principal in the Washington, DC Office of McKinsey & Company. He has spent more than 15 years working with the management teams of leading healthcare organizations to address the Triple Aim of better health, better care, and lower costs.

    David currently leads our Health Care Value service line in North America including health plan network strategy and contracting, payment innovation, care management, and transparency initiatives. He also co-leads McKinsey's Health Care Value Analytics division, an advanced analytics unit that supports value-based payment models through a combination of consumer research, clinical research, actuarial science, statistics, economics, and software programming capabilities.

    David's recent projects have included:
    • Exchange network strategy and/or provider network contracting for Qualified Health Plans in nearly 20 states
    • Design and implementation of ACO and medical home initiatives on behalf of numerous private insurers and state Medicaid programs
    • Design and implementation of the largest multi-payer bundled payment initiative in the U.S., involving 75 hospitals and more than 3,000 physicians
    • Development of State Health Innovation Plans for several states participating in the CMMI State Innovation Models initiative
    David received his M.B.A. in Healthcare Management from the Wharton School at the University of Pennsylvania. In addition, David received an A.B. in Biological Sciences from Harvard University; also while at Harvard, he completed significant graduate coursework in healthcare economics and public policy at the Harvard School of Public Health and the Kennedy School of Government. David resides in Brooklyn, New York.
9:45 a.m.

Provider Bundled Payment Strategies

Karim Habibi, FHFMA, MPH, MS
Senior Vice President and Chief of Managed Care, Office of Managed Care and Healthcare Reform, NYU Langone Medical Center, New York, NY

    Speaker Bio

    Karim is the Senior Vice President of Managed Care and Chief of Managed Care at NYU Langone Medical Center. He is responsible for developing and implementing managed care strategies including pay for performance contracting, contract review, negotiation, implementation, and compliance for the Hospitals and the Faculty Group Practices. Mr. Habibi is also responsible for providing management services for the University Physician Network.

    Karim holds a Master of Science in Health Services Management from New York University and a Master of Public Health in Health Administration from the University of Oklahoma.
    Presentation Material (Acrobat)
Marion A. McGowan, RN, MHA
Executive Vice President and Chief Population Health Officer, Lancaster General Health; President, LG Health Innovation Solutions Inc., Lancaster, PA

    Speaker Bio

    Marion McGowan is a healthcare executive with more than 20 years of experience leading healthcare delivery organizations crossing the spectrum of the care continuum. Her past experiences include serving as the president for large and small acute care hospitals, chief operating officer of a large community health system, and executive leader for home healthcare, physician medical groups, skilled care facility, and other post-acute care services. Presently, she serves as the Executive Vice President and Chief Population Health Officer at Lancaster General Health, the President of Lancaster General Health Community Care Collaborative, an ACO located in Lancaster County, Pennsylvania, and President of the Lancaster General Innovative Solutions company. She has a Bachelor's degree in Nursing, a Master's degree in Public Health Management and is a doctoral candidate in the Philosophy of Leadership. Lancaster General Health (LG Health) is a not-for-profit health system that features a diverse range of healthcare services including three hospitals, downtown and suburban outpatient centers, Express and Urgent Care locations throughout the region, a Visiting Nurse Association, the Pennsylvania College of Nursing & Health Sciences, and Lancaster General Physician Services. Designated a Magnet hospital for nursing excellence, LGH has been recognized regionally and nationally for its intensive care unit and cardiology and orthopedic services. Other key specialty services include obstetrics, open-heart surgery, neurosurgery and trauma.
Michael Spigel, MHA
Executive Vice President and Chief Operating Officer, Brooks Health, Jacksonville, FL

    Speaker Bio

    Michael Spigel serves as the Executive Vice President and Chief Operating Officer for Brooks Rehabilitation, a Jacksonville based not-for-profit health system focused on providing a full portfolio of post-acute care services. The Brooks system includes the nation's largest inpatient rehabilitation hospital, a wide array of homecare services, skilled nursing facilities, extensive outpatient centers, physician services, The Brooks Center for Rehabilitation Research, and extensive community benefit programs and services.

    Mr. Spigel's career has been focused on the post-acute segment of healthcare with broad experience planning, designing and operating post-acute healthcare services. Last year he led a team to submit an application to participate in the CMS Bundled Payment for Care Initiative Program and partnered with an acute care hospital system on a separate application bundling acute and post-acute care services. Additionally, Mr. Spigel speaks nationally on a variety of topics related to post-acute care, payment reform in post-acute care and leadership in healthcare.
Deirdre Baggot, PhD (c), MBA, RN
Vice President, The Camden Group, Expert Panel Reviewer, CMMI Bundled Payment, for Care Improvement Initiative Models 2-4, El Segundo, CA, (Moderator)

    Speaker Bio

    Ms. Baggot is a vice president at The Camden Group and a nationally recognized expert in the area of bundled payment. In 2012, Ms. Baggot was appointed by Centers for Medicare & Medicaid Services ("CMS") to be an expert reviewer for the Bundled Payments for Care Improvement Initiative ("BPCI") for Models 2 through 4.

    Prior to joining The Camden Group, Ms. Baggot served as the administrator of the cardiac and vascular institute at Exempla Saint Joseph in Denver, Colorado, where she played a key role in helping the hospital win the bid to be selected as an Acute Care Episode cardiovascular services pilot program - only one of four in the nation.

    Prior to joining Exempla Saint Joseph Hospital, Ms. Baggot worked for ten years in academic healthcare, first at Northwestern Memorial Hospital and later at The University of Michigan Health System in a number of key leadership roles.

    Currently, Ms. Baggot serves on the Board of the Colorado Organization of Nurse Leaders and is completing her Ph.D. at the University of Colorado, Denver, Colorado.
    Presentation Material (Acrobat)
10:45 a.m. Break
11:15 a.m.

Engaging Consumers

Robert W. Dubois, MD, PhD
Chief Science Officer, National Pharmaceutical Council, Washington, DC

    Speaker Bio

    Robert W. Dubois, MD, PhD, joined the National Pharmaceutical Council in October 2010 as its Chief Science Officer. In this role, he oversees NPC's research on policy issues related to comparative effectiveness research, as well as on how health outcomes are valued.

    Dr. Dubois, who is board certified in internal medicine, brings more than 25 years of experience in health services research and comparative clinical effectiveness.

    Prior to joining Cerner in 2001, Dr. Dubois co-founded Protocare Sciences and was its executive vice president, chief medical officer, and later its chief executive officer. Throughout his career, Dr. Dubois' primary interest has centered on defining "what works" in health care and finding ways for that evidence to inform health care decision making. He is a recognized expert in the areas of defining best practice, disease management and appropriateness of care.

    Dr. Dubois received his AB from Harvard College, his MD from the Johns Hopkins School of Medicine and his PhD in Health Policy from the RAND Graduate School.
Kevin Lembo, MPA
State Comptroller, Office of the State Comptroller, State of Connecticut; Former and First Connecticut Healthcare Advocate, Hartford, CT

    Speaker Bio

    Kevin Lembo was elected Connecticut's State Comptroller in 2010 following 20 years of public service and advocacy.

    Lembo helped design and implement a long-term home care program in New York that successfully prevented premature and permanent admissions to nursing facilities; and he served as program director for an AIDS education, prevention and primary care program. As Connecticut's first state Healthcare Advocate, Lembo spent years helping thousands of residents navigate the complexities of the health care system; and advocated for patients denied coverage or treatment.

    As State Comptroller, Lembo continues to lead the charge for affordable and quality health care, stewarding programs that emphasize preventive care.
    Presentation Material (Acrobat)
Mark Xistris, MAcc
Vice President, Business Development and Provider Relations, The Alliance, Madison, WI

    Speaker Bio

    Mark Xistris joined The Alliance in 1997 and currently serves as Vice President, Business Development & Provider Relations. His main responsibilities include oversight of the provider network, pay-for-performance programs, quality/cost measurement initiatives, and business development for the cooperative.

    In addition to his work at The Alliance, Mark is a founding Board Member of the Wisconsin health Information Organization (WHIO), Wisconsin's voluntary APCD, where he serves on the Executive Committee, chairs WHIO's Data Mart Quality and Value Committees, and is the Treasurer Elect.

    Mark earned a bachelor's degree in accountancy from Arizona State University (summa cum laude) and a master's of accountancy degree in health care fiscal management from the University of Wisconsin-Madison.
    Presentation Material (Acrobat)
A. Mark Fendrick, MD
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy; Director, Center for Value-Based Insurance Design; Director, Health Services Research Core Lab, University of Michigan, Ann Arbor, MI (Moderator)

    Speaker Bio

    A. Mark Fendrick, M.D. is a Professor of Internal Medicine in the School of Medicine and a Professor of Health Management and Policy in the School of Public Health at the University of Michigan. He currently directs the Center for Value-Based Insurance Design at the University of Michigan [www.vbidcenter.org], the leading advocate for development, implementation, and evaluation of innovative health benefit plans.

    Dr. Fendrick's research focuses on the clinical and economic assessment of medical interventions with special attention to how technological innovation influences clinical practice, benefit design, and health care systems. He serves on the Medicare Coverage Advisory Committee and has presented testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions and the U.S. House of Representatives Ways and Means Subcommittee on Health. Dr. Fendrick is the co-editor in chief of the American Journal of Managed Care and is an editorial board member for 3 additional peer-reviewed publications. Dr. Fendrick also remains clinically active in the practice of general internal medicine.
12:00 p.m.

Outpatient Bundles Update

Elizabeth Ireton RN, MS
Director, Premier Performance Partners-Clinical Integration, Premier Healthcare Alliance, Charlotte, NC

    Speaker Bio

    Elizabeth Ireton, RN, MS is a Director with Premier Performance Partners. Her areas of focus include supporting the Premier Population Health Collaborative, and co-leading the Bundled Payment Collaborative. Elizabeth's focus is in a variety of areas such as Population Health, Care Management, Care Re-design, including Post-Acute, and Culture and Change Leadership.

    Previously, Ms. Ireton was a Director of Account Management at Healthways. In that role, she provided direct account management to a number of high profile customers, which included hospitals, health plans and employers. She also supported a hospital service line division and was responsible for business development with existing customers. She has extensive experience in disease and care management, as well as population health and clinical care redesign.
Valinda Rutledge, MBA
President and Chief Executive Officer, Rutledge Health Care Consulting, L.L.C; Former Director, Care Models Group, Center for Medicare and Medicaid Innovation (CMMI); Former Chief Executive Officer, CaroMont Health; Former Chief Executive Officer, Bon Secours Saint Francis Health System, Greenville, SC

    Speaker Bio

    Valinda Rutledge worked as a Senior Advisor and Group Director for the Patient Care Models Group within the Centers of Medicare and Medicaid Innovation (CMMI) where she led the development and roll out of the Bundled Payment for Care Improvement Initiative, Strong Start perinatal care and other National programs. She also served on the Governance Committee that selected the grants for the one billion dollar Health Care Innovation Challenge Grants.

    She is currently the President/CEO of Rutledge Health Care Consulting; a firm that focuses on assisting health systems and start-up companies transform their business models. She is frequently sought as a national speaker and consultant in the area of payment/clinical innovation.
    Presentation Material (Acrobat)
12:30 p.m. Networking Luncheon

AFTERNOON TRACK SESSIONS
TRACK I: SUCCEEDING IN THE MEDICARE BPCI
1:30 p.m.

Welcome and Overview

Ray Herschman
President and Chief Operating Officer, xG Health Solutions, Columbia, MD (Co-moderator)

    Speaker Bio

    Ray is widely known for his experience leveraging IT and informatics to enable organizational change in healthcare.

    Ray was SVP of Enterprise Information Management at WellPoint responsible for Enterprise Information Management strategies, business intelligence, and analytic capabilities roadmaps.

    Ray also served as COO and SVP at WebMD Health Services and prior to that as Mercer Consulting's National Health and Group Benefits Practice Leader, specializing in consumerism and provider performance measurement.

    Ray received his BS in Chemistry, MS in Healthcare Fiscal Management and Accounting, University of Wisconsin.
Charles Wiggins, MHA
Co-founder, Remedy Partners, New York, NY (Co-moderator)
1:45 p.m.

Risk Arrangements

Kate Fitch, RN, MEd
Principal & Healthcare Consultant, Milliman, New York, NY

    Speaker Bio

    Kate is a principal and healthcare management consultant in the New York office of Milliman. Kate developed and manages the health outcomes research practice which focuses on developing payer value strategy and analytics for pharmaceutical companies, medical device manufacturers, healthcare industry trade organizations, and disease and medical management vendors. Kate also consults to provider groups evaluating and engaging in population risk contracts with a focus on benchmarking population claim costs and identification of cost reduction opportunities. Kate also leads a team of actuaries and data analysts working with BPCI awardees, prospective BPCI awardees and providers with commercial bundled payment contracts.
    Presentation Material (Acrobat)
Ray Herschman
President and Chief Operating Officer, xG Health Solutions, Columbia, MD

    Speaker Bio

    Ray is widely known for his experience leveraging IT and informatics to enable organizational change in healthcare.

    Ray was SVP of Enterprise Information Management at WellPoint responsible for Enterprise Information Management strategies, business intelligence, and analytic capabilities roadmaps.

    Ray also served as COO and SVP at WebMD Health Services and prior to that as Mercer Consulting's National Health and Group Benefits Practice Leader, specializing in consumerism and provider performance measurement.

    Ray received his BS in Chemistry, MS in Healthcare Fiscal Management and Accounting, University of Wisconsin.
Kelsey P. Mellard, MPA
Vice President, Payment and Delivery Reform and Lead, Bundled Payment for Care Improvement Initiative, NaviHealth; Former Vice President of Policy for Health Services, UnitedHealth Group; Former Special Assistant to Director, Center for Medicare and Medicaid Innovation (CMMI), Washington, DC
Presentation Material (Acrobat)
Charles Wiggins, MHA
Co-founder, Remedy Partners, New York, NY
3:00 p.m.

Data Analysis and Reporting

John A. Fromhold, MHHA
Chief Executive Officer, HackensackUMC Mountainside Hospital, Montclair, NJ

    Speaker Bio

    John Fromhold is Chief Executive Officer of HackensackUMC Mountainside. In 2007, Mr. Fromhold was instrumental in identifying the hospital (formerly known as Mountainside) as an acquisition candidate for Merit Health Systems, a private company based in Louisville, KY, where he was a partner and Senior Vice President. He subsequently relocated to New Jersey to assume the role of CEO and personally oversee the hospital's transformation. Under his leadership, the 365-bed community hospital located on the Montclair/Glen Ridge border in NJ, has undergone a successful and dramatic revitalization.

    Recognizing that network affiliations were becoming increasingly essential to maintaining clinical excellence and financial viability, in 2012 he was instrumental in negotiating the sale of Mountainside to a not-for-profit/for-profit joint venture network formed by the Hackensack University Health Network, a nationally recognized clinical leader, and LHP Hospital Group, one of the country's leading private hospital management companies. Prior to joining Merit, Mr. Fromhold was a Group Vice President for Community Health Systems with direct responsibility for 13 hospitals in five states. He also held senior management positions with Humana and HCA. Mr. Fromhold is a Fellow of the American College of Healthcare Executives.
    Presentation Material (Acrobat)
Coleen Kivlahan, MD, MSPH
Senior Director of Health Care Affairs, Association of American Medical Colleges, Washington, DC

    Speaker Bio

    As Senior Director of alternative payment strategies and health systems innovation at the American Association of Medical Colleges, Coleen Kivlahan MD, MSPH leads our efforts to support transformation in health care payment systems for academic medical centers, supporting improved quality, cost management and patient care outcomes.

    Prior to her role at AAMC, she served as the Chief Medical Officer (CMO) at Aetna/Schaller Anderson, Inc leading multiple states' Medicaid managed care plans in improving cost, quality and access. She also served as CMO at the University of Missouri health system and as CMO for Fantus Health Center, Cook County Health System, Chicago. She has worked in public health settings, academic health centers, national, state and county government, and in multiple international settings.

    Dr. Kivlahan earned her B.A. degree in biology from St Louis University, her M.D. degree from the Medical College of Ohio, completed family medicine residency at the University of Missouri and the Robert Wood Johnson Family Medicine fellowship achieving her MSPH at the University of Missouri.


    Presentation Material (Acrobat)
Denise Prince, MPH, MPA
System Vice-President, Value-Based Care, Geisinger Health System, Danville, PA

    Speaker Bio

    As System Vice President, Value-Based Care and Vice President, Population Health, Ms. Prince provides senior operational leadership for accountable care and population health initiatives. She is co-leading Geisinger's participation in the CMS Innovation Center's Bundled Payment for Care Improvement Initiative and is the Chief Administrative Officer for the Keystone ACO. In addition she provides senior leadership to the Care Continuum Service Line with operational responsibility for many pre and post-acute services including home health and hospice, home infusion, Geisinger's PACE program, Geisinger's skilled nursing facilities, and a variety of urgent care and walk-in clinics.

    Prior to her current role, Ms. Prince was the Founder & Managing Partner of Geisinger Health System's venture and intellectual asset commercialization group, Geisinger Ventures. In her nine years with the venture group and in her prior role as Senior Vice President of Diversified Services she led the development of more than a dozen new healthcare service businesses in both the not-for-profit and for-profit sectors.
    Presentation Material (Acrobat)
4:00 p.m. Break
4:30 p.m.

Clinical Reengineering

Frederick J. Bloom, Jr., MD, MMM
Chief, Care Continuum, Geisinger Health System; Medical Director, Quality and Performance, Geisinger Health Plan; Chief Medical Officer, Keystone Accountable Care Organization, Danville, PA

    Speaker Bio

    Dr. Frederick Bloom is the Chief, Care Continuum of the Geisinger Health System and Medical Director, Quality and Performance for Geisinger Health Plan. He is responsible for designing reliable, value based systems of care for chronic disease and prevention in the Geisinger Clinic which serve as the foundation for the Geisinger Patient Centered Medical Home, ProvenHealth Navigator.

    Dr. Bloom has taken 37 Geisinger sites to Level 3 NCQA PCC-PCMH recognition and currently serves on the NCQA PCMH Recognition Review Oversight Committee.

    In his role as Medical Director, Quality and Performance of the Geisinger Health Plan, he develops pay for performance partnership relationships for all providers, including thousands of non-Geisinger primary care and specialty providers.
    Presentation Material (Acrobat)
Elizabeth Ireton RN, MS
Director, Premier Performance Partners-Clinical Integration, Premier Healthcare Alliance, Charlotte, NC

    Speaker Bio

    Elizabeth Ireton, RN, MS is a Director with Premier Performance Partners. Her areas of focus include supporting the Premier Population Health Collaborative, and co-leading the Bundled Payment Collaborative. Elizabeth's focus is in a variety of areas such as Population Health, Care Management, Care Re-design, including Post-Acute, and Culture and Change Leadership.

    Previously, Ms. Ireton was a Director of Account Management at Healthways. In that role, she provided direct account management to a number of high profile customers, which included hospitals, health plans and employers. She also supported a hospital service line division and was responsible for business development with existing customers. She has extensive experience in disease and care management, as well as population health and clinical care redesign.
    Presentation Material (Acrobat)
Coleen Kivlahan, MD, MSPH
Senior Director of Health Care Affairs, Association of American Medical Colleges, Washington, DC

    Speaker Bio

    As Senior Director of alternative payment strategies and health systems innovation at the American Association of Medical Colleges, Coleen Kivlahan MD, MSPH leads our efforts to support transformation in health care payment systems for academic medical centers, supporting improved quality, cost management and patient care outcomes.

    Prior to her role at AAMC, she served as the Chief Medical Officer (CMO) at Aetna/Schaller Anderson, Inc leading multiple states' Medicaid managed care plans in improving cost, quality and access. She also served as CMO at the University of Missouri health system and as CMO for Fantus Health Center, Cook County Health System, Chicago. She has worked in public health settings, academic health centers, national, state and county government, and in multiple international settings.

    Dr. Kivlahan earned her B.A. degree in biology from St Louis University, her M.D. degree from the Medical College of Ohio, completed family medicine residency at the University of Missouri and the Robert Wood Johnson Family Medicine fellowship achieving her MSPH at the University of Missouri.


    Presentation Material (Acrobat)
David Rosales, MBA
Vice President, Performance and Innovation, Visiting Nurse Services of New York, New York, NY

    Speaker Bio

    David is Vice President for Performance & Innovation at the Visiting Nurse Service of New York, a ~$2BN non-profit home care provider and health plan. David oversees an internal consulting unit that spearheads strategic and operational improvement initiatives across the enterprise. David has also held roles at Brigham and Women's Hospital and Blue Cross Blue Shield of MA. Prior to entering the health care industry, served as a management consultant with Oliver Wyman. David has a B.A. in History from Harvard College and an M.B.A from Harvard Business School.
    Presentation Material (Acrobat)
5:45 p.m. Adjournment and Networking Reception

TRACK II: CASE STUDIES IN STATE-WIDE BUNDLED PAYMENT INITIATIVES
1:30 p.m.

Welcome and Overview

David Nuzum, MBA
Principal, McKinsey & Company, New York, NY (Moderator)

    Speaker Bio

    David Nuzum is a Principal in the Washington, DC Office of McKinsey & Company. He has spent more than 15 years working with the management teams of leading healthcare organizations to address the Triple Aim of better health, better care, and lower costs.

    David currently leads our Health Care Value service line in North America including health plan network strategy and contracting, payment innovation, care management, and transparency initiatives. He also co-leads McKinsey's Health Care Value Analytics division, an advanced analytics unit that supports value-based payment models through a combination of consumer research, clinical research, actuarial science, statistics, economics, and software programming capabilities.

    David's recent projects have included:
    • Exchange network strategy and/or provider network contracting for Qualified Health Plans in nearly 20 states
    • Design and implementation of ACO and medical home initiatives on behalf of numerous private insurers and state Medicaid programs
    • Design and implementation of the largest multi-payer bundled payment initiative in the U.S., involving 75 hospitals and more than 3,000 physicians
    • Development of State Health Innovation Plans for several states participating in the CMMI State Innovation Models initiative
    David received his M.B.A. in Healthcare Management from the Wharton School at the University of Pennsylvania. In addition, David received an A.B. in Biological Sciences from Harvard University; also while at Harvard, he completed significant graduate coursework in healthcare economics and public policy at the Harvard School of Public Health and the Kennedy School of Government. David resides in Brooklyn, New York.
Daniel Tsai
Associate Principal, McKinsey & Company, Summit, NJ

    Speaker Bio

    Daniel Tsai is an Associate Partner in McKinsey's New Jersey Office. He is a leader in the Firm's Healthcare Services and Solutions practice and works with payors and providers on designing and implementing innovative care delivery and payment models.

    He leads the episode-based payment service line for McKinsey's Healthcare Value Analytics division, a specialized unit that blends actuarial, statistics, economics, and software programming to support payment reform. Daniel has led work across multiple states and commercial payers in designing and implementing at-scale roll out of episode-based payment, including launching episodes of care in a state with >1,000 providers participating in gain and risk sharing.

    Daniel regularly leads workshops and conference sessions on innovative payment and care delivery strategies, and holds an AB in Applied Mathematics/Economics, summa cum laude, from Harvard.
    Presentation Material (Acrobat)
2:15 p.m.

Episodes of Care: Migrating from Fee-for-Service to Fee-for-Quality/Value

Lili Brillstein, MPH
Director, Episodes of Care, Horizon Healthcare Innovations; Former Senior Director, Medicare & Retirement, UnitedHealthcare, Newark, NJ

    Speaker Bio

    Lili Brillstein is the Director of Episodes of Care for the Horizon Healthcare Innovations division of Horizon Blue Cross Blue Shield of New Jersey. She is responsible for the overall direction, strategy, design and oversight of the Episodes of Care Program, which currently includes value-based programs in orthopaedics, OB, colonoscopy, and oncology. Lili also plays a leadership role in the advancement of Horizon's PCMH and ACO models.

    Lili's background is in building public health programs, focusing on improving quality and member experience, while reducing overall cost of care. She has more than 25 years of experience working with hospitals, physicians, and in managed care organizations.

    Lili has a Masters in Public Health.
    Presentation Material (Acrobat)
3:00 p.m.

Piloting Chronic Care Episodes in Colorado: Progress, Pitfalls, and Energizing Potential

Robert Smith, MBA
Project Director, Colorado Business Group on Health, Denver, CO

    Speaker Bio

    Since 2010, Bob has worked with the Colorado Business Group on Health on piloting payment reform and promoting value-based purchasing in Colorado.

    Over a 40 year career as a healthcare executive, Bob's focus has been strategic planning, business development, and performance-based contracting. He has facilitated various joint ventures, partnerships, and collaborative initiatives between providers and purchasers, working within the community hospital, university medical center, and managed care settings. The health plan he started and ran several years was called "the most successful provider-owned plan in the country" by Modern Healthcare at the end of his tenure as CEO and he has overseen development and management of over 20 IPAs and PHOs.

    Bob holds an MBA from Loyola University of Chicago. He has co-authored two books on healthcare contracting strategies, published numerous healthcare articles, and taught as a faculty member of the American College of Healthcare Executives for 15 years. Since 2007 he has served as a member of the St. Vrain Valley School District Board of Education.
    Presentation Material (Acrobat)
3:45 p.m. Break
4:15 p.m.

Implementing Episodes of Care in Arkansas

Kimberly Hartsfield, MPA
Senior Manager, The Camden Group; Former Director, Enterprise Business Intelligence-Medical Informatics, Arkansas Blue Cross Blue Shield, Little Rock, AR

    Speaker Bio

    Ms. Hartsfield is a senior manager with The Camden Group. She specializes in hospital operations with a focus on designing and implementing Medicare and commercial bundled payments. She has more than 22 years of experience in the healthcare industry and has frequently presented at national speaking engagements on a variety of topics including value-based payment models and provider cost and quality transparency as well as provider engagement.

    Prior to The Camden Group, Ms. Hartsfield was the director of enterprise business intelligence -medical informatics for Arkansas Blue Cross and Blue Shield. There she was responsible for the implementation of Arkansas Health Care Payment Improvement Initiatives ("ACHPII"), a multi-payer statewide bundled payment initiative, including the development of reporting, methodology, and provider engagement. She also worked on the development and implementation of Accountable Care Organization ("ACOs") arrangements with facilities and provider groups throughout Arkansas and served as a healthcare consultant in both the employer and provider markets.

    Ms. Hartsfield earned her master's degree in public administration and her bachelor's degree from the University of Arkansas, Little Rock.
    Presentation Material (Acrobat)
5:00 p.m.

Launching an Episode Pilot in Tennessee: Challenges and Opportunities

Jeannie Hubbell, MBA
Director of Payment Innovation, Cigna Healthcare, Franklin, TN

    Speaker Bio

    Jeannie Hubbell is the Director of Value Based Contracting for Cigna Healthcare. Jeannie has over 17 years of health care industry experience with national payors including Cigna, Humana, and Principal. While the majority of her career has been focused on commercial and Medicare network development and contracting, she has also held roles within medical economics and National Account sales. In her current capacity as Director of Value Based Contracting, Jeannie and her team are responsible for designing Cigna's care collaboration programs nationwide, including pay for performance programs, next generation medical home models, and episode of care programs. Jeannie holds a Bachelor of Science degree from Arizona State and an MBA from University of Arizona.
Jim Humphrey, MHA, FACHE
Operations Director, Cigna, Nashville, TN Robert Smith, MBA, Project Director, Colorado Business Group on Health, Denver, CO

    Speaker Bio

    Mr. Humphrey serves as Operations Director for Cigna Healthcare. In this capacity, he directs the nationwide development and implementation of Episodes of Care and other care collaboration programs. He is an experienced executive with over 25 years in healthcare. Jim has worked in the areas of contracting, network development, and managed care operations for several large payors including Maxicare, FHP, Principal Financial Group, and Cigna Healthcare in California, Colorado and Tennessee. His background also includes work in hospital and PHO operations for Tenet and Banner Health. Jim holds a Master's Degree in Health Administration from Washington University School of Medicine in St. Louis, MO and is an accredited Fellow of the American College of Healthcare Executives.
    Presentation Material (Acrobat)
5:45 p.m. Adjournment and Networking Reception

TRACK III: PROVIDER STRATEGIES TO WIN WITH BUNDLED PAYMENTS
1:30 p.m.

Welcome and Overview

Deirdre Baggot, PhD (c), MBA, RN
Vice President, The Camden Group; Expert Panel Reviewer, CMMI Bundled Payment for Care Improvement Initiative Models 2-4, El Segundo, CA (Co-moderator)

    Speaker Bio

    Ms. Baggot is a vice president at The Camden Group and a nationally recognized expert in the area of bundled payment. In 2012, Ms. Baggot was appointed by Centers for Medicare & Medicaid Services ("CMS") to be an expert reviewer for the Bundled Payments for Care Improvement Initiative ("BPCI") for Models 2 through 4.

    Prior to joining The Camden Group, Ms. Baggot served as the administrator of the cardiac and vascular institute at Exempla Saint Joseph in Denver, Colorado, where she played a key role in helping the hospital win the bid to be selected as an Acute Care Episode cardiovascular services pilot program - only one of four in the nation.

    Prior to joining Exempla Saint Joseph Hospital, Ms. Baggot worked for ten years in academic healthcare, first at Northwestern Memorial Hospital and later at The University of Michigan Health System in a number of key leadership roles.

    Currently, Ms. Baggot serves on the Board of the Colorado Organization of Nurse Leaders and is completing her Ph.D. at the University of Colorado, Denver, Colorado.
Peggy Crabtree, RN, MBA
Vice President, The Camden Group; Former Administrator, Cardiovascular and Imaging Service Line, Huntington Memorial Hospital, El Segundo, CA (Co-moderator)

    Speaker Bio

    Ms. Crabtree is a vice president with The Camden Group and an expert on bundled payment, service line planning and implementation, co-management arrangements, and hospital operations. She has more than 25 years of hospital leadership experience and a strong clinical background, having held service line director and executive leadership roles in numerous hospitals.

    Prior to joining The Camden Group, Ms. Crabtree served as the administrator for the Cardiovascular and Imaging Service Line at Huntington Memorial Hospital in Pasadena, California.

    She has been featured in Trustee, Hospitals & Health Networks, Becker's Hospital Review, and Physicians Practice. Additionally, Ms. Crabtree has shared her expertise in service line strategy and bundled payment at national and state levels, including the National Bundled Payment Summit, VHA, and Hospital Council of Northern and Central California.
2:15 p.m.

Measuring Success with Bundles: Winning Strategies in Analytics

Kimberly Hartsfield, MPA
Senior Manager, The Camden Group; Former Director, Enterprise Business Intelligence-Medical Informatics, Arkansas Blue Cross Blue Shield, Little Rock, AR

    Speaker Bio

    Ms. Hartsfield is a senior manager with The Camden Group. She specializes in hospital operations with a focus on designing and implementing Medicare and commercial bundled payments. She has more than 22 years of experience in the healthcare industry and has frequently presented at national speaking engagements on a variety of topics including value-based payment models and provider cost and quality transparency as well as provider engagement.

    Prior to The Camden Group, Ms. Hartsfield was the director of enterprise business intelligence -medical informatics for Arkansas Blue Cross and Blue Shield. There she was responsible for the implementation of Arkansas Health Care Payment Improvement Initiatives ("ACHPII"), a multi-payer statewide bundled payment initiative, including the development of reporting, methodology, and provider engagement. She also worked on the development and implementation of Accountable Care Organization ("ACOs") arrangements with facilities and provider groups throughout Arkansas and served as a healthcare consultant in both the employer and provider markets.

    Ms. Hartsfield earned her master's degree in public administration and her bachelor's degree from the University of Arkansas, Little Rock.
    Presentation Material (Acrobat)
    Handout Material (Acrobat)
Karim Habibi, FHFMA, MPH, MS
Senior Vice President and Chief of Managed Care, Office of Managed Care and Healthcare Reform, NYU Langone Medical Center, New York, NY

    Speaker Bio

    Karim is the Senior Vice President of Managed Care and Chief of Managed Care at NYU Langone Medical Center. He is responsible for developing and implementing managed care strategies including pay for performance contracting, contract review, negotiation, implementation, and compliance for the Hospitals and the Faculty Group Practices. Mr. Habibi is also responsible for providing management services for the University Physician Network.

    Karim holds a Master of Science in Health Services Management from New York University and a Master of Public Health in Health Administration from the University of Oklahoma.
    Presentation Material (Acrobat)
3:30 p.m. Break
4:00 p.m.

An Integrated Approach to Payment Transformation: Coordinating Strategies with Your Payers

Paul N. Casale, MD
Chair of Cardiology and Lead for Bundled Payments, Lancaster General Health, Lancaster, PA

    Speaker Bio

    Paul N. Casale, M.D., is Chief of the Division of Cardiology and Medical Director of Quality at Lancaster General Health and serves as the physician lead for bundled payment initiatives for the health system. He is a member of the Board of Trustees of the American College of Cardiology. Dr. Casale is a graduate of Cornell University Medical College and completed a fellowship in cardiology at Massachusetts General Hospital and Harvard Medical School. He is a Clinical Professor of Medicine at Temple University School of Medicine and is board certified in Internal Medicine, Cardiology and Interventional Cardiology.
Mark I. Froimson, MD, MBA
President, Euclid Hospital; Member, Board of Governors and Board of Trustees; Former Vice Chair, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Euclid, OH

    Speaker Bio

    Mark I. Froimson, MD, MBA, is an Orthopaedic Surgeon and President of Euclid Hospital, a Cleveland Clinic Hospital. He has been with Cleveland Clinic for 14 years, served as Vice Chair and Quality Improvement Officer of the Orthopaedic and Rheumatologic Institute. He has a clinical practice at Euclid Hospital, a Center of Excellence for Orthopaedics.

    Dr. Froimson is an accomplished Joint Replacement Surgeon, performing primary and revision hip and knee replacement. He has published on outcomes, quality improvement and alternative payment models. As the director of Cleveland Clinic's Bundled Payment for Care Improvement program, successfully implemented it at Euclid Hospital.
Marion A. McGowan, RN, MHA
Executive Vice President and Chief Population Health Officer, Lancaster General Health; President, LG Health Innovation Solutions Inc., Lancaster, PA

    Speaker Bio

    Marion McGowan is a healthcare executive with more than 20 years of experience leading healthcare delivery organizations crossing the spectrum of the care continuum. Her past experiences include serving as the president for large and small acute care hospitals, chief operating officer of a large community health system, and executive leader for home healthcare, physician medical groups, skilled care facility, and other post-acute care services. Presently, she serves as the Executive Vice President and Chief Population Health Officer at Lancaster General Health, the President of Lancaster General Health Community Care Collaborative, an ACO located in Lancaster County, Pennsylvania, and President of the Lancaster General Innovative Solutions company. She has a Bachelor's degree in Nursing, a Master's degree in Public Health Management and is a doctoral candidate in the Philosophy of Leadership. Lancaster General Health (LG Health) is a not-for-profit health system that features a diverse range of healthcare services including three hospitals, downtown and suburban outpatient centers, Express and Urgent Care locations throughout the region, a Visiting Nurse Association, the Pennsylvania College of Nursing & Health Sciences, and Lancaster General Physician Services. Designated a Magnet hospital for nursing excellence, LGH has been recognized regionally and nationally for its intensive care unit and cardiology and orthopedic services. Other key specialty services include obstetrics, open-heart surgery, neurosurgery and trauma.
Olivia Ross, MBA, MPH
Senior Manager, Employers Centers of Excellence Network (ECEN), Pacific Business Group on Health, San Francisco, CA

    Speaker Bio

    Olivia Ross is Senior Manager of the Employers Centers of Excellence Network, a program developed by the Pacific Business Group on Health (PBGH) as part of their Paying for Value strategy. Olivia joined PBGH in 2012 after four years at the Northwestern University Institute for Healthcare Studies where she worked with the Chicago Pediatric Patient Safety Consortium to improve clinician communication and teamwork and with the Northwestern University Transplantation Outcomes Research Collaborative conducting health services research in organ transplantation.

    Olivia holds a Master of Public Health (MPH) degree from UCLA and an MBA from the Kellogg School of Management at Northwestern University.
    Presentation Material (Acrobat)
5:45 p.m. Adjournment and Networking Reception


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