AGENDA: DAY II
THURSDAY, APRIL 6, 2017
7:00 am
Registration Opens; Continental Breakfast in Exhibit Hall
MORNING PLENARY SESSION
8:00 am
Welcome and Introductions
Allyson Y. Schwartz
President and Chief Executive Officer, Better Medicare Alliance; Former Member, (D/PA), US House of Representatives, Washington, DC (Co chair)
President and Chief Executive Officer, Better Medicare Alliance; Former Member, (D/PA), US House of Representatives, Washington, DC (Co chair)
Allyson Y. Schwartz, President and CEO of the Better Medicare Alliance and a former member of the U.S. House of Representatives from Pennsylvania who served from 2005-2015, is a nationally recognized leader on health care issues. Better Medicare Alliance is the leading advocacy coalition supporting Medicare Advantage. Having worked as a health service executive, Schwartz was elected to the Pennsylvania State Senate in 1990, serving 14 years until her election to Congress. In the state Senate, Schwartz was the driving force behind Pennsylvania’s CHIP program, which was a model for the federal CHIP program five years later. In Congress, Schwartz was appointed to the Ways and Means Committee and served as a senior member of the Budget Committee. In both capacities, Schwartz was a strong advocate for Medicare. She was the leader in Congress on physician payment reform to encourage value over volume, supported research, innovation, and use of technology to improve quality, efficiency and contain costs. Schwartz is a Distinguished Policy Fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Visiting Fellow at the Penn Wharton Public Policy Initiative and Co-Chair of the Bipartisan Policy Center Health and Housing Task Force.
8:45 am
Keynote Address
Mark T. Bertolini
Chief Executive Officer, Aetna, Hartford, CT
Chief Executive Officer, Aetna, Hartford, CT
Mark T. Bertolini is Chairman and CEO of Aetna, a Fortune 50 diversified health care benefits company. He assumed the role of Chairman in 2011 and CEO in 2010. He also served as President from 2007 to 2014. Mr. Bertolini joined Aetna in 2003 as head of Aetna’s Specialty Products.
Before joining Aetna, Mr. Bertolini held executive positions at Cigna, NYLCare Health Plans, and SelectCare, Inc., where he was President and CEO. Mr. Bertolini also serves as a director of Verizon Communications Inc., Massachusetts Mutual Life Insurance Company, The Hole in the Wall Gang Camp, and the Fidelco Guide Dog Foundation.
Before joining Aetna, Mr. Bertolini held executive positions at Cigna, NYLCare Health Plans, and SelectCare, Inc., where he was President and CEO. Mr. Bertolini also serves as a director of Verizon Communications Inc., Massachusetts Mutual Life Insurance Company, The Hole in the Wall Gang Camp, and the Fidelco Guide Dog Foundation.
9:15 am
The Politics and Policy of Medicare Advantage under the new Administration and Congress
Kavita Patel, MD
Nonresident Senior Fellow, Brookings Institution, Member, Physician-Focused Payment, Model Technical Advisory Committee; Former Director of Policy, The White House; Former Senior Advisor, Senator Edward Kennedy, (D-MA), Washington, DC
Nonresident Senior Fellow, Brookings Institution, Member, Physician-Focused Payment, Model Technical Advisory Committee; Former Director of Policy, The White House; Former Senior Advisor, Senator Edward Kennedy, (D-MA), Washington, DC
Kavita Patel is the Associate Chief Medical Officer and Medicare Director at Johns Hopkins Medicine, Sibley Hospital, responsible for the oversight of primary care transformation and population health in the outpatient setting. She is also a nonresident Senior Fellow at the Brookings Institution. Previously, she was a Fellow and Managing Director of Delivery System Reform and Clinical Transformation at the Engelberg Center for Health Care Reform in the Department of Economic Studies at the Brookings Institution. At the Institution, Dr. Patel is specifically working on helping health care systems understand how to transform their clinical environments to become more accountable for the care they provide as well as other aspects of health reform implementation. Dr. Patel also serves on the GAO Appointed Physician-Focused Payment Model Technical Advisory Committee (PTAC) which is charged with developing alternative payment models for Medicare as a result of the bipartisan, bicameral Medicare and CHIP Reauthorization Act (MACRA) which aims to accelerate the movement to value-based care.
Thomas A. Scully, Esq.
General Partner, Welsh, Carson, Anderson & Stowe, Senior Counsel, Alston & Bird LLP; Former Administrator, Centers for Medicare and Medicaid Services; Former President and Chief Executive Officer, Federation of American Hospitals, Washington, DC
General Partner, Welsh, Carson, Anderson & Stowe, Senior Counsel, Alston & Bird LLP; Former Administrator, Centers for Medicare and Medicaid Services; Former President and Chief Executive Officer, Federation of American Hospitals, Washington, DC
Tom Scully is a General Partner with Welsh, Carson, Anderson & Stowe, a private equity firm in New York, which is the most active US PE investor in healthcare.
Previously, Mr. Scully was the Administrator of the Centers for Medicare & Medicaid Services (CMS). At CMS, Mr. Scully had an instrumental role in designing and passing Medicare reform and Medicare Part D legislation and in making the vast agency more open and accountable to the public. He initiated the first public reporting and disclosure for comparative quality among hospitals, nursing homes, home health agencies and dialysis centers. Before joining CMS, Tom served as President and CEO of the Federation of American Hospitals from 1995 to 2001. The FAH represents 1700 privately owned hospitals.
Previously, Mr. Scully was the Administrator of the Centers for Medicare & Medicaid Services (CMS). At CMS, Mr. Scully had an instrumental role in designing and passing Medicare reform and Medicare Part D legislation and in making the vast agency more open and accountable to the public. He initiated the first public reporting and disclosure for comparative quality among hospitals, nursing homes, home health agencies and dialysis centers. Before joining CMS, Tom served as President and CEO of the Federation of American Hospitals from 1995 to 2001. The FAH represents 1700 privately owned hospitals.
Susan Dentzer
President and Chief Executive Officer, The Network for Excellence in Health Innovation, Analyst on Health Policy, The News Hour, Washington, DC (Moderator)
President and Chief Executive Officer, The Network for Excellence in Health Innovation, Analyst on Health Policy, The News Hour, Washington, DC (Moderator)
Susan Dentzer is President and Chief Executive Officer of the Network for Excellence in Health Innovation, a not-for-profit think tank and membership organization whose more than 80 members span the spectrum of health and health care. Through its research, publications, and convenings, NEHI works to advance the health of the public, improve health care, and produce smarter health care spending for the nation.
One of the nation’s most respected health policy thought leaders, Dentzer was senior policy adviser to the Robert Wood Johnson Foundation and was editor-in-chief of the policy journal Health Affairs, and the on-air Health Correspondent for the PBS NewsHour.
Dentzer is an elected member of the National Academy of Medicine and serves on its Board on Population Health and Public Health Practice. She is an elected member of the Council on Foreign Relations; a fellow of the National Academy of Social Insurance; and a fellow of the Hastings Center, a bioethics institute.
One of the nation’s most respected health policy thought leaders, Dentzer was senior policy adviser to the Robert Wood Johnson Foundation and was editor-in-chief of the policy journal Health Affairs, and the on-air Health Correspondent for the PBS NewsHour.
Dentzer is an elected member of the National Academy of Medicine and serves on its Board on Population Health and Public Health Practice. She is an elected member of the Council on Foreign Relations; a fellow of the National Academy of Social Insurance; and a fellow of the Hastings Center, a bioethics institute.
10:00 am
Addressing Social Determinants of Health and Advancing Quality in Medicare Advantage
David Blumenthal, MD, MPP
President, The Commonwealth Fund; Former National Coordinator for Health Information Technology; Former Chief Health Information and Innovation Officer, Partners Healthcare System, Washington, DC
President, The Commonwealth Fund; Former National Coordinator for Health Information Technology; Former Chief Health Information and Innovation Officer, Partners Healthcare System, Washington, DC
David Blumenthal, M.D., M.P.P., is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues.
Dr. Blumenthal is formerly the Samuel O. Thier Professor of Medicine at Harvard Medical School and Chief Health Information and Innovation Officer at Partners Healthcare System in Boston. From 2009 to 2011, he served as the National Coordinator for Health Information Technology, with the charge to build an interoperable, private, and secure nationwide health information system and to support the widespread, meaningful use of health IT. He succeeded in putting in place one of the largest publicly funded infrastructure investments the nation has ever made in such a short time period, in health care or any other field.
Dr. Blumenthal is formerly the Samuel O. Thier Professor of Medicine at Harvard Medical School and Chief Health Information and Innovation Officer at Partners Healthcare System in Boston. From 2009 to 2011, he served as the National Coordinator for Health Information Technology, with the charge to build an interoperable, private, and secure nationwide health information system and to support the widespread, meaningful use of health IT. He succeeded in putting in place one of the largest publicly funded infrastructure investments the nation has ever made in such a short time period, in health care or any other field.
Richard J. Bringewatt
Co-founder and President, National Health Policy Group, Co-founder and Chair, SNP Alliance; Co-founder and Former President and Chief Executive Officer, National Chronic Care Consortium, Washington, DC
Co-founder and President, National Health Policy Group, Co-founder and Chair, SNP Alliance; Co-founder and Former President and Chief Executive Officer, National Chronic Care Consortium, Washington, DC
Mr. Bringewatt is Co-founder and President of the National Health Policy Group (NHPG) and Co-founder and President of the SNP Alliance. The SNP Alliance provides national leadership and advocacy for advancing integration and specialty care for high-risk/high-need beneficiaries through Special Needs Plans (SNPs) and Medicare-Medicaid Plans (MMPs). Prior to his current leadership positions, Mr. Bringewatt co-founded and served as President and CEO of the National Chronic Care Consortium (NCCC), a strategic alliance of leading acute and long-term care systems seeking to advance improvements in care for persons with severe or disabling chronic conditions as their conditions evolve over time and across care settings. Functioning as a policy entrepreneur and catalyst for change, Mr. Bringewatt works with other national leaders and groups to transform payment, policy and oversight practices to better serve poor, frail, disabled and chronically ill persons.
Peggy O’Kane
President, National Committee for Quality Assurance, Washington, DC
President, National Committee for Quality Assurance, Washington, DC
Margaret E. O’Kane is the founder and president of the National Committee for Quality Assurance (NCQA).
She was elected a member of the Institute of Medicine in 1999 and received the 2009 Picker Institute Individual Award for Excellence in the Advancement of Patient-Centered Care. Modern Healthcare magazine has named O’Kane one of the “100 Most Influential People in Healthcare” eleven times, most recently in 2016, and one of the “Top 25 Women in Healthcare” three times. She received the 2012 Gail L. Warden Leadership Excellence Award from the National Center for Healthcare Leadership.
She was elected a member of the Institute of Medicine in 1999 and received the 2009 Picker Institute Individual Award for Excellence in the Advancement of Patient-Centered Care. Modern Healthcare magazine has named O’Kane one of the “100 Most Influential People in Healthcare” eleven times, most recently in 2016, and one of the “Top 25 Women in Healthcare” three times. She received the 2012 Gail L. Warden Leadership Excellence Award from the National Center for Healthcare Leadership.
10:45 am
Break
AFTERNOON MINI SUMMITS GROUP I: 11:15 am – 12:15 pm
PLAN TRACK: Mini Summit 1: The Medicare Advantage Value-Based Insurance Design (VBID) Pilot Program
11:15 am
Introductions, Panel Discussion and Q&A
A. Mark Fendrick, MD
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management, Policy Director, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management, Policy Director, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI
Mark Fendrick, M.D. is a Professor of Internal Medicine and a Professor of Health Management and Policy at the University of Michigan.
Dr. Fendrick conceptualized and coined the term Value-Based Insurance Design (V-BID) and currently directs the V-BID Center at the University of Michigan [www.vbidcenter.org], the leading advocate for development, implementation, and evaluation of innovative health benefit plans. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care, health care disparities, and health care costs.
Dr. Fendrick is an elected member of National Academy of Medicine (formerly IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, the U.S. House of Representatives Ways and Means Subcommittee on Health, and the U.S. Senate Committee on Armed Services Subcommittee on Personnel. Dr. Fendrick is the co-editor in chief of the American Journal of Managed Care.
Dr. Fendrick conceptualized and coined the term Value-Based Insurance Design (V-BID) and currently directs the V-BID Center at the University of Michigan [www.vbidcenter.org], the leading advocate for development, implementation, and evaluation of innovative health benefit plans. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care, health care disparities, and health care costs.
Dr. Fendrick is an elected member of National Academy of Medicine (formerly IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, the U.S. House of Representatives Ways and Means Subcommittee on Health, and the U.S. Senate Committee on Armed Services Subcommittee on Personnel. Dr. Fendrick is the co-editor in chief of the American Journal of Managed Care.
Jonathan Harding, MD
Chief Medical Officer, Senior Products, Tufts Health Plan, Boston, MA
Chief Medical Officer, Senior Products, Tufts Health Plan, Boston, MA
Dr. Harding is currently the Senior Medical Director for Senior Products, overseeing Quality, Utilization, Pharmacy, Medical Trend, and Network relationships for a population of over 125,000 Medicare and Retiree members at Tufts Health Plan in Massachusetts. Previously, he was Vice President for Health Services at Touchstone Health Partnership, a Medicare IPA/PSO in New York. Prior to that he was Chief Medical Officer of the Fallon Clinic in Worcester, MA, a multi-specialty globally capitated group practice with over 300 practitioners, and held several different positions at FHP in California, a multi-faceted health care company with HMO, medical group, and hospital businesses. He also continues his role as a physician reviewer for the National Committee on Quality Assurance (NCQA), reviewing Health Plans, Disease Management companies, Special Needs Plans, and Medical practices. He is a Certified Content Expert in Patient Centered Medical Home. He brings over 25 years of experience in medical management.
Stephen Z. Jenkins, MPP
Lead, Medicare Advantage Value-Based Insurance Design Model, Centers for Medicare and Medicaid Services, Alexandria, VA
Lead, Medicare Advantage Value-Based Insurance Design Model, Centers for Medicare and Medicaid Services, Alexandria, VA
Stephen Jenkins is the Medicare Advantage Value-Based Insurance Design (VBID) Model Lead for the Center for Medicare and Medicaid Innovation (CMMI). Prior to working on VBID, he served as the Model Lead of the ACO Investment Model and the Advance Payment Model. Before joining CMMI, he spent time working on health policy for the United States Senate – Finance Committee. He received his M.P.P. from the Harvard Kennedy School and his bachelors from the University of Michigan.
Helene Weinraub, MPH
Vice President, UPMC Health Plan, President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Vice President, UPMC Health Plan, President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Ms. Weinraub oversees the overall performance, strategic direction, and program development for UPMC Health Plan’s Medicare products. Prior to joining UPMC, she led a national consulting firm, W Squared Health, specializing in Medicare Advantage and Dual products.
Previously, Ms. Weinraub has taught strategic management at the University of Pittsburgh and held senior leadership positions at Highmark Blue Cross Blue Shield and Metropolitan Jewish Geriatric Health System in Brooklyn, NY. She has also served on the Governor’s Intergovernmental Council on Long Term Care.
Previously, Ms. Weinraub has taught strategic management at the University of Pittsburgh and held senior leadership positions at Highmark Blue Cross Blue Shield and Metropolitan Jewish Geriatric Health System in Brooklyn, NY. She has also served on the Governor’s Intergovernmental Council on Long Term Care.
PLAN TRACK: Mini Summit 2: Ongoing Development of the Encounter Data System for Risk-Adjustment Purposes in Medicare Advantage
11:15 am
Introductions, Panel Discussion and Q&A
Lynn F. Dong, FSA, MAAA
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA
Lynn Dong, FSA, MAAA, Principal and Consulting Actuary has over 20 years of healthcare actuarial experience and consults extensively with provider organizations and commercial and Medicare health plans. She has significant experience in evaluating risk-based contacts and alternative payment models for provider organizations. Lynn serves on Milliman’s Health Research Board and is deeply involved in the research and development of multiple components of Milliman’s Health Cost Guidelines.
Professional Designations
–Fellow, Society of Actuaries
–Member, American Academy of Actuaries
Education
–BS, Mathematics, University of Washington
–BA, Japan Studies, University of Washington
Current Responsibility
— Lynn is a principal and consulting actuary with the Seattle office of Milliman. She joined the firm in 1994.
Professional Designations
–Fellow, Society of Actuaries
–Member, American Academy of Actuaries
Education
–BS, Mathematics, University of Washington
–BA, Japan Studies, University of Washington
Current Responsibility
— Lynn is a principal and consulting actuary with the Seattle office of Milliman. She joined the firm in 1994.
Arati Swadi, MBA
Senior Director, Risk Adjustment Products, Inovalon, Bowie, MD
Senior Director, Risk Adjustment Products, Inovalon, Bowie, MD
My current title: Senior Director Risk Adjustment Product Execution
Experience at Inovalon – 9 years
Medicare Advantage Related Experience: As part of Product development and execution at Inovalon, I actively work on reading and understanding the policy changes announced by CMS as it relates to Risk adjustment. Based on the active reading and understanding, I work internally to implement the changes so that our system mimic the CMS Risk adjustment model and our products comply with CMS guidance. I have been involved with EDs transition right from its inception and am currently working Avalere and RISE group to understand the impact (risk score and financial) through the RAPs to EDs transition.
I have been part of various conferences and risk adjustment forums , and have actively been a speaker in several webinars and in conferences talking about the policy changes for Medicare Advantage and its impact on the industry.
Experience at Inovalon – 9 years
Medicare Advantage Related Experience: As part of Product development and execution at Inovalon, I actively work on reading and understanding the policy changes announced by CMS as it relates to Risk adjustment. Based on the active reading and understanding, I work internally to implement the changes so that our system mimic the CMS Risk adjustment model and our products comply with CMS guidance. I have been involved with EDs transition right from its inception and am currently working Avalere and RISE group to understand the impact (risk score and financial) through the RAPs to EDs transition.
I have been part of various conferences and risk adjustment forums , and have actively been a speaker in several webinars and in conferences talking about the policy changes for Medicare Advantage and its impact on the industry.
Stephen Wood, MPP
Managing Partner, Clear View Solutions; Former Senior Vice President, Universal American; Former Senior Vice President and Managing Principal, OptumInsight, Chicago, IL
Managing Partner, Clear View Solutions; Former Senior Vice President, Universal American; Former Senior Vice President and Managing Principal, OptumInsight, Chicago, IL
Stephen Wood is a co-founder and Partner at Clear View Solutions, LLC. He is a nationally recognized leader in managed care, Medicare and Medicaid, Accountable Care and strategic consulting to the health insurance industry.
Mr. Wood works with organizations to respond to changing market conditions, evaluating high risk populations such as dually eligible Medicare and Medicaid beneficiaries, design and implement care management approaches as well as offering the full continuum of management services organization capabilities. Previously Mr. Wood was a Senior Vice President at Universal American Corporation as well as Senior Vice President and Partner at Optum Insight where he led the Government Programs Management and Strategy practice.
Mr. Wood works with organizations to respond to changing market conditions, evaluating high risk populations such as dually eligible Medicare and Medicaid beneficiaries, design and implement care management approaches as well as offering the full continuum of management services organization capabilities. Previously Mr. Wood was a Senior Vice President at Universal American Corporation as well as Senior Vice President and Partner at Optum Insight where he led the Government Programs Management and Strategy practice.
James Gutman
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
James Gutman was Vice President and Managing Editor of Atlantic Information Services, Inc. (formerly Executive Editor) from 2001 until his retirement in April 2016. While there he wrote and edited Medicare Advantage News, a biweekly subscription newsletter that’s the dominant publication in its field. He also oversaw Health Reform Week after successfully launching that subscription newsletter until 2014.
SPECIAL ISSUES TRACK: Mini Summit 3: Update on CMS’s RADV Program, RAC Contracting, and Medicare Advantage Program Audit Trends
11:15 am
Introductions, Panel Discussion and Q&A
Michael S. Adelberg
Senior Director, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, Washington, DC
Senior Director, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, Washington, DC
Mike Adelberg has more than 20 years of progressive experience with Medicare, Medicaid and the Health Insurance Exchanges. Before joining Faegre Baker Daniels, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO) where he developed and implemented Affordable Care Act policy. Prior to that, Mike was the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage contracts and led monitoring of Medicare Advantage contractors. His other senior roles at CMS included serving as the associate regional administrator for Medicare operations (Chicago Region) where he oversaw 30 Medicare +Choice contracts. Mike gained private sector experience while serving as vice president of product development and government affairs with a medium-sized Medicare Advantage Organization.
Thomas E. Hutchinson, MPA
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, Baltimore, MD
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, Baltimore, MD
Thomas E. Hutchinson is a Strategic Advisor for EBG Advisors, Inc. He has more than 25 years of experience in both the private sector and in federal service implementing programs and policies directly affecting Medicare and Medicaid beneficiaries. Mr. Hutchinson advises clients on a wide range of payment policy and operations issues relating to the Centers for Medicare and Medicaid Services (CMS).
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership.
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership.
12:15 pm
Networking Luncheon with Presentations
12:30 pm
2018 Final Rate Notice and Changes to Come
Jane Gilbert
Director of Retiree Health, Kentucky Retired Teachers Association, Louisville, KY
Director of Retiree Health, Kentucky Retired Teachers Association, Louisville, KY
Jane Gilbert is the Director of Retiree Health Care for the Teachers’ Retirement System of the State of Kentucky (TRS) and has served TRS retirees since April 2002. She manages two retiree health plans covering 46,000 retirees. She also serves as a leader in the areas of health insurance cost containment, project management, risk management and federal health care solutions.
Ms. Gilbert served in management and directorship positions for a Louisville Kentucky law firm and cost containment company, The Rawlings Company, from 1989 through 2002. Prior to serving at The Rawlings Company, she worked as an accountant for a national CPA firm.
Ms. Gilbert graduated with honors from Bellarmine University in Louisville, Kentucky, with a Bachelor of Arts in Accounting in 1987 and became a CPA in 1992. Ms. Gilbert currently serves on the Retiree Membership Committee for the State and Local Government Benefits Association and is a proud member of the Public Sector Healthcare Roundtable.
Ms. Gilbert served in management and directorship positions for a Louisville Kentucky law firm and cost containment company, The Rawlings Company, from 1989 through 2002. Prior to serving at The Rawlings Company, she worked as an accountant for a national CPA firm.
Ms. Gilbert graduated with honors from Bellarmine University in Louisville, Kentucky, with a Bachelor of Arts in Accounting in 1987 and became a CPA in 1992. Ms. Gilbert currently serves on the Retiree Membership Committee for the State and Local Government Benefits Association and is a proud member of the Public Sector Healthcare Roundtable.
Thomas E. Hutchinson, MPA
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, Baltimore, MD
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, Baltimore, MD
Thomas E. Hutchinson is a Strategic Advisor for EBG Advisors, Inc. He has more than 25 years of experience in both the private sector and in federal service implementing programs and policies directly affecting Medicare and Medicaid beneficiaries. Mr. Hutchinson advises clients on a wide range of payment policy and operations issues relating to the Centers for Medicare and Medicaid Services (CMS).
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership.
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership.
Mark Newsom, MSc
Vice President, Public Policy Analysis, Humana; Former Director Public Policy, CVS Health; Former Director, Division of Payment Reconciliation, Centers for Medicare and Medicaid Services; Former Specialist in Health Financing, Congressional Research Service, Washington, DC
Vice President, Public Policy Analysis, Humana; Former Director Public Policy, CVS Health; Former Director, Division of Payment Reconciliation, Centers for Medicare and Medicaid Services; Former Specialist in Health Financing, Congressional Research Service, Washington, DC
Mark Newsom has 20 years of experience focusing on the intersection of health policy and business. He currently serves as Vice President of Public Policy Analysis at Humana, where he advises senior business executives on the policy environment and leads analysis of CMS regulations and guidance. Mark joined Humana in July 2015, after serving as a Director of Public Policy at CVS Health, where he focused on the pharmacy benefit manager (PBM) subsidiary and the Business Development /Merger and Acquisition team. Prior to CVS Health, Mark spent nearly 6 years at CMS, developing Medicare Advantage (MA) and Part D payment policies and operations. Mark also served two years as a senior policy analyst at the Congressional Research Service (CRS) and as Director of Medicare Policy and Compliance at Coventry.
Stacy Sanders, MSW
Federal Policy Director, Medicare Rights Center, Former Director, National Neighbors Silver at the National Community Reinvestment Coalition, Former Director, Elder Economic Security Initiative, Wider Opportunities for Women, Washington, DC
Federal Policy Director, Medicare Rights Center, Former Director, National Neighbors Silver at the National Community Reinvestment Coalition, Former Director, Elder Economic Security Initiative, Wider Opportunities for Women, Washington, DC
Stacy Sanders was formerly Director of National Neighbors Silver at the National Community Reinvestment Coalition (NCRC). Prior to joining NCRC, she was Director of the Elder Economic Security Initiative (Elder Initiative) at Wider Opportunities for Women (WOW), where she worked with state- and community-based organizations across the country to promote the use of an economic security framework and tools in senior programs and policies. She has also served as a National Advisory Panel member on the Social Work Leadership Institute’s Hartford Partnership Program for Aging Education.
Sanders has a master’s degree in social work from the University of Michigan and is the recipient of a McGregor Geriatric Fellowship award. She is also a member of the National Academy of Social Insurance and serves on the National Commission for Quality Assurance (NCQA) Consumer Advisory Board and the National Council on Aging (NCOA) Center for Benefits Access Advisory Board.
Sanders has a master’s degree in social work from the University of Michigan and is the recipient of a McGregor Geriatric Fellowship award. She is also a member of the National Academy of Social Insurance and serves on the National Commission for Quality Assurance (NCQA) Consumer Advisory Board and the National Council on Aging (NCOA) Center for Benefits Access Advisory Board.
Molly T. Turco, MPH
Director, Policy and Research, Better Medicare Alliance, Washington, DC (Moderator)
Director, Policy and Research, Better Medicare Alliance, Washington, DC (Moderator)
AFTERNOON MINI SUMMITS GROUP II: 1:30 pm – 2:30 pm
PATIENT ENGAGEMENT TRACK: Mini Summit 4: How Medicare Advantage Plans can Improve the Lives of Low Income Beneficiaries
1:30 pm
Introductions, Panel Discussion and Q&A
Margaret A. Murray, MPA
Founding Chief Executive Officer, Association for Community Affiliated Plans; Former Medicaid Director, State of New Jersey, Washington, DC
Founding Chief Executive Officer, Association for Community Affiliated Plans; Former Medicaid Director, State of New Jersey, Washington, DC
Margaret A. Murray is the founding CEO of the Association for Community Affiliated Plans (ACAP). She has led the organization since its inception in 2001, steering it through tremendous growth from its origins as an Association of 14 community health center-owned plans to 59 Safety Net Health Plans across the nation, covering more than 17 million people through Medicaid, Medicare and Marketplaces.
Prior to leading ACAP, Ms. Murray was the Medicaid Director for the State of New Jersey and oversaw the expansion of the FamilyCare program to cover all children under 350% of poverty. She was also a senior budget analyst for the U.S. Office of Management and Budget, with responsibility for negotiating the budget neutrality agreements for Medicaid managed care waivers.
Prior to leading ACAP, Ms. Murray was the Medicaid Director for the State of New Jersey and oversaw the expansion of the FamilyCare program to cover all children under 350% of poverty. She was also a senior budget analyst for the U.S. Office of Management and Budget, with responsibility for negotiating the budget neutrality agreements for Medicaid managed care waivers.
Seemin Pasha
Vice President, External Affairs, Alliance of Community Health Plans; Former Director of Policy and Communications, Families USA; Former Director, Public Outreach and Policy for the Institute, OneWorld Health, Washington, DC
Vice President, External Affairs, Alliance of Community Health Plans; Former Director of Policy and Communications, Families USA; Former Director, Public Outreach and Policy for the Institute, OneWorld Health, Washington, DC
Seemin Pasha has more than 15 years’ experience developing legislative and regulatory strategies to influence health care policy. As Vice President of External Affairs, Seemin directs national advocacy strategy for the Alliance of Community Health Plans, and oversees communications, policy and lobbying efforts. Prior to ACHP, Seemin managed advocacy efforts around prescription drug policy and health care delivery issues at The Pew Charitable Trusts. Her background includes policy development and legislative and regulatory lobbying on the Affordable Care Act, Physician Payments Sunshine Act, Medicare Parts B, C and D and issues related to payment alignment and care coordination between Medicaid and Medicare.
Ghita Worcester
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Ghita Worcester brings more than 40 years of health care management experience to her role as Senior Vice President, Public Affairs and Chief Marketing Officer. She provides strategic direction for marketing, business development and strategy, public relations, legislative, regulatory, government programs, and community outreach activities. She oversees the organization’s federal and state health care reform efforts and policy formulation related to national and state health policy issues. Ghita is also instrumental in the development and implementation of UCare’s strategic and operational plans. Before joining UCare, Worcester served as Director of Policy and Operations for Minneapolis-based University Affiliated Family Physicians (UAFP), the management company that started UCare in 1984
SPECIAL ISSUES TRACK: Mini Summit 5: Medicare Advantage Provider Network Adequacy
1:30 pm
Introductions, Panel Discussion and Q&A
Michael S. Adelberg
Senior Director, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, Washington, DC
Senior Director, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, Washington, DC
Mike Adelberg has more than 20 years of progressive experience with Medicare, Medicaid and the Health Insurance Exchanges. Before joining Faegre Baker Daniels, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO) where he developed and implemented Affordable Care Act policy. Prior to that, Mike was the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage contracts and led monitoring of Medicare Advantage contractors. His other senior roles at CMS included serving as the associate regional administrator for Medicare operations (Chicago Region) where he oversaw 30 Medicare +Choice contracts. Mike gained private sector experience while serving as vice president of product development and government affairs with a medium-sized Medicare Advantage Organization.
Helaine I. Fingold, Esq.
Senior Counsel, Health Care and Life Sciences Practice, Epstein Becker Green; Former Team Lead on MA Applications and Contracts; Former Senior Technical/Policy Lead, Division of Plan Manage- ment, and Acting Director, Rates & Benefits Branch, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Baltimore, MD
Senior Counsel, Health Care and Life Sciences Practice, Epstein Becker Green; Former Team Lead on MA Applications and Contracts; Former Senior Technical/Policy Lead, Division of Plan Manage- ment, and Acting Director, Rates & Benefits Branch, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Baltimore, MD
Helaine Fingold is a Senior Counsel in the Health Care and Life Sciences practice, in the Baltimore office of Epstein Becker Green. She has more than 20 years of broad health law and regulatory experience, including prior government experience in both the legislative and executive branches of the federal government.
Prior to rejoining the firm, Ms. Fingold worked at the Center for Medicare & Medicaid Services’ (“CMS’s”) Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group. As both a Senior Technical/Policy Lead and as the Acting Director, Rates & Benefits Branch, Division of Plan Management, Ms. Fingold was responsible for defining and interpreting requirements relating to the qualification of qualified health plans and stand-alone dental plans in both state and federally-facilitated exchanges, oversight of these plans, essential health benefits, and market-wide cost sharing limitations.
Prior to rejoining the firm, Ms. Fingold worked at the Center for Medicare & Medicaid Services’ (“CMS’s”) Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group. As both a Senior Technical/Policy Lead and as the Acting Director, Rates & Benefits Branch, Division of Plan Management, Ms. Fingold was responsible for defining and interpreting requirements relating to the qualification of qualified health plans and stand-alone dental plans in both state and federally-facilitated exchanges, oversight of these plans, essential health benefits, and market-wide cost sharing limitations.
Michelle K. Strollo, DrPH, MHS
Vice President, Health Care Department, NORC; Former Director, Eligibility and Enrollment, Policy and Operations Division, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Vice President, Health Care Department, NORC; Former Director, Eligibility and Enrollment, Policy and Operations Division, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Washington, DC
Michelle Kitchman Strollo, DrPH, MHS is Vice President and Associate Director of NORC’s Health Care Department with two decades of experience in policymaking and analysis, program development, administration, and evaluation. She leads and advises a number of projects related to public and private insurance including the CMS Medicare-Medicaid Coordination Office’s Financial Alignment Initiative – a demonstration to test new approaches to providing integrated service delivery and payment models for individuals enrolled in both Medicare and Medicaid. She also co-directs the CMS Nationwide Adult Medicaid CAHPS survey – the first-of-its kind national patient experience survey of adults in both the Medicaid fee-for-service and managed care delivery systems. Strollo oversees NORC’s work on Marketplace projects for CCIIO including developing a monitoring strategy for use of federal, state, and commercial data to facilitate Marketplace and Medicaid eligibility determinations.
James Gutman
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
James Gutman was Vice President and Managing Editor of Atlantic Information Services, Inc. (formerly Executive Editor) from 2001 until his retirement in April 2016. While there he wrote and edited Medicare Advantage News, a biweekly subscription newsletter that’s the dominant publication in its field. He also oversaw Health Reform Week after successfully launching that subscription newsletter until 2014.
POLICY TRACK: Mini Summit 6: Medicare Advantage Star-Rating Changes
1:30 pm
Introductions, Panel Discussion and Q&A
Joyce Chan
Vice President, Population Health Strategy, Healthfirst, New York, NY
Vice President, Population Health Strategy, Healthfirst, New York, NY
Joyce Chan is the Vice President of Population Health Strategy at Healthfirst, a not-for-profit managed care organization sponsored by major New York not-for-profit and public health care systems. She oversees performance on Quality Ratings across Medicare, Medicaid, Managed Long Term Care, and Exchange products and uses analytics, reporting, and provider incentives to ensure that Healthfirst members receive the best possible quality and experience of care. Prior to joining Healthfirst, Ms. Chan was a consultant in the Global Health Practice at Booz & Company, where she advised providers, payers, and pharmaceutical companies on strategy and operations. With a deep interest in reducing health disparities, she is an active contributor to industry workgroups and speaks regularly with policymakers and regulatory agencies on this topic.
Doug Fulton
Vice President, Government Quality, Highmark, Inc.
Vice President, Government Quality, Highmark, Inc.
Jonathan Harding, MD
Chief Medical Officer, Senior Products, Tufts Health Plan, Boston, MA
Chief Medical Officer, Senior Products, Tufts Health Plan, Boston, MA
Dr. Harding is currently the Senior Medical Director for Senior Products, overseeing Quality, Utilization, Pharmacy, Medical Trend, and Network relationships for a population of over 125,000 Medicare and Retiree members at Tufts Health Plan in Massachusetts. Previously, he was Vice President for Health Services at Touchstone Health Partnership, a Medicare IPA/PSO in New York. Prior to that he was Chief Medical Officer of the Fallon Clinic in Worcester, MA, a multi-specialty globally capitated group practice with over 300 practitioners, and held several different positions at FHP in California, a multi-faceted health care company with HMO, medical group, and hospital businesses. He also continues his role as a physician reviewer for the National Committee on Quality Assurance (NCQA), reviewing Health Plans, Disease Management companies, Special Needs Plans, and Medical practices. He is a Certified Content Expert in Patient Centered Medical Home. He brings over 25 years of experience in medical management.
John Gorman
Founder and Executive Chairman, Gorman Health Group; Former Assistant to the Director, Office of Managed Care, HCFA; Former Press Secretary and Staff Director, US Representative John Conyers, Jr. (D-MI), Washington, DC (Moderator)
Founder and Executive Chairman, Gorman Health Group; Former Assistant to the Director, Office of Managed Care, HCFA; Former Press Secretary and Staff Director, US Representative John Conyers, Jr. (D-MI), Washington, DC (Moderator)
John Gorman is Founder and Executive Chairman at Gorman Health Group (GHG). In this role, he has led the development and launch of several entrepreneurial ventures in both software and business process outsourcing in government health programs. John’s work focuses on government health programs strategy, cultural transformation within health care companies, governance,and turnaround of distressed health plans. John brings GHG clients more than 25 years of experience in government-sponsored health program strategy, compliance and operations.
Prior to founding his own company in 1996, John served as Assistant to the Director of Health Care Financing Administration’s (HCFA) Office of Managed Care, where he provided day-to-day management, and served as the external liaison for the Medicare and Medicaid managed care programs.
Prior to founding his own company in 1996, John served as Assistant to the Director of Health Care Financing Administration’s (HCFA) Office of Managed Care, where he provided day-to-day management, and served as the external liaison for the Medicare and Medicaid managed care programs.
PROVIDER TRACK: Mini Summit 7: Joint Payor-Provider Panel on Shared Savings and Navigating Value-Based Purchasing Agreements
1:30 pm
Introductions, Panel Discussion and Q&A
Steven Blumberg, MBA
President, Omega Health Strategies, Inc.; Former Senior Vice President and Executive Director, Geisinger Health System, AtlantiCare Division; Former Vice President, Planning and Business Development, Shands Healthcare, Egg Harbor Township, NJ
President, Omega Health Strategies, Inc.; Former Senior Vice President and Executive Director, Geisinger Health System, AtlantiCare Division; Former Vice President, Planning and Business Development, Shands Healthcare, Egg Harbor Township, NJ
Steven Blumberg is currently leading Omega Health Strategies, focused on bringing value based models of care to the marketplace. He is also providing interim leadership at UF Health’s Jacksonville organization. Previously, he served as the Senior Vice President and Executive Director of AtlantiCare Health Solutions, a part of the Geisinger organization. At AtlantiCare, Steve developed a highly successful population health model including program development and delivery. Steve was also responsible for the 350 provider group practice at AtlantiCare as well as the organization’s continuum care services. Steve’ leadership experience includes strategic planning, business development, M&A, joint ventures, risk model development and operational integration. Prior to joining AtlantiCare, Steve was vice president for Planning and Business Development at UF Health – Shands Healthcare at the University of Florida. Prior to UF Health, Steve held several leadership roles at Baptist Health in Jacksonville including vice president for Planning and Marketing and vice president for the Baptist Physician Group. He earned his Bachelor of Science degree at the University of Florida and his Master of Business Administration degree at Florida State University.
Robb Cohen, MBA
Vice President, Government Affairs, PopHealthCare (www.pophealthcare.com); Former Chief Executive Officer, Advanced Health Collaborative, Former Chief Government Affairs Officer, XLHealth, Baltimore, MD
Vice President, Government Affairs, PopHealthCare (www.pophealthcare.com); Former Chief Executive Officer, Advanced Health Collaborative, Former Chief Government Affairs Officer, XLHealth, Baltimore, MD
Robb Cohen was a Co-Founder and Senior Executive of XLHealth, which was founded as a diabetes disease management company, became the nation’s leading Medicare Advantage Chronic Special Needs Plan, and was acquired by United Healthcare. Robb is the former / founding CEO of Advanced Health Collaborative, a network that includes 7 health systems with 10 hospitals. Robb has payer, provider, investment banking and consulting experience. Robb has an MBA from The Wharton School, and is now active with family, investments, and many not-for-profits. He is married and has two teenage daughters, and can be reached at 410 967 2526, or robbcohen@comcast.net.
Chip Howard
Market Vice President and Payment Innovation Leader, Humana; Former Director, Accountable Care Organizations, WellPoint; Former Director, Provider Contracting Performance and Cost Analytics, Kaiser Permanente, Louisville, KY
Market Vice President and Payment Innovation Leader, Humana; Former Director, Accountable Care Organizations, WellPoint; Former Director, Provider Contracting Performance and Cost Analytics, Kaiser Permanente, Louisville, KY
Chip Howard joined Humana Inc. as Vice President, Payment Innovation in the Provider Development Center of Excellence in September 2014. He is responsible for advancing Humana’s Accountable Care Continuum, expanding its Provider Reward Programs and innovative payment models and programs that enable providers to become successful population health managers.
Chip has close to 20 years of healthcare and actuarial experience. Prior to joining Humana, he served as Director of Accountable Care Organizations for Wellpoint, Inc. and was the Director of Value-based Program Reimbursement with Florida Blue where he worked on all facets of development and implementation of commercial Accountable Care and Patient-Centered Medical Home programs. Chip has also served in a variety of contracting and analytics management roles with WellPoint and Kaiser Permanente. In addition, Chip’s experience at the Blues, Coventry Health Care, Cigna and William M. Mercer, Inc. includes various pricing, reserving and contracting analytics roles.
Chip has close to 20 years of healthcare and actuarial experience. Prior to joining Humana, he served as Director of Accountable Care Organizations for Wellpoint, Inc. and was the Director of Value-based Program Reimbursement with Florida Blue where he worked on all facets of development and implementation of commercial Accountable Care and Patient-Centered Medical Home programs. Chip has also served in a variety of contracting and analytics management roles with WellPoint and Kaiser Permanente. In addition, Chip’s experience at the Blues, Coventry Health Care, Cigna and William M. Mercer, Inc. includes various pricing, reserving and contracting analytics roles.
Luis Rivera
AVP Managed Care, Northwell Health, New Hyde Park, NY
AVP Managed Care, Northwell Health, New Hyde Park, NY
Donald H. Crane, JD
President and Chief Executive Officer, CAPG, Los Angeles, CA (Moderator)
President and Chief Executive Officer, CAPG, Los Angeles, CA (Moderator)
Don Crane is the President and CEO of CAPG, a national professional association composed of physician groups dedicated to coordinated, accountable care. It is the nation’s largest trade association that explicitly promotes capitation as the payment model for its members, all of whom accept various forms of risk-based capitation or other population-based payment. These groups are in the forefront of national healthcare reform and represent the care model and payment methodologies adopted by federal legislation for the entire nation.
Mr. Crane joined CAPG in 2001 and has served as President and CEO since that time. During his tenure CAPG has expanded from being a division of a regional hospital trade association consisting of 40 member groups to a national professional association consisting of more than 250 physician organizations.
Mr. Crane serves on the Board of Directors of the National Coalition on Health Care. He is also the Editor-in-Chief of CAPG Health, a magazine that reports on business trends, legislation, and industry initiatives impacting coordinated care.
Mr. Crane received his B.A. from the University of California at Berkeley and his J.D. from Loyola University of Los Angeles.
Mr. Crane joined CAPG in 2001 and has served as President and CEO since that time. During his tenure CAPG has expanded from being a division of a regional hospital trade association consisting of 40 member groups to a national professional association consisting of more than 250 physician organizations.
Mr. Crane serves on the Board of Directors of the National Coalition on Health Care. He is also the Editor-in-Chief of CAPG Health, a magazine that reports on business trends, legislation, and industry initiatives impacting coordinated care.
Mr. Crane received his B.A. from the University of California at Berkeley and his J.D. from Loyola University of Los Angeles.
2:30 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP III: 2:45 pm – 3:45 pm
PROVIDER TRACK: Mini Summit 8: Making Medicare Advantage Work: CAPG Compendium of Alternative Payment Models: 14 Case Studies on how Physician Organization are Paid in Medicare, Medicaid and Commercial and How those Groups then Pay Individual Physicians Downstream
2:45 pm
Introductions, Panel Discussion and Q&A
Scott W. Disch, MPH
National Practice Leader, Privia Health, Arlington, VA
National Practice Leader, Privia Health, Arlington, VA
Scott Disch’s work in partnering with physicians encompasses an understanding of how to optimize practice workflow, coordinate and leverage group buying power, and create long-lasting relationships through transparency, communication, shared decision-making and prompt issue resolution through execution. He focuses on building healthcare networks that improve our communities’ health through robust referral systems, accountability for the patient-centered medical home philosophy, and elevating staff performance and education to allow physicians to maximize their medical license and gain efficiency.
Prior to Privia, Scott worked for Vanguard Health Systems in their New England market, Catholic Health East in South Florida, and an independent healthcare system, St. Francis Hospital, in Columbus, Georgia. Within each of these organizations, Scott was responsible for medical group development, strategic planning, and physician partnerships.
Prior to Privia, Scott worked for Vanguard Health Systems in their New England market, Catholic Health East in South Florida, and an independent healthcare system, St. Francis Hospital, in Columbus, Georgia. Within each of these organizations, Scott was responsible for medical group development, strategic planning, and physician partnerships.
Mara McDermott
Vice President of Federal Affairs, CAPG, Washington, DC
Vice President of Federal Affairs, CAPG, Washington, DC
Mara McDermott serves as the Vice President of Federal Affairs for CAPG, heading up the association’s federal legislative and regulatory activities in Washington, DC. Mara works on behalf of CAPG member organizations to advance policies that promote coordinated care. This role includes advocacy and education efforts with members of Congress and their staffs, the Administration, and other health policy stakeholders. Prior to joining CAPG, Mara was Counsel in the health industry practice at Akin Gump Strauss Hauer & Feld. In this role, she focused on a variety of issues affecting health industry clients, with a particular emphasis on health policy and regulatory issues facing physician organizations, hospitals, pharmaceutical companies, and academic medical institutions. Mara received her JD with high honors from George Washington University School of Law and her MPH from George Washington University. She received her BA from the University of California, Davis.
Matt Poffenroth, MD, MBA
INOVA, Chief Executive Officer & Chief Medical Officer, Falls Church, VA
INOVA, Chief Executive Officer & Chief Medical Officer, Falls Church, VA
Matt Poffenroth, MD, MBA, has the dual role of CEO and CMO for Signature Partners Network, the clinically integrated network affiliated with Inova Health System which brings together over 2000 physicians and three hospital systems in Northern Virginia. Prior to joining Inova, Dr. Poffenroth served as Director of Clinical Integration for Johns Hopkins Community Physicians and Medical Director for the Johns Hopkins Medicare Shared Savings Program/ACO. Dr. Poffenroth received his MD from Indiana University in 1994 and his MBA from Johns Hopkins in 2006, is board certified in internal medicine and maintains a clinical practice.
Richard Manning
Senior Vice President, Enterprise Clinic Operations, WellMed Medical Management, San Antonio, TX (Moderator)
Senior Vice President, Enterprise Clinic Operations, WellMed Medical Management, San Antonio, TX (Moderator)
Richard Manning has more than a quarter century of experience as a leader of healthcare operations. For the past decade in his role on WellMed’s Executive Leadership Team, Mr. Manning has directed strategic initiatives including mergers and acquisitions, business development in new markets, strategic operations initiatives, Charitable Foundation management and governmental affairs.
Mr. Manning presently directs Clinic Operations and has bottom line financial responsibility for profit, including membership and revenue growth for the Enterprise and directing the new Enterprise EMR system implementation. He previously led the award winning Disease Management and Medicare Risk Adjustment management divisions, (DataRAP®).
Mr. Manning is the current executive leader of the WellMed Charitable Foundation, a non-profit 501(c) 3 organization that supports seniors and caregivers of seniors in the communities that WellMed serves. He continues to be involved as a member of the foundation’s Board of Directors.
Mr. Manning presently directs Clinic Operations and has bottom line financial responsibility for profit, including membership and revenue growth for the Enterprise and directing the new Enterprise EMR system implementation. He previously led the award winning Disease Management and Medicare Risk Adjustment management divisions, (DataRAP®).
Mr. Manning is the current executive leader of the WellMed Charitable Foundation, a non-profit 501(c) 3 organization that supports seniors and caregivers of seniors in the communities that WellMed serves. He continues to be involved as a member of the foundation’s Board of Directors.
PATIENT ENGAGEMENT TRACK: Mini Summit 9: Technologies and Business Solutions: Personalization: The Secret to Driving Engagement and Improving Health Outcomes
2:45 pm
Introductions, Panel Discussion and Q&A
Gary Capistrant, MA
Chief Policy Officer, American Telemedicine Association; Former Director, Congressional Relations, American Health Care Association; Former Staff Director, State Medicaid Directors Association; Former Health Legislative Assistant, Rep. Jim Corman, Washington, DC
Chief Policy Officer, American Telemedicine Association; Former Director, Congressional Relations, American Health Care Association; Former Staff Director, State Medicaid Directors Association; Former Health Legislative Assistant, Rep. Jim Corman, Washington, DC
Gary Capistrant’s expertise in health policy is based on over 30 years experience with Medicare, Medicaid, and national health reforms. Mr. Capistrant’s knowledge of health policy has lead him to become a trusted advisor to associations, innovative health providers and investment analysts. He is also the former Director of Congressional Relations for the American Health Care Association, Staff Director of the State Medicaid Directors Association and Health Legislative Assistant for former Rep. Jim Corman.
Mr. Capistrant earned a MA in Public Affairs from the Humphrey School at the University of Minnesota and he also earned a BA from the same University.
Mr. Capistrant earned a MA in Public Affairs from the Humphrey School at the University of Minnesota and he also earned a BA from the same University.
Jaewon Ryu, MD, JD
Executive Vice President, Chief Medical Officer, Geisinger Health System; Former President, Integrated Care Delivery, Humana; Former Chief Medical Officer, University of Illinois Hospital and Health Sciences System, Danville, PA
Executive Vice President, Chief Medical Officer, Geisinger Health System; Former President, Integrated Care Delivery, Humana; Former Chief Medical Officer, University of Illinois Hospital and Health Sciences System, Danville, PA
Dr. Jaewon Ryu is the Executive Vice President and Chief Medical Officer at Geisinger Health System. He came to Geisinger from Humana, where he was President of Integrated Care Delivery and was responsible for Humana’s care delivery assets, a business segment with nearly $3 billion of revenue and comprised of owned and joint ventured clinic practices, as well as Transcend, a management services organization (MSO) assisting affiliated practices to adopt population health under value-based reimbursement methodologies.
Prior to Humana, he was the Chief Medical Officer at the University of Illinois Hospital and Health Sciences System. He has also previously held leadership roles at Kaiser Permanente, the Centers for Medicare and Medicaid Services, and as a White House Fellow at the Department of Veterans Affairs. He was also a practicing corporate healthcare attorney in the Los Angeles office of the firm McDermott, Will & Emery.
Prior to Humana, he was the Chief Medical Officer at the University of Illinois Hospital and Health Sciences System. He has also previously held leadership roles at Kaiser Permanente, the Centers for Medicare and Medicaid Services, and as a White House Fellow at the Department of Veterans Affairs. He was also a practicing corporate healthcare attorney in the Los Angeles office of the firm McDermott, Will & Emery.
SPECIAL ISSUES TRACK: Mini Summit 10: Medicare Advantage as a Catalyst to Reduce Health Disparities and Advance Health Equity in Medicare
2:45 pm
Introductions, Panel Discussion and Q&A
Daniel E. Dawes, JD
Executive Director, Government Relations, Policy and External Affairs, Morehouse School of Medicine; Former Health Law and Policy Advisor, Health, Education, Labor and Pensions Committee, United States Senate, Atlanta, GA
Executive Director, Government Relations, Policy and External Affairs, Morehouse School of Medicine; Former Health Law and Policy Advisor, Health, Education, Labor and Pensions Committee, United States Senate, Atlanta, GA
Daniel E. Dawes, J.D. is an attorney, administrator and author who has led numerous efforts to address health policy issues impacting diverse populations in urban and rural communities both domestically and globally. His extensive legal, policy, administration, education, research and government experiences and focus on health reform, health equity, and health system transformation has made him widely sought after by governmental and non-governmental entities across the United States. His work bridges research, health care, population health and public health, and takes an interdisciplinary and community-engaged approach to develop effective and innovative solutions in order to tackle healthcare, behavioral health and public health issues. He is the author of the groundbreaking and best-selling health policy book, 150 Years of ObamaCare, published by Johns Hopkins University Press.
Cara James, PhD
Director, Office of Minority Health, Centers for Medicare and Medicaid Services; Former Director, Disparities Policy Project and Barbara Jordan Health Policy Scholars Program, Henry J. Kaiser Family Foundation, Baltimore, MD
Director, Office of Minority Health, Centers for Medicare and Medicaid Services; Former Director, Disparities Policy Project and Barbara Jordan Health Policy Scholars Program, Henry J. Kaiser Family Foundation, Baltimore, MD
Dr. Cara James is the Director of the CMS Office of Minority Health, and a nationally recognized expert and thought leader in health disparities, health equity, and improving health outcomes for vulnerable populations. She is also co-chair of the CMS Rural Health Council.
As the Director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (OMH), Dr. James leads CMS’s efforts to meet the unique needs of minority and underserved populations. In this capacity, she provides leadership, vision, and direction to address the Department of Health and Human Services and CMS’s Strategic Plan goals and objectives related to improving minority health and eliminating health disparities.
As the Director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (OMH), Dr. James leads CMS’s efforts to meet the unique needs of minority and underserved populations. In this capacity, she provides leadership, vision, and direction to address the Department of Health and Human Services and CMS’s Strategic Plan goals and objectives related to improving minority health and eliminating health disparities.
Gary A. Puckrein, PhD
President and Chief Executive Officer, National Minority Quality Forum; Executive Director, Alliance of Minority Medical Associations, Washington, DC
President and Chief Executive Officer, National Minority Quality Forum; Executive Director, Alliance of Minority Medical Associations, Washington, DC
Gary A. Puckrein, PhD, is President and Chief Executive Officer of the National Minority Quality Forum. He also serves as Executive Director of the Alliance of Minority Medical Associations (a collaborative effort of the Asian and Pacific Physicians’ Association, the Association of American Indian Physicians, the Interamerican College of Physicians and Surgeons, and the National Medical Association). In 1989 Dr. Puckrein founded the Forum’s predecessor organization, the National Minority Health Month Foundation, to help communities and policy makers eliminate the disproportionate burden of premature death and preventable illness in special populations through the use of evidence-based, data-driven initiatives.
Dr. Puckrein is responsible for congressional proclamations designating April as National Minority Health Month each year. Dr. Puckrein leads the Zip Code Analysis Project, which is building a comprehensive database that links vital statistics and other elements (including demographic, environmental, claims, prescription, laboratory, hospital, and clinic data) in a centralized warehouse, organized around zip codes.
Dr. Puckrein is responsible for congressional proclamations designating April as National Minority Health Month each year. Dr. Puckrein leads the Zip Code Analysis Project, which is building a comprehensive database that links vital statistics and other elements (including demographic, environmental, claims, prescription, laboratory, hospital, and clinic data) in a centralized warehouse, organized around zip codes.
POLICY TRACK: Mini Summit 11: The Ongoing Changes and Regulation of Medicare Advantage Employer Group Waiver Plans (EGWPs), including Changes in the Bidding Process and Funding Cuts
2:45 pm
Introductions, Panel Discussion and Q&A
Tara O’Neill Hayes, MPP
Health Care Policy Analyst, American Action Forum; Legislative Assistant, Congressman Tom Rice, (R-SC) Congressman Tim Scott, (R-SC) and Congressman Gresham Barrett, (R-SC) US House of Representatives, Washington, DC
Health Care Policy Analyst, American Action Forum; Legislative Assistant, Congressman Tom Rice, (R-SC) Congressman Tim Scott, (R-SC) and Congressman Gresham Barrett, (R-SC) US House of Representatives, Washington, DC
Tara O’Neill Hayes is a health care policy analyst with American Action Forum. Before joining AAF, Tara worked as a Legislative Assistant in the U.S. House of Representatives for more than four years, covering a broad portfolio of issues, including health care, Medicare, and Medicaid. After her time on Capitol Hill, Tara earned her Master’s of Science in Public Policy and Management with a health policy concentration from Carnegie Mellon University. For her undergraduate studies, Tara earned a Bachelor’s of Science in Political Science from Clemson University in her home state of South Carolina.
Andrew C. Mueller, FSA, MAAA
Consulting Actuary, Milliman, Brookfield, WI
Consulting Actuary, Milliman, Brookfield, WI
Andy is a Consulting Actuary with Milliman. He joined the firm in 2001.
Andy’s area of expertise is health insurance and managed healthcare programs. He has advised managed care organizations, hospital systems, state government agencies, insurance companies, employers, and other organizations.
Andy assists health plan clients with several facets of their business including rating, self-funded rate development, liability estimates, product design, health care reform issues, development of risk sharing arrangements, and other actuarial projections.
Further, Andy is considered a firm-wide leader in Medicare Advantage and Part D consulting. He has completed feasibility studies and bid development for many clients.
Andy’s area of expertise is health insurance and managed healthcare programs. He has advised managed care organizations, hospital systems, state government agencies, insurance companies, employers, and other organizations.
Andy assists health plan clients with several facets of their business including rating, self-funded rate development, liability estimates, product design, health care reform issues, development of risk sharing arrangements, and other actuarial projections.
Further, Andy is considered a firm-wide leader in Medicare Advantage and Part D consulting. He has completed feasibility studies and bid development for many clients.
Matt Timm, FSA, MAAA
Consulting Actuary, Milliman, Brookfield, WI
Consulting Actuary, Milliman, Brookfield, WI
Matthew Timm is a Consulting Actuary with the Milwaukee office of Milliman. He has experience in benefit analysis, premium rate development, estimation of reserves and liabilities, and actuarial projections. Matthew has also worked with Medicare Advantage organizations since 2006. He developed Part C and Part D bids for Medicare Advantage plans in all stages of their operation. He has also assisted with pricing and development of Employer Group Waiver Plans, RDS attestation, feasibility analysis of product launches, profit and loss analysis, comparisons of experience to fee-for-service levels, and other issues related to Medicare.
3:45 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP IV: 4:00 pm – 5:00 pm
PLAN TRACK: Mini Summit 12: Challenges and Opportunities Entering into SNP and D-SNP Market
4:00 pm
Introductions, Panel Discussion and Q&A
G. Lawrence Atkins, PhD
Executive Director, Long-Term Quality Alliance; Former Executive Director, US Public Policy, Merck; Former Deputy Staff Director and Republican Staff Director, US Senate Special Committee on Aging, Washington, DC
Executive Director, Long-Term Quality Alliance; Former Executive Director, US Public Policy, Merck; Former Deputy Staff Director and Republican Staff Director, US Senate Special Committee on Aging, Washington, DC
Dr. Atkins is Executive Director of the Long-Term Quality Alliance and President of the National Academy of Social Insurance in Washington, DC. Prior to this position, he was the Staff Director of the Federal Commission on Long-Term Care, which issued its final report in September 2013, and was Executive Director, U.S. Public Policy at the global pharmaceutical manufacturer Merck.
Dr. Atkins is a veteran of more than 30 years of health and social policy analysis, policy development, and legislative representation at the local, state, and federal levels. Recent experience includes, Director, Public Policy at Schering-Plough Corporation; Founder and President of Health Policy Analysts, Inc.; Executive Director, Corporate Health Care Coalition.
Dr. Atkins is a veteran of more than 30 years of health and social policy analysis, policy development, and legislative representation at the local, state, and federal levels. Recent experience includes, Director, Public Policy at Schering-Plough Corporation; Founder and President of Health Policy Analysts, Inc.; Executive Director, Corporate Health Care Coalition.
John Lovelace, MS
President, Government Programs and Individual Advantage, UPMC Health Plan, Pittsburgh, PA
President, Government Programs and Individual Advantage, UPMC Health Plan, Pittsburgh, PA
John Lovelace is President of UPMC for You, a managed care organization that serves Medical Assistance and Medicare Advantage Special Needs Plan recipients in 40 counties in Pennsylvania.
Mr. Lovelace provides leadership, direction, and administration for the services provided by UPMC for You, which offers coverage to eligible Medical Assistance recipients through its contracts with the Pennsylvania Department of Public Welfare as well as coverage options for Medicare beneficiaries who are also enrolled in the Pennsylvania Medical Assistance program.
He is also President of Government Programs and Individual Advantage for the UPMC Insurance Services Division. In this role, he oversees Medicare products, Medicaid, and the Children’s Health Insurance Program (CHIP) of UPMC Health Plan, known as UPMC for Kids. He also oversees a group of Medicare Advantage special needs plans for people who are dually eligible for Medicare and Medicaid, and for individuals who are eligible for long-term care services.
Mr. Lovelace provides leadership, direction, and administration for the services provided by UPMC for You, which offers coverage to eligible Medical Assistance recipients through its contracts with the Pennsylvania Department of Public Welfare as well as coverage options for Medicare beneficiaries who are also enrolled in the Pennsylvania Medical Assistance program.
He is also President of Government Programs and Individual Advantage for the UPMC Insurance Services Division. In this role, he oversees Medicare products, Medicaid, and the Children’s Health Insurance Program (CHIP) of UPMC Health Plan, known as UPMC for Kids. He also oversees a group of Medicare Advantage special needs plans for people who are dually eligible for Medicare and Medicaid, and for individuals who are eligible for long-term care services.
Ghita Worcester
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Ghita Worcester brings more than 40 years of health care management experience to her role as Senior Vice President, Public Affairs and Chief Marketing Officer. She provides strategic direction for marketing, business development and strategy, public relations, legislative, regulatory, government programs, and community outreach activities. She oversees the organization’s federal and state health care reform efforts and policy formulation related to national and state health policy issues. Ghita is also instrumental in the development and implementation of UCare’s strategic and operational plans. Before joining UCare, Worcester served as Director of Policy and Operations for Minneapolis-based University Affiliated Family Physicians (UAFP), the management company that started UCare in 1984
PROVIDER TRACK: Mini Summit 13: Risk Adjustment and Risk Assumption Managing Duals in Medicare Advantage/Medicaid
4:00 pm
Introductions, Panel Discussion and Q&A
Tim Engelhardt, MHS
Director, Medicare-Medicaid Coordination Office, Centers for Medicare and Medicaid Services; Former Deputy Director, Long-Term Care Financing, Maryland Department of Health and Mental Hygiene, Washington, DC
Director, Medicare-Medicaid Coordination Office, Centers for Medicare and Medicaid Services; Former Deputy Director, Long-Term Care Financing, Maryland Department of Health and Mental Hygiene, Washington, DC
Tim Engelhardt directs the CMS Medicare-Medicaid Coordination Office, dedicated to improving services for individuals dually eligible for Medicaid and Medicare. Prior to joining CMS in 2010, Tim was a consultant with The Lewin Group, and he previously served as the Deputy Director for Long Term Care Financing at the Maryland Department of Health and Mental Hygiene. Tim received a BA in Sociology from the University of Notre Dame and an MHS from the Johns Hopkins School of Public Health.
Lois Simon, MPH
Executive Vice President, Policy and Programs, Seniorlink; Founder and Principal, Simon Solutions LLC; Former President and Co-founder, Commonwealth Care Alliance; Former Vice President, Care Delivery Systems, Neighborhood Health Plan, Boston, MA
Executive Vice President, Policy and Programs, Seniorlink; Founder and Principal, Simon Solutions LLC; Former President and Co-founder, Commonwealth Care Alliance; Former Vice President, Care Delivery Systems, Neighborhood Health Plan, Boston, MA
I am the Executive Vice President for Policy and Programs for Seniorlink, an innovative national caregiving company, supporting caregivers and their loved ones with expert in-home care management support and pioneering caregiver-informed technology that facilitates needed collaboration for the health care system.
Prior to joining Seniorlink, I founded L.Simon Solutions LLC, a healthcare integration consulting firm.
From 2003-2016, I was the co-founder and President of Commonwealth Care Alliance, a pioneer managed care organization taking on Medicare and Medicaid risk to focus exclusively on caring for dual eligible in a fully integrated medical, behavioral health, and long term services and support program. I have over three decades of experience in the healthcare and LTSS space working in government, provider and managed care organizations.
Prior to joining Seniorlink, I founded L.Simon Solutions LLC, a healthcare integration consulting firm.
From 2003-2016, I was the co-founder and President of Commonwealth Care Alliance, a pioneer managed care organization taking on Medicare and Medicaid risk to focus exclusively on caring for dual eligible in a fully integrated medical, behavioral health, and long term services and support program. I have over three decades of experience in the healthcare and LTSS space working in government, provider and managed care organizations.
Christie Teigland, PhD
Vice President, Advanced Analytics, Avalere Health, Washington, DC
Vice President, Advanced Analytics, Avalere Health, Washington, DC
Christie Teigland, PhD, is expert in the design and implementation of statistical studies focused on comparative effectiveness, predictive analytics, and performance measure development. Prior to joining Avalere, she served as Senior Director of Statistical Research at Inovalon where she managed quality measure projects awarded by the National Committee on Quality Assurance (NCQA), URAC, the Pharmacy Quality Alliance (PQA), and other organizations. In 2014-15, she directed an impactful study investigating disparities in outcomes in dual eligible and socioeconomically disadvantaged Medicare beneficiaries. Dr. Teigland was invited to serve on the newly formed National Quality Forum (NQF) Disparities Standing Committee in 2015, and was invited to serve on the Pharmacy Quality Alliance (PQA) Quality Metrics Expert Panel in 2017.
James Gutman
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
James Gutman was Vice President and Managing Editor of Atlantic Information Services, Inc. (formerly Executive Editor) from 2001 until his retirement in April 2016. While there he wrote and edited Medicare Advantage News, a biweekly subscription newsletter that’s the dominant publication in its field. He also oversaw Health Reform Week after successfully launching that subscription newsletter until 2014.
POLICY TRACK: Mini Summit 14: MACRA and Medicare Advantage Synergies
4:00 pm
Introductions, Panel Discussion and Q&A
Lynn F. Dong, FSA, MAAA
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA
Lynn Dong, FSA, MAAA, Principal and Consulting Actuary has over 20 years of healthcare actuarial experience and consults extensively with provider organizations and commercial and Medicare health plans. She has significant experience in evaluating risk-based contacts and alternative payment models for provider organizations. Lynn serves on Milliman’s Health Research Board and is deeply involved in the research and development of multiple components of Milliman’s Health Cost Guidelines.
Professional Designations
–Fellow, Society of Actuaries
–Member, American Academy of Actuaries
Education
–BS, Mathematics, University of Washington
–BA, Japan Studies, University of Washington
Current Responsibility
— Lynn is a principal and consulting actuary with the Seattle office of Milliman. She joined the firm in 1994.
Professional Designations
–Fellow, Society of Actuaries
–Member, American Academy of Actuaries
Education
–BS, Mathematics, University of Washington
–BA, Japan Studies, University of Washington
Current Responsibility
— Lynn is a principal and consulting actuary with the Seattle office of Milliman. She joined the firm in 1994.
Christopher Kunkel, PhD, FSA, MAAA
Consulting Actuary, Milliman, Inc., Seattle, WA
Consulting Actuary, Milliman, Inc., Seattle, WA
Chris is a consulting actuary with the Seattle office of Milliman. He joined the firm in 2009.
Chris’s experience covers a variety of healthcare programs. His primary focus ha been Medicare, Medicaid, and other government programs. He has worked on many projects, including the development of capitation rates for Medicare and Medicaid programs, savings analyses for managed care programs, morbidity studies and analyses of current and upcoming accountable care organizations. His recent projects include feasibility studies for new Medicare Advantage products, actuarially sound capitation rate setting for a state Medicaid agency and longitudinal morbidity studies in various populations. He is a Fellow of the Society of Actuaries and a member of the America Academy of Actuaries.
Chris’s experience covers a variety of healthcare programs. His primary focus ha been Medicare, Medicaid, and other government programs. He has worked on many projects, including the development of capitation rates for Medicare and Medicaid programs, savings analyses for managed care programs, morbidity studies and analyses of current and upcoming accountable care organizations. His recent projects include feasibility studies for new Medicare Advantage products, actuarially sound capitation rate setting for a state Medicaid agency and longitudinal morbidity studies in various populations. He is a Fellow of the Society of Actuaries and a member of the America Academy of Actuaries.
5:00 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP V: 5:15 pm – 6:15 pm
POLICY TRACK: Mini Summit 15: The Easing of Regulations Governing Medicare Advantage Rewards and Incentives Programs for Plan Members
5:15 pm
Introductions, Panel Discussion and Q&A
Kelli Back, Esq.
Attorney, Law Offices of Mark S. Joffe; Former Senior Policy Associate, America’s Health Insurance Plans, Washington, DC
Attorney, Law Offices of Mark S. Joffe; Former Senior Policy Associate, America’s Health Insurance Plans, Washington, DC
Since 1992, Kelli Back has assisted managed care organizations and their associations in legal and policy issues. First, as Federal Programs Counsel for the American Managed Care and Review Association, then, as the Senior Policy Associate at GHAA (now AHIP). Her activities at AHIP included writing comment letters, analyzing and drafting legislative language, drafting Congressional testimony and working with the industry to develop both legislative and regulatory policy on Medicare and Medicaid. Since October 1995, Ms. Back has worked for the Law Offices of Mark S. Joffe, a firm specializing in legal and business issues affecting managed care organizations.
Kristin Gasteazoro
Vice President, Payer Sales, novuhealth, St. Louis Park, MN
Vice President, Payer Sales, novuhealth, St. Louis Park, MN
Charro Knight-Lilly
Chief Sales Officer, Gorman Health Group, Washington, DC (Moderator)
Chief Sales Officer, Gorman Health Group, Washington, DC (Moderator)
Charro Knight-Lilly is Chief Sales Officer at Gorman Health Group (GHG). In this role, Charro brings GHG clients the unique ability to merge both compliance requirements and business operating knowledge and has more than 20 years of experience in the Medicare Advantage industry. As a key member of the executive leadership team, Charro will continue to build and foster relationships, promote customer satisfaction, while navigating through a rapidly-evolving industry. Her experience and knowledge allows her to understand executive goals, business needs, operating requirements, and regulatory guidance, thereby offering a full-spectrum view of customized options for our clients.
PLAN TRACK: Mini Summit 16: What can Medicare Advantage Plans do to Optimize Medication Use: Price is only a Piece of the Puzzle
5:15 pm
Introductions, Panel Discussion and Q&A
Derek L. Asay
Senior Director, Government Strategy, Federal Accounts and Quality, Eli Lilly and Company, New York, NY
Senior Director, Government Strategy, Federal Accounts and Quality, Eli Lilly and Company, New York, NY
Derek Asay is Senior Director, Government Strategy, Federal Accounts and Quality at Lilly USA. Derek established and maintains the ongoing Lilly relationship with Centers for Medicare and Medicaid Services (CMS) across all Medicare and Medicaid business. His team is responsible for Lilly business strategy across all government segments, including Medicare, Medicaid, and 340B. He leads the implementation of health care reform legislation and regulations from the Lilly business perspective, which includes actively preparing for the 2014 Medicaid expansion and the launch of the state health insurance exchanges. Derek’s team is responsible for health care reform education, both internally with Lilly employees and externally with payer and healthcare professional customers. His team also leads all Lilly engagement with national quality organizations such as the National Quality Forum (NQF). Prior to his current role, Derek held leadership positions in brand management and payer marketing.
Babette S. Edgar, PharmD, MBA, FAMCP
Principal, BluePeak Advisors; Former Director, Division of Finance and Operations, Medicare Drug Benefit Group, Centers for Medicare and Medicaid Services; Former Vice President, Clinical Business Development, Caremark/AdvancePCS, Baltimore, MD
Principal, BluePeak Advisors; Former Director, Division of Finance and Operations, Medicare Drug Benefit Group, Centers for Medicare and Medicaid Services; Former Vice President, Clinical Business Development, Caremark/AdvancePCS, Baltimore, MD
Babette S. Edgar, Pharm.D., MBA, FAMCP is a Principal at BluePeak Advisors (BPA). Babette has been in the managed care industry for 25 years and advises health plans, pharmacy benefit management companies and pharmaceutical companies on Medicare and managed care strategies, operational and compliance issues. Babette has worked at CMS and with several PBMs and health plans in product development, account management, clinical services and specialty programs. She is the current President of the Academy of Managed Care Pharmacy and is a national thought leader in topics related to managed care pharmacy, Medicare strategy and value-based pharmaceutical care.
Steve Miller, MD, MBA
Senior Vice President and Chief Medical Officer, Express Scripts; Former Vice President and Chief Medical Officer, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
Senior Vice President and Chief Medical Officer, Express Scripts; Former Vice President and Chief Medical Officer, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
Dr. Steve Miller, a nationally recognized advocate for fair drug pricing, supports government relations, leads the Pharmacy & Therapeutics Committee, manages the Medical Affairs team and interfaces with client groups. His expertise represents years as a medical researcher, clinician and administrator, and spans numerous healthcare subjects.
Steve has served as Chief Medical Officer since 2006, focused on clinical matters including e- prescribing initiatives, specialty solutions and overall development of products that make prescription drugs safer and more affordable.
He previously was the vice president and chief medical officer at Barnes-Jewish Hospital, Washington University School of Medicine in St. Louis.
He received his medical degree from the University of Missouri-Kansas City. He trained in the Pathology and Research fellowship at the University of Alabama at Birmingham. He was the William J. and Dorothy Fish Kerr Fellow in Cardiology at the University of California, San Francisco. Steve also did Internal Medicine training at the University of Colorado and Nephrology and Transplantation at Washington University in St. Louis. He earned his MBA at the Olin School of Business at Washington University.
Steve has served as Chief Medical Officer since 2006, focused on clinical matters including e- prescribing initiatives, specialty solutions and overall development of products that make prescription drugs safer and more affordable.
He previously was the vice president and chief medical officer at Barnes-Jewish Hospital, Washington University School of Medicine in St. Louis.
He received his medical degree from the University of Missouri-Kansas City. He trained in the Pathology and Research fellowship at the University of Alabama at Birmingham. He was the William J. and Dorothy Fish Kerr Fellow in Cardiology at the University of California, San Francisco. Steve also did Internal Medicine training at the University of Colorado and Nephrology and Transplantation at Washington University in St. Louis. He earned his MBA at the Olin School of Business at Washington University.
Robert W. Dubois, MD, PhD
Chief Science Officer, National Pharmaceutical Council, Washington, DC (Moderator)
Chief Science Officer, National Pharmaceutical Council, Washington, DC (Moderator)
Robert W Dubois, MD, PhD, is the chief science officer and executive vice president of the National Pharmaceutical Council (NPC). Dr. Dubois, who is board certified in internal medicine, brings more than 25 years of experience in health care research, with a particular focus on understanding and ensuring that patients receive high value health 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. He is a member of the Medicare Evidence Development and Coverage Advisory Committee, Steering Committee for the Electronic Data Methods Forum, and the Advisory Board of the Institute for Clinical and Economic Review. Additionally, he is the associate editor of the Journal of Comparative Effectiveness Research and is on the editorial board for Health Affairs and The American Journal of Managed Care.
PATIENT ENGAGEMENT TRACK: Mini Summit 17: Consumer Perspective — Understanding the Key Decision Making Factors and Simplifying Complexity of Medicare
5:15 pm
Introductions, Panel Discussion and Q&A
Joe Baker, JD
President, Medicare Rights Center; Adjunct Professor, New York University School of Law; Former Deputy Secretary, New York Department of Health, New York, NY
President, Medicare Rights Center; Adjunct Professor, New York University School of Law; Former Deputy Secretary, New York Department of Health, New York, NY
Joe Baker has been President of the Medicare Rights Center since June 2009. Mr. Baker is a member of the Institute of Medicine’s Board on Health Care Services and Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care. He also serves on the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services’ Advisory Panel on Outreach and Education. He is an adjunct professor at the New York University School of Law, where he teaches a class on implementation of the Affordable Care Act.
Previously, he was the deputy secretary for health and human services in New York State under Governor David A. Paterson, where he was instrumental in developing Medicaid reforms and a proposal to extend health coverage to younger New Yorkers. Mr. Baker served as assistant deputy secretary for health and human services under Governor Eliot Spitzer, after having directed the Health Care Bureau under Spitzer when he was attorney general of New York.
Previously, he was the deputy secretary for health and human services in New York State under Governor David A. Paterson, where he was instrumental in developing Medicaid reforms and a proposal to extend health coverage to younger New Yorkers. Mr. Baker served as assistant deputy secretary for health and human services under Governor Eliot Spitzer, after having directed the Health Care Bureau under Spitzer when he was attorney general of New York.
Jane Galvin
Director, Regulatory Affairs, Blue Cross Blue Shield Association, Washington DC
Director, Regulatory Affairs, Blue Cross Blue Shield Association, Washington DC
Jane Galvin is the Managing Director, Regulatory Affairs, for BlueCross and BlueShield Association in their Office of Policy and Representation. She works with Blue Plans on federal regulations and other health care issues that impact Plan businesses, working directly with the US Departments of Labor, Health and Human Services, Treasury, and the Centers for Medicare and Medicaid Services on federal regulatory issues and government programs such as Medicare Advantage, Part D, Medicare Secondary Payor issues.
She has close working relationships with the CMS on Medicare Advantage, Part D, and other Medicare issues and is part of the BCBSA team working on regulations with the Departments of HHS, Labor and Treasury related to implementation of the Affordable Care Act.
She previously worked for Kaiser Permanente in their Mid-Atlantic Region and other health care trade associations such as GHAA, Health Insurance Association of America, as well as for a Member of Congress.
She has close working relationships with the CMS on Medicare Advantage, Part D, and other Medicare issues and is part of the BCBSA team working on regulations with the Departments of HHS, Labor and Treasury related to implementation of the Affordable Care Act.
She previously worked for Kaiser Permanente in their Mid-Atlantic Region and other health care trade associations such as GHAA, Health Insurance Association of America, as well as for a Member of Congress.
Tricia Neuman, MA
Senior Vice President and Director, Program on Medicare Policy; Director, Project on Medicare’s Future, Kaiser Family Foundation; Former Professional Staff, Committee on Ways and Means, US House of Representatives; Former Committee Staff, Special Committee on Aging, US Senate, Washington, DC
Senior Vice President and Director, Program on Medicare Policy; Director, Project on Medicare’s Future, Kaiser Family Foundation; Former Professional Staff, Committee on Ways and Means, US House of Representatives; Former Committee Staff, Special Committee on Aging, US Senate, Washington, DC
As senior vice president of the Henry J. Kaiser Family Foundation and Director of the Foundation’s Program on Medicare Policy, Tricia Neuman oversees the Foundation’s policy analysis and research pertaining to Medicare, and health coverage and care for aging Americans and people with disabilities. A widely cited Medicare policy expert, Dr. Neuman focuses on topics such as the health and economic security of older adults, the role of Medicare Advantage plans, Medicare and out-of-pocket spending trends, prescription drug costs, payment and delivery system reforms, and policy options to strengthen Medicare for the future. Before joining the Foundation in 1995, Dr. Neuman served on the professional staff of the Ways and Means Subcommittee on Health in the U.S. House of Representatives and on the staff of the U.S. Senate Special Committee on Aging working on health and long-term care issues.