The Race to Stay Relevant: Lessons MA Plans Can Learn from New Kids on the Block

The Race to Stay Relevant:
Lessons MA Plans Can Learn from New Kids on the Block

Tuesday, May 4th, 2010
1:00 p.m. to 2:15 p.m. Eastern (10:00 - 11:15 a.m. Pacific)
Click here to find out what time your event starts in your time zone.

Positioning MA Plans for the future through patient centered models
Adapting for Medical Homes and Accountable Care Organizations

Register for $225
Call 209.577.4888 or
Click here to register

How Health Care Reform promotes and enables payer-provider collaboration
Key tenets of next generation medical management
Underpinnings of Medical Home and Accountable Care Organizations
Building a new payer-provider model: from feasibility to implementation to measurement
Implications for Medicare Advantage Plans in order to position for the future

Faculty:
John Gorman
CEO, Gorman Health Group

Faculty:
William MacBain, MPS
Senior Vice President, Finance, Gorman Health Group

Health Care Reform has arrived. Medicare Advantage plan must quickly adapt to survive and stay relevant for the future. Lessons regarding the emerging patient centered models of medical homes and accountable care organizations can provide a road map for MA plans to set a course built upon care management and delivery through an accountable, patient-centered approach.

This “sea change” translates into new rules, new business drivers and new opportunities for every health plan. One change is clear – a health plan’s ability of to leverage the power of local physician and hospital relationships to build collaborative payer-provider care delivery models will be a game changer.

A new era of medical management is set to emerge allowing health plans the opportunity to identify, treat and improve patient outcomes in an accountable, patient-centered approach—comprehensive care, structured around a primary care physician that is accessible, continuous, and family-centric. Patient centeredness has given rise to two hot trends that will quickly gain traction: primary care medical home and accountable care organizations.

Medical home is primary care that is accessible, continuous, and family-centric. Care is coordinated across all components of the patient’s healthcare community – hospitals, specialty physicians, pharmacists, social services, home health, nursing homes, and ancillary providers. Medical home provides a vision of care for all stages of life, acute and chronic, wellness and prevention, and end-of-life.

Accountable Care Organizations, ACOs, are provider-centric organizations responsible for the cost and quality of care received by a specific group of patients. Payment incentives (and disincentives) are built-in so physician groups and hospitals become financially “at-risk” to meet quality and cost targets. ACOs provide a well-designed outlet to foster management of an entire episode of care in an integrated patient-centered structure.

Without question, these trends represent a vastly different mind-set for many health plans. Patient-centered programs are not just a reinvention of utilization management and prior authorization. They place the health plan is in the role of facilitating, not limiting, providers. They become a central resource directing communications with the member through the doctor-patient relationship. It also means supporting clinicians with reliable, complete information, giving front-line professionals the data and tools to “connect the dots” of the patient care continuum.

Discussion topics include:

How Health Care Reform promotes and enables payer-provider collaboration
Key tenets of next generation medical management
Underpinnings of Medical Home and Accountable Care Organizations
Building a new payer-provider model: from feasibility to implementation to measurement
Implications for Medicare Advantage Plans in order to position for the future

Interested attendees would include:

CEOs and other plan executives
Strategy, Planning and Policy Executives and Staff
Chief Medical Officers
Chief Pharmacy Officers
Chief Nursing Officers
Medical Directors
Medicare Officers
Care Management Teams
Provider Relations staff, etc.
Other Interested Parties

Attendees would represent organizations including:

Health Plans
PBMs
Provider Networks
Solutions Providers
Associations, Institutes and Research Organizations
Media
Other Interested Organizations

Individual Registration Fee: $225. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!

John Gorman

CEO, Gorman Health Group

John Gorman is CEO of Gorman Health Group, a company he founded in 1996 to provide Medicare regulatory compliance advisory services to healthcare payers. Under John’s leadership, Gorman Health Group has since emerged to become the leading consulting firm in Medicare managed care, providing thought leadership along with expert strategic, operational, financial, and other professional services to the healthcare industry, including an array of leading-edge business process outsourcing solutions.

Mr. Gorman and his team of more than 65 senior-level consultants are considered by many in the industry to be the go-to source for understanding the regulatory and business implications of the Medicare Modernization Act (MMA) and the introduction of the Medicare Part D prescription drug program. John and his team are largely credited with having spearheaded the creation and design of the Medicare Advantage PPO product, and for being early advocates for plans having diverse product portfolios.

John is a dynamic, engaging, and highly-regarded speaker -- known for his on-the-mark insights as well as his candid, no-nonsense, cut-to-the-chase style. John speaks at dozens of healthcare industry conferences each year, reaching thousands of senior healthcare executives and professionals nationally. John was ranked Best Speaker for the Industry Collaboration Effort (ICE) annual conference each of the last three years, the nation’s largest annual convention of the managed care industry.

John is regularly quoted in the trade press and the national media, including the The New York Times and The Wall Street Journal, and serves on the editorial advisory boards of several industry publications. He is also frequently sought out by the investment community for his insights, analyses, and predictions about the evolving Medicare managed care market.

In addition to founding Gorman Health Group, John was a founding partner of Leprechaun, the industry’s leading risk adjustment management outsourcing company.

Prior to founding his own company in 1996, John served as Assistant to the Director of HCFA’s 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. During the 1993 debate on national health care reform, John was chief lobbyist on health care financing issues for the National Association of Community Health Centers, an organization of Federally-funded primary care clinics for the medically underserved. Prior to that, he served as Press Secretary and Staff Director for U.S. Representative John Conyers, Jr. (D-MI), then-Chairman of the Government Operations Committee.

William MacBain, MPS
Senior Vice President, Finance, Gorman Health Group

Bill has over twenty-five years' experience in health plan senior management positions, encompassing finance, management consulting, and health insurance operations. He is experienced in financial management and analysis, business planning and budgeting, contract negotiations, product design, and government affairs.

Bill fills a dual role at Gorman Health Group. As a senior consultant he focuses on financial planning and analysis. As chief financial officer, he manages the firm's finances, IT, and human resources. He has consulted for numerous health plans, health care providers, and government agencies. Representative projects include financial feasibility analyses, financial planning, financial "due diligence" reviews, HIPAA privacy rule compliance, provider contracting, grant program analysis and grant application review. He also coauthored and published a series of successful HIPAA privacy rule policy templates.

Bill contributed to federal and state health insurance policy as a member of two federal Medicare advisory commissions (MedPAC and ProPAC), and as president of the Managed Care Association of Pennsylvania. He has also served as a board member of the American Association of Health Plans and the Group Health Association of America, predecessors of today's AHIP.

Bill's executive experience includes service as CFO for a large regional health plan, chief operating officer for one of the largest rural-based health plans in the nation, and senior finance and operations positions with several start-up health plans.

1101 Standiford Ave. Suite C-3 Modesto, CA 95350 Phone 209.577.4888 | e-Mail infohws@healthwebsummit.com | Fax 209.577.3557