|
 |
 |
|
|
| |
| |
| |
Tuesday,
September 28th,
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. |
|
Register
for $225
Call 209.577.4888 or
Click here to register |
Establishing Actuarial Cost and Utilization
Targets for ACOs
Using Medical Management to Achieve these
Targets
|
|
|
Using ACO population data to build actuarial utilization
targets that tie into financial budgets
Benchmarking services that can be targeted for reduction
Medical Management Gap Analysis (supply and demand side)
Leveraging resources to provide medical management
services
Best practice medical management operations |
| |
Faculty:
Kathryn V. Fitch, RN, MEd
Principal, Healthcare Mgmt.
Consultant, Milliman |
Faculty:
David P.
Mirkin, MD, Principal,
Physician Healthcare Mgmt.
Consultant, Milliman |
Faculty:
Catherine
M. Murphy-Barron,
FSA, MAAA, Principal,
Consulting Actuary, Milliman |
|
|
| |
 |
The Patient Protection and Affordable Care Act (PPACA) calls for the
creation of accountable care organizations (ACOs) as a more
cost-effective way of paying for healthcare. In order to succeed, ACOs
will have to establish actuarial cost and utilization targets and use
medical management to achieve those targets. This process of
benchmarking and managing toward targets requires a delicate balance of
actuarial and clinical know-how.This session, led by national
experts Kate Fitch, David Mirkin and Cathy Murphy-Barron from Milliman, Inc., guides
participants through a roadmap to Accountable Care Organization success
with a detailed presentation addressing actuarial benchmarking, medical
and operations management in an ACO setting.
Topics discussed include degrees of ACO risk sharing, ACO
financial budgets and targets, medical management priorities, ACO
utilization models, supply side medical management services, demand
management services, benchmarking, global capititation, a case
study, and more.
|
| |
 |
Participants will be able to:
- Understand the process of using experience claims data for an
ACO's designated population to build actuarial utilization targets
that tie to the financial budget
- Learn what impactable services should be benchmarked in claims
data and targeted for reduction
- Ascertain the critical services to evaluate in a medical
management gap analysis (supply and demand side)
- Identify current capabilities and resources that can be
leveraged to provide medical management services build versus buy
decisions
- Examine best practice medical management operations
- Consider ACO medical and operations management challenges
highlighted by an ACO case study
|
 |
Interested attendees would
include:
- C-Suite Executives
- Medical Directors
- Care Management Executives and Staff
- Actuarial
Executives and Staff
- Managed Care and
Revenue Cycle Executives and Staff
- Operations Executives
and Staff
- Provider Network
Managers and Staff
- Provider Contracting
Managers and Staff
- Analytics and Informatics Managers and Staff
- Strategy and Planning
Executives and Staff
Attendees would represent
organizations including:
- Hospitals
- Provider Networks
- Medical Groups
- Health Plans
- Care Management Organizations
- Business Process
Organizations
- Solutions Providers
- Associations,
Institutes and Research Organizations
- Government
- Media
- Other Interested
Parties
|
|
 |
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!
|
| |
 |
| |
|
Kathryn V. Fitch, RN, MEd, Principal, Healthcare
Management Consultant, Milliman, Inc.
|
|
Kate is a principal and healthcare management consultant in the New
York office of Milliman. She joined the firm in 1999. Kate's expertise
is in the intersection of benefit design, disease processes, financing
health benefits, and managing care. She leads teams of actuaries,
benefits consultants, clinicians, and data analysts in projects for
disease-management companies, hospitals, employers, HMOs, pharmaceutical
companies, and healthcare industry trade organizations. As project lead,
she is instrumental in designing data analytics and communicating the
implications for clients, as well as managing Milliman resources.
Kate leads projects that require analyzing quantitative and financial
outcomes of benefit designs, therapies, processes, and care management,
and converting these findings into measurable improvements in quality
and financial outcomes. Kate's role typically includes promoting these
findings in organizations through reengineering, training, and process
improvement. Recent projects have included helping employers and payers
evaluate disease management, wellness, and other vendors; groundbreaking
work on value-based benefit design; the impact on employers of
population-based cardiovascular risk programs; health plan medical
management program assessments and redesigns; and inpatient process
improvement at several hospitals focused on improved denial management
and length-of-stay reduction.
Prior to joining Milliman, she worked for a case-management company,
where she developed the company's case manager training and education
program. Kate was previously an instructor in the nursing program at
Columbia University School of Nursing. Prior to that, she was a research
assistant at Memorial Sloane Kettering, where she was involved in
nursing research studies. She also worked as a research assistant in
pharmaceutical research studies at Roosevelt Hospital. Kate's clinical
background includes extensive experience as a registered nurse in
emergency, adult inpatient, and ambulatory care units.
Kate is a member, ERISA Industry Committee (ERIC), health policy
committee; and serves on the Patient Care Primary Care Collaborative.
She received her BSN at Villanova University and her MA, MEd at Columbia
University.
|
|
| |
|

David P. Mirkin, MD, Principal, Physician
Healthcare Management Consultant, Milliman, Inc.
|
|
David is a principal and healthcare management consultant with the
New York office of Milliman. He joined the firm 1995. David is a family
practitioner with 25 years experience in medical management. He serves
as a senior consultant assisting clients in a variety of areas including
tradition utilization management, provider profiling, disease
management, LOS management for hospitals, ROI evaluations for disease
management and wellness programs, and clinical data analysis. David has
significant international experience, having consulted to clients in the
U.K., Europe, and Asia. Prior to joining Milliman, he was corporate
medical director and senior medical director for Medicare risk at FHP
International. David holds active medical licenses in California,
Utah, and Pennsylvania. His affiliations include: Member, Editorial
Board, The American Journal of Managed Care; Member, Editorial Board,
Disease Management; and Senior Scholar, Department of Health Policy,
Jefferson Medical College, Thomas Jefferson University. David has been
active in the sports medicine field and worked as a volunteer physician
at the United States Olympic training center in Colorado Springs, Colo.
David is a graduate of the University of California, Riverside, and
received his Medical Doctorate at the University of Washington. David's
post-graduate training was at the San Bernardino County Medical Center,
where he completed a residency in family medicine in 1981. He served as
chief resident for the medical center from 1980 to 1981. He has also
attended the University of Utah Graduate School of Business Executive
MBA program,
|
|
| |
|

Catherine M. Murphy-Barron, FSA, MAAA
Principal, Consulting Actuary, Milliman, Inc.
|
|
Cathy focuses primarily on health insurance and managed care consulting.
Her clients include Blue Cross/Blue Shield plans, HMOs, commercial
insurers, healthcare providers, educational institutions, and
pharmaceutical companies. Cathy also works with Medicare and Medicaid
programs.
Cathy's experience includes assisting clients with pricing, benefit plan
design, cost projections, risk analysis, and claim liability estimates.
She helps clients with reimbursement and incentive system development,
including capitation, pay for performance, and other incentive
arrangements. Cathy also assists clients with their regulatory filings
and experience analysis.
Cathy's recent consulting assignments have included: Pricing of a
preferred provider organization (PPO) plan for an HMO; Development of a
case rate/risk sharing payment methodology for a group of hospitals;
Analysis of actual to expected claim costs for a provider organization;
Examination of disease incidence and drug use; Review and appraisal of a
health plan; Premium development for the student health plan of an
educational institution; Development of a prescription drug risk sharing
arrangement for a pharmaceutical company; Dual Eligible Medicare
Advantage Part D Special Needs Plan premium filingCathy is currently
vice-chairperson of the American Academy of Actuaries’ Committee on
Federal Health Issues and a member of the American Academy of Actuaries’
Health Practice Council. She is also a member of the Academy's Uninsured
Workgroup and its Disease Management Workgroup. Cathy received a B
Commerce degree from the University College Galway, Galway, Ireland.
|
|
| |
 |
|
-
1101 Standiford Ave. Suite C-3 Modesto, CA 95350
Phone 209.577.4888 |
e-Mail
infohws@healthwebsummit.com
| Fax
209.577.3557
- copyright
, MCOL All rights reserved. Terms
of Use apply to this site and participation in events.
|
|