ACO Success: Actuarial Benchmarking, Medical and Operations Management

 
 
 
  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
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      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
 
Overview
  
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.

 
Learning Objectives
 
Participants will be able to:
  1. 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
  2. Learn what impactable services should be benchmarked in claims data and targeted for reduction
  3. Ascertain the critical services to evaluate in a medical management gap analysis (supply and demand side)
  4. Identify current capabilities and resources that can be leveraged to provide medical management services build versus buy decisions
  5. Examine best practice medical management operations
  6. Consider ACO medical and operations management challenges highlighted by an ACO case study
     
Who Should Attend
  
 
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
Registration
  
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!

 
Faculty
 
 
Kate Fitch, Milliman
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 Mirkin, Milliman

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,
 


 
 
Cathy Murphy-Barron, Milliman

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 filing

Cathy 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.
 


 
 
 
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