MACRA Positioning for Plans and Providers - Key Considerations for Providers and Health Plans

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Risk and Reward: Strategy and Value Creation Alignment for Payment Model Transformation  
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Our marketplace is evolving at a rapid pace and as seen through the lens of any particular healthcare organization... each market has its own transformation equilibrium. The three largest impacts on provider organizations and by extension, many of the third party payer managed care organizations with whom they contract and/or align with, are the transition processes associated with:
  1. Clinical care models to manage patient populations across a care continuum;
  2. Revenue models with all three major fiscal class sources of revenue (i.e., managed care, Medicare and State Medicaid) moving from FFS volume based models to a value-based outcomes focused payment models; and
  3. The operational business model infrastructure and IT which is required to support a successful transition for # 1 and #2.
Virtually all provider and managed care payer organizations have critical strategic decisions ahead of them regarding how their business environment will change, how they will sustain their revenue and care delivery business models and what they need to do to strategically reposition their organizations for the future.

Provider organizations cannot afford to get either their pricing model or their care delivery model wrong when they are at financial risk for managing patient populations. This will require a rethinking of traditional pricing and payer contracting strategies as well as the re-purposing of care delivery capacity and assets, to delivery care in the most appropriate care setting specific to a patientís clinical risk/care complexity profile. An organizationís ability to successfully navigate this transitional and transformative processes will determine the financial sustainability of their organization in the future.

For the participants attending this webinar... what is your theory of market in terms of how your home market will make the transition to value-based payments and will you be ready?

Please join us Thursday November 17th, 2016 at 1 PM Eastern as Navigant's Christopher Kalkhof helps position you for value based payments and more in the HealthcareWebSummit event: Risk and Reward: Strategy and Value Creation Alignment for Payment Model Transformation.
Learning Objectives

During the presentation we will examine:

  1. The changing provider business environment of ďdoing more with less.Ē
  2. The managed care or contracted services pricing environment and payment methodologies associated with differing degrees of risk sharing payment arrangements.
  3. The process involved in building your managed care pricing strategy at a service line level as well as across an organizationís aligned network of provider organizations, under different risk based payment methodologies.
  4. The impact of physician integration on different risk models and payer contracting strategy.
  5. Core competency requirements for a value-based enterprise.
  6. Plus engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Healthcare Innovation, Transformation and Reform Executives
  • Healthcare Payment Transformation Executives
  • Legal, Regulatory and Policy Executives and Staff
  • Provider Relations and Contracting Executives and Staff
  • Provider Network Operations Executives and Staff
  • Finance and Revenue Cycle Executives and Staff
  • Managed Care Executives and Staff
  • Planning and Strategic Executives and Staff
  • Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Health Plans
  • Hospitals and Health Systems
  • Medical Groups
  • Accountable Care Organizations
  • Provider Networks
  • Other Healthcare Providers
  • Government
  • Pharmaceutical Organizations
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
Risk and Reward: Strategy and Value Creation Alignment for Payment Model Transformation
  Individual Registration Fee: $195. Post-event materials, with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $240 for non-attendees after the event. Register online or download the event brochure.
Register Now   Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!
Christopher Kalkhof

Christopher Kalkhof,
Director, Strategic Solutions
Navigant Consulting, Inc

  Chris is a senior healthcare executive with nearly 30 years of operations, finance, managed care / contracting, M&A, strategic alliances, and new business development experience across hospital, physician organization, post-acute care and health plan industry verticals.

Current and recent client projects include:
  • An academic health systemís enterprise wide revenue model and payer strategy (and recently finished the same for another AMC and a community hospital health system)
  • Two provider-payer product specific value-based payment models
    Contract Negotiations Assistance: Turnaround Scenario
  • Multiple hospital and physician reimbursement benchmarking/pricing strategy projects
  • Development/operationalization support for a Next Gen ACO (including CIN funds flow model).
  • Operational and financial due diligence for a health plan acquisition
  • A teaching hospital Ė surgical group JV to establish a destination care, clinical institute model.
  • A financial feasibility analysis for a women and childrenís hospital site expansion build.

Other directly relevant experience to todayís presentation includes:

  • Deep experience in developing, negotiating and executing payer contract content and negotiation strategies for both FFS and alternate payment reimbursement models.
  • Facilitating provider-payer strategic alliances and preferential / collaborative working relationships.
  • Health Plan network strategy development for both FFS and alternate payment reimbursement models (e.g., shared savings, capitation, and bundled payments) as well as health plan product development and execution.
  • Hospital and physician alignment strategies for mutual strategic growth in core / non-core markets.
  • Over his career, Chris has directly negotiated more than 300 payer contracts and advised clients on over 1,000 contracts to help provider clients to improve their payer strategies / tactics, payer operations and financial revenue improvement outcomes. This has resulted in improved annualized (recurring) net revenues in excess of $1 billion.
The topics discussed today are from actual leading edge revenue model and managed care strategy projects. As such, todayís discussion illustrates some of the real world applications of payer and revenue optimization strategies as well as provide attendees with examples of what its provider industry peer groups are doing across the country. All of these items can be addressed and integrated into participant organizationís own payer contracting strategies to address go forward, market specific scenarios.
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