CD-ROMs of past events

 Upcoming Events

Keynote Presentations: Pay for Performance

Session 1: Paying for Performance
Beau Carter
Executive Director, Integrated Healthcare Association

Mr. Carter will provide an update on IHA's two Rewarding Results grants dealing with performance-based payment -- (1) Pay for Performance, involving 6 commercial HMOs and their 300+ delegated medical groups and (2) the Local Initiative Rewarding Results Collaborative, involving the 8 Local Initiative plans and their providers serving low-income children in the Medi-Cal and Healthy Families programs.

Session 2: Provider Pay for Performance Programs: Lessons Learned
Geoffrey Baker (President), Peter Mongroo (Vice President)
Med-Vantage, Inc.

Mr. Baker and Mr Mongroo will present the results from groundbreaking research in 2003 of over 30 healthplans, purchasers, vendors, and luminaries on the use of quality-based Incentives in provider and Institutional reimbursement strategies. The session will address the strategic, operational, and tactical issues payers and purchasers face with implementing these pay for performance incentive programs. Also available in two live webcast sessions.

Featured Presentations

Session 3: Best Practices in Managed Care Contract Operations
Paul B. Stevenson, MPA, CPA
Senior Manager, ECG Management Consultants

In this session, the participants will be exposed to the Managed Care Cycle, which embodies all managed care functions of the modern provider organization. The presentation defines the managed care cycle, its evolution and each component. The components include contract performance monitoring, managed care contract terms, managed care contract operations, managed care contract forecasting and analysis and auditing contract compliance.

Session 5: How should you measure a reimbursement program's success?
George G. Karahalis, FACHE
President & Adjunct Assistant Professor, HealthSystems Direct & Emory/Rollins School of Public Health

For more than a decade the prevailing wisdom was that provider's should be financially incented to save money and achieve good outcomes. More recent consideration reveals that the public, involved patients and regulators view incentives with concern because of apparent perversions of the incentives. What should the structure of incentives be? Against what criteria should provider performance be judged ... and rewarded? This presentation re-opens a debate: How can health plan sponsors assure the "right" behavior if it cannot be defined or adequately measured in a way that balances the needs of those in need versus pressures to control costs? And, are incentives the "right" thing to do if we are unsure of unintended consequences? What are the costs of measuring ... or not?

Session 6: Transforming the Revenue Cycle
Chuck Lund
Senior Manager, Mid Atlantic Support Services Leader
Cap Gemini Ernst & Young

Mr. Lund's presentation will provide insights on what is involved in the transformation of a hospital's revenue cycle management practices. Identifies how transformed hospitals leverage processes, technologies relationships, and business structures to improve their financial performance. Focuses on the specific revenue transformation opportunities associated with: Denial Management -- avoidance and recovery; Follow-up Processes -- viable, practical business rules; Patient Payments -- POS collections and assertive follow-up; Third-party payment compliance -- and contract simplification; Vendor contracts -- coordinating RFP processes to assure optimum pricing and service levels.

Session 7: Provider Pay Practices, Physician Compensation Arrangements and What Plans Are Doing Today to Compensate Providers for Superior Performance 
William J DeMarco MA CMC
President and Chief Executive Officer, DeMarco and Associates

As managed care adopts the tiering of hospital and physicians payment to performance quality indicators and outcomes measurement will be a vital part of the providers relationship with managed care organizations. This session will address specific measures now being used by plans to incent superior performance as well as offer up to date pay practices and physicians compensation arrangements from the Warren Survey, a national subscriber database. Implications of how this movement will affect consumer driven plans will also be discussed.

Session 8: Containing Revenue-Cycle Costs
Robert Geer
Senior Consultant, Accelerated Receivables Management, 'ARM'

This session provides a unique step-by-step plan to develop cost savings in the management of the Revenue Cycle while improving results. Mr. Geer will show you where to look for cost savings, when is the right time to initiate a cost savings programs, and how to compute the costs to a provider..

Session 14: Roundtable Discussion on the future direction of Provider Payments

Moderator: Claire Thayer, Vice President Research and Development

MCOL 

 

Various members of the faculty and special guest participants exchange perspectives on key questions regarding the future direction of provider payments from a variety of perspectives.

Session 15: Measuring and Rewarding Physician Performance: A National Movement

David S. P. Hopkins, Ph.D.
Director of Quality Measurement and Improvement, Pacific Business Group on Health

 

This presentation describes an initiative being undertaken by the Pacific Business Group on Health, a West Coast-based coalition of large employers and small group purchasers, with various other partners to develop and standardize reporting of quality and efficiency measures at the physician level. Uses of this information include physician pay-for-performance, health benefits design, informed consumer choice, and quality improvement.