Agenda

Tuesday, February 26, 2019
7:00

Registration and Continental Breakfast

8:00

Chairman's Welcome

W. Christopher Johnson, FHFMA, Vice President Patient Financial ServicesAtrium Health, formerly Carolinas Healthcare System

Stuart Hanson, Managing Director, Head of Healthcare PaymentsJ.P. Morgan

TECHNOLOGY & OPERATIONAL INNOVATIONS TO EXPEDITE PAYMENTS WHILE BOOSTING ACCURACY & INTEGRITY
8:05

Strategic Look at Transformative Payment Disruptions on the Horizon


Stuart HansonManaging Director, Head of Healthcare PaymentsJ.P. Morgan

8:35

Healthcare Technology Checklist: Data Exchange, Data Security and Patient Control

Technology is ever evolving and expanding. WEDI’s Charles Stellar will offer his thoughts, that despite our advances, health professionals must continue to recognize data interoperability, data security and patient control as main priorities.  He will address the evolving technologies challenges and how data exchange is central to all.

Charles StellarPresidentWEDI

09:05

Exclusive CAQH CORE Study Results: Applying the Lessons of FFS to Streamline Adoption of Value-based Payments

Today, as elements of value-based payments are being implemented by a growing number of stakeholders, CAQH CORE sees opportunities to strengthen the operational processes and systems supporting it. Many features of value-based payment do not align with the current fee- for-service operational system. Indeed, proprietary systems and processes for implementing

value-based payment have already begun to introduce variation. Without collaboration to minimize variations, the current environment is ripe for repeating a scenario that cost stakeholders billions of dollars and slowed and complicated adoption of fee-for-service transactions. CAQH CORE conducted an 18-month study to examine value-based payment operational processes and to identify opportunity areas that, if improved, would streamline implementation of value-based payment. This presentation will detail the results of this study – a report proposing five opportunity areas associated with value-based payment including data harmonization, interoperability, patient risk stratification, provider attribution and quality measurement. Within each opportunity area, unique challenges and recommended industry- wide strategies to address each opportunity will be highlighted.

By collaborating now, before proprietary systems and processes become entrenched in value- based payment operations, by reaching out to potential collaborators across the industry and by applying lessons learned through its success in the fee-for-service space, CAQH CORE hopes to energize an effort to ease value-based payment operational inefficiencies.
Learning Objectives:

  • Become familiar with the challenges industry is facing in its transition from fee-for- service to value-based payments.
  • Understand the CAQH CORE study and resulting report on value-based payment operational processes and opportunity areas that, if improved, would streamline implementation of value-based payment.
  • Learn how to get involved in the effort to address the challenges contained in the five opportunity areas to ease value-based payment operational inefficiencies.

Erin WeberDirectorCAQH CORE

9:35

Networking Refreshment Break

09:55

The HC Digital Highway – Assuring Data Integrity -- Security, Privacy, ID Authentication/Verification And Risk

The advent of 21 st Century Cures Act, the focus on patient consumerism, connecting healthcare stakeholders, the opioid epidemic, portability of records and assuring connectivity are all issues driving the evolution of the digital highway for healthcare. Healthcare organizations are increasingly looking to the latest technologies to improve patient care and cost efficiencies. These technologies include telemedicine and virtual care, mobile devices and wearables, the Internet of Things (IoT), artificial intelligence (AI), big data, blockchain and the cloud. In addition, healthcare organizations are employing IoT and other advanced technologies to create the connected hospitals of the future. The need for population health analytics and the ability to analyze data longitudinally is critical for states,

at the federal level and at the local level. It’s all about managing big data today either leveraging IBM’s Watson or through various analytical engines and managing the multiple portals, multiple logons, communicating between EHR’s, the use of cloud service providers for storage and dissemination of data and the myriad of interfaces necessary is creating significant risk of breach and many points of cyberattack vulnerability.

This session will discuss the disparate highway access points, the issues of security, privacy, ID authentication/verification and risk vectors that the healthcare ecosystem faces. The session will discuss various strategies, tools, assessment and risk management/mitigation planning that is needed to minimize your organizational risk and the planning that is critical for when a breach, cyber or ransomware attack occurs. The session will also discuss the variables currently taking place in healthcare and based upon this new environment and how legislation and other industry initiatives are shaping the future of healthcare. Bring your issues, concerns and challenges to discuss in this interactive session.

Lee BarrettExecutive Director, CEOEHNAC

Karly RoweVice President New Product Development, Identity & Care Management ProductExperian Health

Timothy C. Zevnik, CIPP/US, CIPP/GVP Compliance & Corporate Privacy OfficialMolina Healthcare,Inc.

CONSUMER-CENTRIC PAYMENT INNOVATIONS TO EXPEDITE CASH FLOW
10:40

Pricing Transparency and the Impact on the Patient Experience and Consumerism

Individuals are no longer just patients, they are consumers.  As with any consumer they want to know they are getting a good price and quality for the needed services. Having a surgery is not the same as buying an item off the shelf, there are variances in costs based on the actual procedure, so how can a health care organization provide patients with a price? How does a health care organization account for the variances and how do patients pay for the services needed? These are the topics that will be discussed in Pricing Transparency and the Impact on Patient Experience and Consumerism.

Judy LB Parker, EdDEnterprise Director of Patient AccessPresbyterian Healthcare Services

11:10

Consumer Payment Portals

Samuel E. RubensteinChief Architect, Business & Revenue Cycle SolutionsMontefiore Medical Center

11:40

Operationalizing Bundled Payments

12:10

Networking Lunch

1:10

Case Study: Accelerating Cash Payments from Patients

Part I: Focus on the Patient Experience

  • Measurement methods associated with Patient Financial experience.
  • How St. Luke’s has monetized Patient Financial Experience.
  • What each point of Financial Experience means in terms of operational costs.
Part 2: Patient Segmentation
  • Most Hospital organizations believe you should treat all patients the same. St. Luke’s does not agree.
  • St. Luke’s scores and operationalizes that scoring to improve results.
Part 3: Billing Statement Redesign
  • While digital portals are all the rage, St. Luke’s still only has 25% of its patients on a digital platform.
  • This means 75% of patients have “paper accounts.”
  • How a statement redesign has improved cash performance of St. Luke’s.

Michael Rawdan, Ph.D., MBASystem Senior Director of Revenue Cycle & Patient ExperienceSt. Luke's Health System

1:40

Networking Refreshment Break

2:00

Panel: Streamlining Billing and Collections

Panelists:

Samuel E. RubensteinChief Architect, Business & Revenue Cycle SolutionsMontefiore Medical Center

2:40

Integrating Billing Systems

W. Christopher Johnson, FHFMAVice President Patient Financial ServicesAtrium Health, formerly Carolinas Healthcare System

3:10

Evidence Based Revenue Cycle: Reimbursement as an Outcome, Not a Goal

Healthcare Revenue Cycle is foundationally is no different than Healthcare Delivery.  It should be evidence-based; using past failures and outcomes as the compass towards future behavior.  Our industry has come to chase cash as a goal; perpetually engaging in the same inefficient behaviors that keep costs high and reimbursement in line with a “fake” net revenue figure; built to help us collect in line with our own past inefficiencies.  In this session, hear how Northern Arizona Healthcare has laid the foundation for driving improved performance through focusing on: Customer Experience, Physician Engagement, Record Integrity, Revenue Integrity, and NOT focusing on the CBO.

Ryan O’HaraChief Revenue OfficerNorthern Arizona Healthcare

3:40

Blockchain in Healthcare Payments, RCM, Claims Integrity & More - Early Adopters and Emerging Use Cases

The past year has seen plenty of hype about blockchain being a potential solution to some of healthcare's biggest challenges.  While the industry is seeing an increase in early trailblazers, plenty of people still want to know what it is, how it works and where it's being deployed.  By providing faster access to trusted information, better collaboration and increased transparency, blockchain could go a long way to help transform healthcare in areas such as personalized patient engagement, payment and claims integrity, reduced counterfeit medicines and more effective research and development (R&D).

In this session we will provide an overview of the core concepts and technology underlying the blockchain operating model.  We will share insights on some of the emerging use cases and early adopters that are generating the earliest transformational investments.  And we will dive deeper into a specific example of Revenue Cycle, Provider Licensure & Credentialing.

Donna Houlne, BSN, MHA, MHRMUS Healthcare Leader, Global Business ServicesIBM

4:10

Specialty Provider Case Study: Operationalizing Value-based Payments

Florida Cancer Specialists and Research Institute began its journey into Value Based Care with PQRS and since then the journey has taken us into a variety of programs and partnerships with multiple payers and organizations as we strive to improve quality and efficiency for our practice, payers, and most importantly the patients we serve. As a Hematology Oncology practice with multiple sub-specialties, such as urology, radiation oncology, gynecology oncology, and hematopathology in addition to medical oncology we have had to put processes in place through all levels of the organization including leveraging technology solutions to ensure seamless flow from the time we know a patient is coming to see us to the time the claim is paid. Now more than ever a team approach is critical to ensure we continue to move to the needle toward higher value for everyone. I look forward to sharing how FCS continues to work through this endeavor.

Sierra Tomlinson RN MBA BSN OCNDirector of Value Based CareFlorida Cancer Specialists & Research Institute

4:40

Panel: Facilitating Payments to Providers in a High Deductible Environment

  • Autopay programs
  • Payors taking on billing for deductibles and copays
  • Enhancing payment plan shopping experience
  • Extending credit options
  • Moderator:

    Mike MannaExecutive Director, Healthcare SolutionsJ.P. Morgan

    Panelists:

    Robin Wright-KingDirector of Consumer Directed Health Product and StrategyBlue Cross Blue Shield of Massachusetts

    W. Christopher Johnson, FHFMAVice President Patient Financial ServicesAtrium Health, formerly Carolinas Healthcare System

    Brad TinnermonVice President of Revenue Cycle and Revenue IntegrityBanner Health

5:20

Networking Reception

Wednesday, February 27, 2018
7:00

Networking Continental Breakfast

8:00

Co-Chairpersons’ Remarks

W. Christopher Johnson, FHFMAVice President Patient Financial ServicesAtrium Health, formerly Carolinas Healthcare System

Stuart HansonManaging Director, Head of Healthcare PaymentsJ.P. Morgan

8:05

Transforming Healthcare Payments with Artificial Intelligence

Prasanna GanesanCEO, Co FounderMachinify Inc.

8:35

Panel Discussion: Facilitating Patient Refunds – Harnessing New Technologies & Complying with Regulatory Constraints

Today’s healthcare providers need to process more one-off payments (i.e., refunds) than ever before. This is being driven primarily by the increase in consumer directed healthcare plans and higher deductibles, which has required providers to collect more upfront patient payments at point of service leading to over collected patient responsibilities and dissatisfied patients. But simple solutions are hindered by hurdles, including:

  • Assessing the effectiveness of various disbursement options including ACH, tokenized payments and check;
  • Anticipating market demand for various payment types over time, based on patient demographics;
  • Ever-evolving regulatory guidelines (e.g., ICD-10, The Affordable Care Act, Medical Loss Ratio, etc.);
  • Technology constraints that inhibit the ability to keep up with demand, inquiries, tracking and audits; and
  • Legacy systems that challenge standardizing payments.
  • Dealing with 50 state law differences related to escheatment reporting of abandoned property in the form of unclaimed patient refunds.
Join this discussion to hear the specific issues providers are facing, how they are coping today and the types of forward thinking solutions that are needed to help providers handle the myriad forces they face.

Moderator:

June St. JohnSenior Vice President, CTP Healthcare Product ManagerWells Fargo

Moderator:

Kim RoelfsonDirector of Customer Service, Revenue ManagementCentura Health

Jim CrawfordVice President, Relationship Officer, Treasury Services HealthcareBNY Mellon

9:15

Real-time Payments

Irfan AhmadSenior Vice President, Product Development and StrategyThe Clearing House

9:45

Networking Refreshment Break

PAYER PAYMENTS INNOVATIONS – STREAMLINING PROVIDER PAYMENTS
10:05

Overcoming Cash Flow Challenges for Incentivizing Providers in Value Based Contracts

Michael RuizVice President, Provider Relations & ContractingUCare

10:35

Innovative Risk Model Eliminates Prior Authorizations and Denials

CMS’ Acceptable Use Criteria Program will require physician organizations to select and practice against a set of Acceptable Use Criteria starting in 2020. Along with implementing the required Clinical Decision Support Mechanisms, the infrastructure for providers to manage their own clinical performance will finally be in place. By forming collaborative partnerships with our providers that shares information in both directions, we are able to work with providers to identify the drivers of practice variation and make corrections where appropriate. This partnership gives us the confidence to remove authorizations and denials while ensuring the providers continue to practice the way that they agreed to practice.

Jason WoodsVice President, Provider ContractingPriority Health

11:05

The Evolution from Fee for Service to Value-Based Care -- Moving from Retrospective, Upside- only Models to Risk-based Models

  • Understand the nature of the evolution of migrating from fee for service to value-based care, and the benefits of beginning in a no-risk model
  • Hear from the country’s largest administrator of Episodes of Care
  • Find out how moving to a risk-based model and a prospective payment model helps to put money into the hands of providers more quickly

Lili BrillsteinDirector, Episodes of Care, Market InnovationsHorizon Blue Cross Blue Shield of New Jersey

11:35

Driving Claims Payments Integrity to Boost Member & Provider Experience

As consumers face reduced switching costs and become, on the whole, more involved in their healthcare, we will all need to meet new standards of quality and price, impacting both the clinical and administrative aspects of health care delivery. At Kaiser Permanente, we are driving improved levels of auto-adjudication, which of course improves administrative costs, but more importantly drives better claims payment quality, which in turn, favorably impacts the member and provider experience. We currently measure quality through audit results and claims adjustment rates. Going forward, through the continued use of data management and analytics, our view of quality will advance to be more comprehensive and be an “end-to-end” definition.

  • The Criticality of “System” Quality
  • Analytics Team Roles (the traditional, some mold breaking, the power of struggle and cross functional unity)
  • Data Architecture & Integration (design with the end in mind, dimensional modeling)
  • Desktop Data Blending Tools (a new layer: data prep tools)
  • Front End Analytics (analysis, dashboard systems, reports, tools)
  • Economies of Scope (using the data for another subject)

Raul MatasDirector of Analytics, National Claims Auto Adjudication & Outside Medical ExpenseKaiser Permanente

12:00

Close of Conference