Speaker Presentation
Tuesday, February 26, 2019

Registration and Continental Breakfast


Chairman's Welcome

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


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


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


Networking Refreshment Break


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.


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


Automating Denials Workflow Using AI and Other Technologies

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


Operationalizing Bundled Payments

Session will cover conventional bundled payment wisdom + learning’s from Geisinger’s direct-to-employer bundled contracts. Plus, benefit from key takeaways from Geisinger’s 13 years’ experience with bundled payments.

Christy L. Pehanich, MHSA, FHFMA, CPCAssociate Vice President of Revenue Management – Revenue Management Professional ServicesGeisinger


How the Fintech Revolution is Impacting Payments Between Payers and Providers

Recent leaps forward in digital payment technology means the combination of claims data (835 ERA) and the payment in one place. Find out how this structural advance will change the way payments and claims are managed, with unprecedented accuracy of payments and vast reductions in reconciliation effort.

Gordon MatthewsFounderAmplaPay


Networking Lunch

Sponsored By: Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.


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


Panel: Streamlining Billing and Collections


June St. John, CTPSenior Vice President, Healthcare Product ManagerWells Fargo


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

Ginger A Ryder, CMPE, CHBME, CPCPresident, EMEDEXPresident, Healthcare Billing and Management Association (HBMA)

Ryan O’HaraChief Revenue Officer, Northern Arizona Healthcare


Case Study: Patient Financial Engagement Through A/R System Conversion: What It Really Means To Put Patients First

In 2018 Atrium Health completed a multi-year conversion to Epic’s System Business Office Revenue Cycle module which consolidates patient balances for hospital and professional services onto a single patient statement and supports a single point of contact for patient inquires relating to hospital and professional patient balances. While this multi-year, multi facility, approach allowed Atrium Health to most efficiently align organizational resources, protect revenue and cashflow, it created an environment in which patients could receive billing statements from multiple billing systems and/or multiple facilities and professional providers over an extended period of time.

In this session Chris will share the process Atrium Health followed to minimize the impact of this system conversion on their patient population, tools Atrium Health developed; including enhancements to patient communications, billing statements, integrated voice response systems (IVR), and patient payment portals. Additionally Chris will share with attendees tools developed to assist the Customer Service Team Members during the migration to a new system, overall challenges presented, successes achieved and lessons learned from the Atrium Health Journey.

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


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


Networking Refreshment Break


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


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


Arnold TorresExecutive Director, Healthcare Industry SolutionsJ.P. Morgan


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

Brad TinnermonVice President of Revenue Cycle and Revenue IntegrityBanner Health

Dr. Steve NeelemanCo-Founder and Vice ChairmanHealthEquity

Doug BilbreyVice President, SalesVestaCare, Inc.


Earned Underpaid Managed Care Revenue

A technological approach to a Zero Balance payment review.

Theresa KalemFounder and CEOHealthcare Retroactive Audits, Inc.


Networking Reception

Sponsored By: Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

Wednesday, February 27, 2019

Networking Continental Breakfast


Chairperson’s Remarks

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


Transforming Healthcare Payments with Artificial Intelligence

Prasanna GanesanCEO, Co FounderMachinify Inc.


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


The RTP® Network, the Prescription for Improved Cash Flow and Efficiency in Healthcare Payments

While the need for fast and simple payments between individuals is easy to understand, the case for large and small businesses is equally if not more compelling, although perhaps not as obvious. Much of the discussion typically revolves around the cost of payments, but the real value lies in the ability for businesses to reengineer the way the manage their cash flow, and improve the way they interact with their clients and suppliers. Speed of the payment is only one component of value, with integrated messaging playing a more dominant role in the value that Faster Payments can provide. This session will explore the drivers of demand for Faster Payments across all business segments, including the need for more flexible and precise cash flow management, improved STP and back office efficiencies, alternatives to inefficient payment methods such as cash and check. Learn how the RTP® Network can help you achieve these goals.

Irfan AhmadSenior Vice President, Product Development and StrategyThe Clearing House


Networking Refreshment Break


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


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


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


Close of Conference