Health Datapalooza - Creating a Virtuous Cycle: Design and Curate a Risk-Ready Network
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The document discusses the challenges and strategies of managing risk in healthcare amidst changing populations and dynamic payment models. It emphasizes the importance of utilizing public health data and analytic approaches to reduce low-value care, which accounts for a significant portion of healthcare spending. The session aims to equip participants with the knowledge to design effective networks and incentivize value-based care delivery.
Health Datapalooza - Creating a Virtuous Cycle: Design and Curate a Risk-Ready Network
- 1. OWNING RISK IS TOUGH, BUT IT’S WHERE THE ACTION’S AT Once upon a time plans had large group commercial populations with years of consistency and providers simply delivered services for a fee. But government programs like Medicare Advantage, Marketplace / Exchange and Medicaid, have populations changing every year, or even every month and providers managing a population's health over time. Changing populations and dynamic payment models may make it tough to predict and achieve member outcomes in a financially sustainable way precisely when providers are getting in the game to take on risk. Public health data are providing solid case studies of achieving member health and happiness with sustainable financial models for all players in this new game. If you are managing risk, considering taking on risk, or investing in or providing products or services to anyone bearing risk, camp out in these sessions to learn how to use public data and internal resources to: § Effectively leverage analytic approaches to manage risk § Accurately assess risks and project costs § Effectively align providers and incentivize care delivery CREATING A VIRTUOUS CYCLE: DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE FROM FEE FOR SERVICE AND CREATE VALUE-BASED WINS FOR BOTH PAYERS AND PROVIDERS USING CMS BENCHMARK DATA Value Proposition: Designing and Curating a Pay-for-Value Ready Network Moderator: Joshua Rosenthal, Co-Founder and Chief Scientific Officer at RowdMap, Inc. Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer at Health Care Service Corporation “The value propositions for public data either disintermediate or innovate owning risk – either way they can’t be ignored.” Session Participants Joshua Rosenthal, PhD, Co-Founder and Chief Scientific Officer at RowdMap, Inc. Jonathan Blum, EVP at CareFist and Former Principal Deputy Administrator at CMS Sachin Jain, MD, Chief Medical Officer and Chief Operating Officer at CareMore Steve Ondra, MD, Chief Medical Officer at Health Care Service Corporation Chair & Vice Chair Kavita Patel, MD, Brookings Institute and Former Director of Policy, The White House Niall Brennan, Chief Data Officer, CMS
- 2. CREATING A VIRTUOUS CYCLE: DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE FROM FEE FOR SERVICE AND CREATE VALUE-BASED WINS FOR BOTH PAYERS AND PROVIDERS USING CMS BENCHMARK DATA Value Proposition: Designing and Curating a Pay-for-Value Ready Network Moderator: Joshua Rosenthal, Co-Founder and Chief Scientific Officer at RowdMap, Inc. Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer at Health Care Service Corporation Description: High-performing networks are not enough to succeed in value based arrangements and classic triple aim measures miss a major key to success: reducing low-value care. 30 cents of every dollar paid goes to low-value care, or procedures and prescriptions that do not produce any additional positive outcomes. Low-value care accounts for roughly 3% of GDP and drove billing in Fee-for-Service economic arrangements. The key to succeeding in value based programs and risk arrangements is identifying and reducing low-value care. Newly released CMS data allows anyone to determine design and curate a network of providers to succeed in value based programs. Join this session to see real-world, operational examples of a virtuous cycles where payers and providers successfully reduce low value services and share the positive results. No-Value Care (30%) Necessary Utilization (70%) Care That Doesn’t Produce Better Outcomes $850 Billion Unnecessary Spend in 2014 (Institute of Medicine) Low Value Care Drives Billing in Fee for Service “#1 Weakness of FFS Payment System Is Excess Use of Low Value Services” Dr. Patrick Conway, Chief Medical Officer, CMS