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Tuesday, April 14, 2009
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12:55 pm -
1:45 pm
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- Similarities between California and federal reform proposals
- The role played by health plans in the California reform effort
- How Congress and the administration can overcome the obstacles that defeated reform in California
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Bruce Bodaken
Chairman, President and Chief Executive Officer
Blue Shield of California
 View Biography
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- Protect the ability to innovate at the state level
- Examples of state advances in the medical home, baskets of care, consumer engagement
- Minnesota's unique set of assets that have been successful in promoting overall health care
- Effective marketplace collaboration to promote health care outcomes
- "Prevention Minnesota" – Advances made in smoking cessation and the continued benefits of the historic Tobacco settlement (MN holding a lower smoking rate than the national average from – dropping from a 22% smoking rate to a 17% state wide smoking rate; compared to the 22% national rate
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Patrick Geraghty
President and CEO
Blue Cross and Blue Shield of Minnesota
View Biography
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1:50 pm -
2:40 pm
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- The development and use of new lifestyle-based predictive models that operate in the absence of HRA and/or medical claims data
- How new models use consumer segmentation and sociodemographic data to identify individuals at risk for the harmful effects of lifestyle-related behaviors and conditions, including smoking and obesity
- Strategies to engage individuals to participate in programs aimed at improving their lifestyles and lowering risk of future costly medical conditions
- Health Net Case Study: The application of these models in Health Net's wellness program, with a focus on cardiometabolic risk management
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3:10 pm -
4:00 pm
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- Strategic Use of the Pay-for-Performance and Integrated Health Management
- Pay-for-performance program results with 65+ measures: impact on measures and outcomes
- Differential impact of P4P on lower quartile performing providers
- Supporting Infrastructures: Subsides for EMRs and Sharing Data
- Align quality measures with DHHS value-based measures and migration to PQRI and Standard Measures
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Richard Chung, MD
Senior Vice President, Health Services Division
Hawaii Medical Service Association (HMSA)/Blue Cross Blue Shield of Hawaii
View Biography
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Pay-for-Performance, Part II:
Paying Providers for Quality - The Alternative Quality Contract |
- Moving beyond pay-for-performance to provider contracts that pay for quality and reward efficiencies
- Tying new payment models to evidence-based medicine and comparative effectiveness models
- Development and launch of the Alternative Quality Contract to pay providers for quality and outcomes, not volume and complexity
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John A. Fallon, MD, MBA
Senior Vice President and Chief Physician Executive
Blue Cross Blue Shield of Massachusetts
View Biography
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10:40 am -
11:30 am
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| Part I. Deploying a Care Management Platform for Members and Physicians |
- The analytics of HCSC’s population and identifying a member’s Opportunity Score
- Strategies to identify greatest risk patients with the highest potential for behavior change
- The Opportunity Score – Review of data from the enterprise, plan and individual/group level
- Proliferation of data into 3 areas: Web portal for members, nurse case mangers and physicians in network
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William E. Gerardi, MD
Vice President and Executive Medical Director, Enterprise Health Care Management
Health Care Service Corporation
View Biography
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| Part II. Strategies to Secure Engagement |
- Critical elements of the care plan
- Direct to member outreach – implementation of IVR technology for screening
- Benefit design and incentives – employer incentives for health risk reduction, impact of high deductible health plans on screening
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Roberta Herman, MD
Chief Medical Officer and Senior Vice President of Health Services
Harvard Pilgrim Health Care
View Biography
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11:35 am -
12:20 pm
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- Consumer Engagement through Personal Health Records; Blue Cross Blue Shield of Massachusetts' strategy
- Implementing Google Health™ as part of a consumer engagement strategy for health plan members
- How do PHRs fit into an HIT strategy
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Steven J. Fox
Vice President, Provider Network Management
Blue Cross Blue Shield of Massachusetts
View Biography
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Lisa Latts, MD, MBA
Vice President, Programs in Clinical Excellence
WellPoint, Inc.
View Biography
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