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Monday August 1, 2005
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7:00 am
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8:00 am
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8:15 am - 9:00 am
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This session is a case study of the large scale pay- for- performance collaborative in California.
During this case study you will:
- Investigate the results of the first two years of performance measurement in the clinical, patient experience and information technology domains.
- Analyze lessons learned in data collection, measure selection, physician group engagement and payment incentives
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Tom Davies
Chairman, IHA Board of Directors
Integrated Healthcare Association
 View Biography
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Tom Williams
President
Integrated Healthcare Association
View Biography
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9:00 am - 9:45 am
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In 2002 Massachusetts Health Quality Partners received a 3 year grant from RWJF as part of its Rewarding Results program. This grant enabled MHQP to aggregate physician-level clinical quality information across its five member health plans (with about 4.3 million members in Massachusetts), provide physician organizations comparative results at the practice site, medical group and network levels, to publicly release comparative results at the network and group levels, and to assess the effect of health plan financial and non-financial incentives and the MHQP public release on the quality of care provided and improvements in quality over time.
During this case study you will:
- Consider the benefits and pitfalls of MHQP’s processes of aggregating data across different systems and accurately assign physicians to groups
- Recognize the need for collaboration within the physician community to increase the utilization of the information for quality improvement
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Janice A. Singer
Director of Operations
Massachusetts Health Quality Partners
View Biography
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10:00 am
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10:15 am - 11:00 am
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A model pay-for-performance program has been implemented in the Rochester community, based on previous experience in Rochester and Buffalo. The program is composed of a preventive health, acute care and chronic illness measures with improvement tools. This three year project has refined understanding of the essential requirements of practitioner performance improvement programs. For example, the requirement of program commitment from the plan and the physician community, an understanding of the cycles of change that plan management and the physician community must process in shifting to performance measurement and companion financing programs, and the technical requirements of developing and using accurate measures with effective, action oriented improvement tools for physicians and useful impact management reports to confirm return on investment for the plan’s business case is significant.
During this case study you will:
- Exchange strategies for reporting on improvements in care, utilization and cost
- Uncover insight from physician feedback on the program
- Determine tactics for plan-wide expansion of the program
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Howard Beckman M.D.
Medical Director
Rochester Individual Practice Association (RIPA)
View Biography
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Kathleen Curtin
Senior Vice President for Client Services
MedVantage, Inc;
former Vice President for Practitioner Performance
Excellus Health Plan
View Biography
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11:30 am
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Howard Beckman
M.D.
Medical Director
Rochester Individual Practice Association (RIPA)
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| Howard Beckman, MD is Medical Director of the Rochester Individual Practice Association. He is also Clinical Professor of Medicine and Family Medicine at the University of Rochester School of Medicine and Dentistry. Between 1990 and 1998, Dr. Beckman was Chief of Medicine at Highland Hospital where he also served as Program Director for their Primary Care Internal Medicine Training Program and helped create an integrative medicine program. Since 1998, Dr. Beckman’s research interest in creating effective partnerships has turned to creating a win-win relationship between the Rochester Individual Practice Association and Excellus BlueCross BlueShield – Rochester region. Together, the organizations have agreed to share data, create transparent physician profiling reports, gain share on cost savings and most recently, develop pay-for-performance programs. |
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Kathleen Curtin
Senior Vice President for Client Services
MedVantage, Inc;
former Vice President for Practitioner Performance
Excellus Health Plan
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| Ms. Curtin is the Vice President for Practitioner Performance for Excellus Health Plan, a non-profit Blue Cross Blue Shield Plan serving 2 million enrollees in New York State. She has served as vice president of quality management for Univera and Excellus for close to twenty years. Quality management programs have addressed clinical, service and risk improvements, as well as HEDIS reporting, NCQA accreditation and regulatory compliance. The foundation of these quality improvement programs has been practitioner profiling, companioned with patient specific improvement tools. Building on experience in two managed care communities, the program will serve all plan regions and products to include PPO and indemnity. Ms. Curtin has taken responsibility for this program expansion leading a formal, interdisciplinary project management team. |
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Tom Davies
Chairman, IHA Board of Directors
Integrated Healthcare Association
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Tom is the immediate past chairman of the Integrated Healthcare Association (IHA), and serves also as steering committee chair for IHA’s Pay for Performance Project. This undertaking is the nation’s most far reaching effort to demonstrate the business case for quality health care through substantial performance based health plan payment incentives to physician groups.
Additionally, in his day job as an independent health care management consultant, Mr. Davies leads Verizon’s quality driven “value purchasing” strategy for providing health benefits to more than 50,000 employees, retirees and dependents in 17 western states. This role includes the evaluation, selection, service and performance monitoring, and annual premium and renewal contracting involving more than thirty competing HMO and specialized managed care product offerings in Verizon’s health benefits program.
He is a long time member of the Board of Directors of the Pacific Business Group on Health and, until recently, its executive committee. Additionally, Tom serves on the Financial Solvency Standards Board of the California Department of Managed Health Care, and he chairs the Purchasers Advisory Committee of the National Committee on Quality Assurance.
Tom joined the former GTE (now Verizon) in 1992, bringing a background in health care both as a consultant to managed care and provider organizations, and as a Senior Vice President of Blue Cross of California. He is a graduate of Miami University (BA); the University of Pittsburgh Graduate School of Public and International Affairs (MPA); and the John Marshall School of Law (JD). |
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Katy Henrickson
Senior Analyst
Forrester Research
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| Ms. Henrickson is a senior analyst on Forrester’s Healthcare and Life Sciences team. Her research focuses on technologies and solutions that support core health plan functions, especially claims administration, provider network management, and medical management. Prior to joining Forrester, Ms. Henrickson was a strategy and operations consultant for Deloitte Consulting, where she advised health plan, provider, and life sciences clients. She led teams in a broad variety of engagements, conducting technology assessments, evaluating competitive strategies, and developing business cases.
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Janice A. Singer
Director of Operations
Massachusetts Health Quality Partners
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| Ms. Singer joined Massachusetts Health Quality Partners (MHQP) in 2003 to become its Director of Operations. She participates in MHQP’s business planning and directs MHQP’s RWJF Rewarding Results initiative to aggregate and publicly report comparative clinical quality performance for physician networks and medical groups. Ms. Singer has over 20 years of experience in health care program development, management and research. She has served as Director of Managed Care Programs for the Massachusetts Medicaid Program and as a Senior Project Director for the Health Policy Center of Brandeis University where she managed a federal health policy grant for a coalition of research centers and evaluated health care programs across the United States. Ms. Singer spent 11 years with Blue Cross and Blue Shield of Massachusetts, directing a variety of program development and strategic planning departments. Directly before joining MHQ, she was the Director of Market Research and Business Development at Fallon Community Health Plan. |
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Tom Williams
President
Integrated Healthcare Association
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| Tom Williams was appointed Executive Director of the Integrated Healthcare Association (IHA) in April 2004. He serves as the organization’s chief executive officer, as a member of the Board of Directors and the Executive Committee, and is actively engaged in management of its statewide pay-for-performance initiative. Williams has more than twenty years in the field includes extensive experience with mergers, acquisitions and general management of health care organizations. Prior to IHA, Williams served as a consultant to private healthcare companies in business development, medical management and healthcare technology. Williams was an executive at Aetna, Inc. from 1989 through 2002. Before Aetna, Williams was an executive at Maxicare, a national HMO and administrator of a multi-specialty physician group. |
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