Concurrent and Breakfast Session Tracks

These dynamic sessions feature organizations that provide leading products and services to help with reform implementation. These sessions showcase innovations, strategies, and solutions for your business and operational challenges.

Tracks Include: 

Consumer Engagement Strategies to Drive Sustainable Consumer Behavior Change |  Leveraging Data, Information, and Analytics to Streamline Operational and Administrative Processes New Technologies Transforming Health Care Alternative Care Delivery and Payment Models that Promote Value, Efficiency, and Quality Innovative Health Insurance Plan Strategies, Models and Products for a Post-Reform Environment Compliance Track: Building Your Compliance Capabilities  


 

Consumer Engagement Strategies to Drive Sustainable Consumer Behavior Change 
  • What is the role of incentives in consumer engagement?
  • How are companies designing benefits that promote employee engagement and accountability?
  • How can companies create a consumer experience that enhances member satisfaction and retention?

 

Achieving Total Population Health Management by Applying Private Sector Solutions
Presented by Healthways 

More companies are implementing population-based integrated health initiatives as a means of enhancing the health and well-being of their employees. This session will highlight proven strategies for creating a culture of health and well-being while adapting to new healthcare reforms. The speakers will focus on all determinants of health and apply frameworks that can help shape strategic priorities for future success.

 

Reconciling the Great Healthcare Consumer Paradox: Are Consumers Willing to Change to Get What They Want?
Presented by Accenture  

Join a lively discussion on the next generation of Consumerism and Consumer Engagement.  With an expanding "retail" health care marketplace, there is a greater opportunity for health plans to develop innovative strategies to reach consumers entering this marketplace for the first time. It will be critical for plans to effectively engage these new consumers and assist them in making good health care decisions. More than half of employers say that lack of engagement is their biggest obstacle to changing their employees’ health habits. This session will explore the approaches and barriers to effective engagement, and discuss how one health plan has transformed itself to give consumers what they want.

Speakers: 

  • Steven C. Nelson, Senior Vice President, Health Services Strategy, Product, & Marketing, Highmark Blue Cross Blue Shield
  • Jean-Pierre Stephan, Senior Executive, Health CRM, Accenture

 

Incentive Tracking... A Health Plan Case Study
Presented by HealthTrio, LLC 

Many health plans are using incentives to encourage consumers to participate in health management programs and alter unhealthy behaviors. An incentive tracking service can provide plans with a platform to track financial and non-financial rewards for members who have completed wellness, prevention or other designated activities. In this session, you will hear how an incentive tracking service has helped a leading health plan streamline its reward disbursement process.

Speaker: 

  • Bob Trombly, Deputy Chief Information Officer, Harvard Pilgrim Health Care

 

Redefining Healthcare Through Shared Decision Making
Presented by Health Dialog Services Corporation 

With the shift towards patient centeredness and more accountable care, time and resource-constrained doctors are embracing new models for delivering and organizing care. In this session, hear how one of the country’s leading non-profit health plans is redefining the doctor-patient relationship through the practice of Shared Decision Making. By combining state-of-the-art patient decision aids with focused discussion on treatment options and patient preferences, quality of care improves, costs are reduced, and patients and providers experience renewed satisfaction with the system.

Speakers: 

  • Paul Sherman, MD, MHA, Executive Medical Director for Health Plan Services & Medical Director for Care Systems Development, Group Health Cooperative
  • Peter Goldbach, MD, Chief Medical Officer, Health Dialog

  

Driving Toward Wellness: The Road to Success
Presented by Amylin Pharmaceuticals 

This session will highlight a real-life example of a successful diabetes health care program that addressed the problem of unsustainable health care costs and disengaged consumers. Learn from the decisions made by multiple stakeholders who worked together to achieve their most important common goal: the well-being of patients and consumers. You will leave with a better understanding of how consumers can reduce their health care costs, and what steps companies can take to help them. 

Speakers: 

  • Gary L. Moffitt, MD, Owner, Arkansas Occupational Health Clinic
  • David W. McKinney, MD, MPH, Chief Executive Officer, California Occupational Medical Professionals
  • Richard Kersch, President, Human Factors Analytics, Inc.

 

Don’t Forget About Direct: Building a Best in Class Telesales Capability
Presented by Deloitte Consulting, LLP  

Health Insurance Exchanges are a priority marketplace for many health plans future growth strategies, but telesales will continue to be an important direct distribution channel long after 2014. This session will present a model for the telesales organization of the future, one that can have the capabilities and scale to support the complex and varying demands of customers in the individual marketplace. This session will focus on executable practices to help develop or enhance a telesales organization and will include talent, incentives, flexible work arrangements, and alternative delivery models; processes, operating models, and performance management; technology platforms and data integration; and multi-channel considerations.

Speakers: 

  • Andy Haas, Director, Deloitte Consulting LLP
  • Danielle Robinson, Specialist Leader, Deloitte Consulting LLP

 

The New Era of Customer Communications – The Journey Begins Here
Presented by Thunderhead.com 

Supporting the customer journey within health insurance is complex, competitive, and becoming much more regulated. As health insurance plans evolve from what was once a primary business-to-business sales model, with a transactional claims adjudication focus, to a personalized consumer-oriented sales and service model, the need to meet or exceed customer expectations will become more critical. This presentation will provide insights on the key trends, issues, and implications for payer communications approaches, and a look at the payer best practices that are yielding the biggest impact to customer experience. The speakers will also discuss opportunities to positively impact both customer satisfaction and administrative costs by changing approaches to member communications.

Speakers: 

  • Dean Heckman, Solution Architect, Thunderhead.com  
  • Lawrence Hogan, Global Director of Industry Marketing for Insurance, Thunderhead.com

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Leveraging Data, Information, and Analytics to Streamline Operational and Administrative Processes 
  • How are companies aligning health IT initiatives, business strategies, and reform priorities?
  • What are strategies for leveraging disparate data sources for clinical analytics, risk management, and driving business decisions?
  • What are strategies for improving timeliness, transparency and accuracy in claims processing?

 

Real Data, Real Impact: Claims Processing and the Business Case for Improving Adjudication
Presented by OpenConnect  

This session will highlight the results of a recent survey examining claims processing and provide insights on market solutions that can improve efficiencies in key metrics. The panel will use the survey data as the basis for a business case discussion that also demonstrates the benefits of claims adjudication for the health plan and consumer. A sample of the data points surveyed include: electronic vs. paper claims; claims processing and receipt times; adjudicated claims, and audited claims.

Speakers: 

  • Jeff Lemieux, Senior Vice President, Center for Policy and Research, AHIP 
  • Edward Peters, Chief Executive Officer, OpenConnect

 

Maximizing the Clinical and Financial Value of Big Data Using Digital Enterprise Strategy as a Guide
Presented by Tata Consultancy Services 

Health care, like other industries, is now learning to unlock the potential of Big Data. Internally generated administrative claims data is being supplemented with provider-based clinical outcomes data and information gleaned from third party sources. These sources include social media, mobile medical devices and unstructured customer service and medical management case notes. As other industries have demonstrated, predictive risk models and business decisions can benefit greatly from the addition of these non-traditional sources. Optimizing the value of Big Data, however, requires an overarching Digital Enterprise Strategy. Information obtained from diverse, new data sources can inform decision-making across the organization, rather than individual business units. This session will explore how an up-front investment in a Digital Enterprise Strategy can help health plans to realize the value of Big Data and optimize clinical and clinical risk management in the changing marketplace.

Speaker: 

  • Christopher Scheib, Healthcare Consulting Practice, Tata Consultancy Services  

 

Strategies for Optimizing Medical Record Retrieval
Presented by Enterprise Consulting Solutions, Inc. 

Medical record retrieval can be challenging and costly for health plans that haven’t implemented a strategy to manage the process. This session will examine common concerns associated with medical retrieval projects and key issue surrounding outsourcing and solution provider selection. The speaker will address the role of supporting call centers and documentation procedures/requirements for 2013 medical record retrieval projects.

Speaker: 

  • Craig Mercure, Vice President, Enterprise Consulting Solutions, Inc.

 

Risk Adjustment Strategies for Health Insurance Exchanges
Presented by Inovalon 

Risk adjustment has been used for years in managed care for reimbursement. With the arrival of health insurance exchanges, risk-based contracting requires the implementation of risk adjustment programs. There will be similarities and differences in the models and strategies for achieving risk score accuracy. Best practices from years of experience in risk adjustment may be applied with modifications for the unique requirements of the health insurance exchanges.

Speaker: 

  • Troy Dinkel, MD, Chief Product Officer, Inovalon

 

Care is the New Core. Population Health Strategies Drive Better Care Coordination and Better Member Outcomes
Presented by DST Health Solutions 

In today’s continually evolving healthcare landscape, health plans must be proactive in their efforts to dramatically improve coordination and quality of care. Imagine if a health officer had access to real-time information on the health status and care patterns by neighborhood or by leveraging EHRs linked to smart devices, a medical director could identify, monitor and improve the care of tens of thousands of persons with chronic diseases. This is a new era in population health. Join this insightful discussion where industry experts share trends and best practice approaches to population health management that are enhancing care collaboration in the community they serve.  

Speaker: 

  • Teri Mullaney, Vice President, Strategic Solutions, DST Health Solutions

 

Industry Survey Offers Insights for 2013 Planning
Presented by HTMS, an Emdeon Company 

Each year leading researchers assess the top priorities and challenges for health plans in the coming year through an annual survey initiative. The results of this research contribute a health plan voice to the public health care dialogue, the industry's dynamic challenges and enable payers to benchmark their organizations against the industry as a whole. This session will offer insights into this year’s survey results with a focus on the dynamics of this unique period of time for the health care industry. Learn about the ongoing shifts in health plan priorities and operational challenges; the response and perspectives on the Supreme Court ruling and recent elections; perspectives on ACOs and other payment reform initiatives; and updated insights on how Health Information Exchanges and Health Insurance Exchanges could impact health plans business.

Speakers: 

  • Alan Abramson, Senior Vice President of IS&T and Chief Information Officer, HealthPartners
  • Tom Carleton, Director of Strategic Development, Blue Cross Blue Shield of North Carolina
  • Ferris Taylor, Director, Managed Care Executive Group (MCEG)
  • Nancy Wise, Vice President of Strategy, HTMS, an Emdeon company

 

Leveraging Advanced Analytics to Understand and Influence Member Behavior
Presented by SAS 

As the health care landscape evolves, health plans should consider managing their operations by employing methods from other successful consumer-focused industries. These industries utilize a myriad of consumer data along with advanced analytics to understand customer preferences, attributes and behaviors. Health plans could achieve this same level of sophistication while adhering to HIPAA and other health-care specific guidelines by incorporating non-traditional member data along with similar advanced analytics solutions. This session will explore the benefits to health plans of engaging continuous-learning software and refreshed data to refine their business proposition, predict and guide member behavior, and further understand and manage risk.

Speakers: 

  • Arjun Aggarwal, Managing Director, Healthscape Advisors LLC
  • John Steele, Managing Director, Healthscape Advisors LLC
  • Dipti Patel-Misra, Senior Manager, SAS’ Center for Health Analytics & Insights

 

Leveraging Data Analytics and Operational Integrity to Overcome the Challenges of the New Healthcare Exchanges
Presented by Infogix, Inc. 

With the addition of the new healthcare exchanges comes an increase in the need for real-time operational views into your data. What solutions exist to provide this insight into in-flight data?  The speakers in this session will discuss tools to gather analytics that reduce risk and improve your company’s operations. Hear about one health plan’s experience and how they are able to leverage software that ensures the integrity of their operations in preparation for Exchanges. The speakers will also provide insight into how these tools can be sustained in the new marketplace.

Speakers: 

  • John Gatto, Divisional Vice President, IT Audit & Advisory Services, Health Care Services Corporation
  • Sumit Nijhawan, Chief Executive Officer, Infogix, Inc.

 

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New Technologies Transforming Health Care 
  • How are mobile monitoring technologies improving care for individuals with chronic conditions?
  • How is social media transforming the patient experience and increasing consumer engagement?
  • What new apps and gaming strategies are enhancing the care continuum?
  • What are strategies for leveraging modern technology platforms to meet 21stcentury business goals?

 

Facing the Impact of Healthcare Reform – How Telehealth Will Help
Presented by Teladoc Medical Services 

Telehealth is a solution designed to improve access, cost, and quality of care by bringing health care to the patient -- instead of the reverse. And through the use of expanding consumer technologies, telehealth will continue to evolve to reach the patient as an affordable, accessible, and convenient solution for quality care. Learn about the state of telehealth today, including examples of the direct impact of telehealth on lowering costs through the redirection of high-cost services such as the emergency department and urgent care centers for non-urgent diagnosis. Our speaker will also discuss the unique advantages of a telehealth strategy as plans prepare for ACOs and Exchanges, as well how health plans can use telehealth to expand their service portfolio for their ASO accounts.

 

Deciphering QHP Certification
Presented by Softheon, Inc. 

This session will focus on the Qualified Health Plan (QHP) certification process as it relates to the coordination of data-collection efforts and technical implementation of state health benefit Exchanges. The speakers will address CMS and NAIC SERFF guidelines and relate experience gained from participation in the Massachusetts Commonwealth Connector. The speakers will also discuss how multi-state carriers can participate in several State Health Benefit Exchanges using the common Exchange Plan Management platform functions. 

Speakers: 

  • Jim Donnelly, Managing Director, Softheon, Inc. 
  • Robert Miller, Healthcare Reform Program Manager, Softheon, Inc. 
  •  Eugene Sayan, CEO & President, Softheon, Inc.

 

Beyond Accountable Care Organizations: Creating the Accountable Consumer
Presented by Dell  

Health care reform to date has focused on providers, health plans, and funders of care, but only incremental attention has been paid to the stakeholder at the center of care—the individual consumer. This session will focus on the future of the consumer, including how data can be leveraged to accelerate genetic analysis and identify targeted treatments for individual patients. The speakers will also examine how health insurers are embracing incentives, data analytics, social media, and mobile health applications, to engage consumers and build a broader partnership for accountable care. 

Speakers: 

  • Robert Teague, MD, Physician Advisor, Dell Services Healthcare & Life Sciences
  • Andy Arends, Practice Leader, Dell Services Healthcare & Life Sciences

 

Fad or Tipping Point: The Impact of Exchanges on Employer-Based Health Plans
Presented by bswift 

In this session, you'll learn about the forces driving employer interest in private exchanges, predictions about the long term staying power of exchanges, and which types of exchanges are most likely to succeed. The panel will compare and contrast different exchange approaches, and weigh the issues that carriers must consider when determining which and how many exchanges to engage.

Speakers: 

  • Vince Ashton, CEO, HealthPass New York
  • Craig Hasday, COO, Frenkel & Company, International Insurance Brokers
  • Paul Wingle, Head of Exchange Strategy and Implementation, Aetna

 

Provider/Patient Texting: The Promise and the Peril
Presented by 3pTALK 

Text messaging is a dominant form of communication that most providers and many patients, especially the younger demographic, are increasingly familiar with. On the one hand it provides us with a powerful new communication tool to supplement provider portals, email and social media. Yet, several barriers exist to actually using it for communications between providers and patients or between providers. Are texts taken as seriously as more formal forms of communication? Can it be made secure and HIPAA compliant? Do providers really want ability to let patients text them indiscriminately? Are payors willing to underwrite the time and communication expenses?  Join panelists representing the various constituencies for a lively debate on the promises and perils.

Moderator:  

  • Ravi Ganesan, Founder, 3pTALK 

Speakers: 

  • Andrew Albert, MD, MPH, Chicago Gastro LLC and co-Founder, Fibroblast 
  • Kevin Arner, CEO, PaySpan Inc. 
  • Meghan Bradley, Member Program Manager, Illinois Technology Association (ITA) 
  • Dan Phillips, Vice President, Sandbox Industries

 

Creating Optimal Customer Service Programs, Post-Reform 
Presented by Sykes Enterprises, Inc. 

This session will explore the full range of customer care programs from sales, enrollment, general customer service, provider care and telehealth and discuss how to adapt customer service for the post-reform environment. The discussion will provide insight into customer care delivery strategies for each type of care that will accomplish the goals of creating outstanding customer service experiences. You will learn what individual plan members and providers can expect from their customer service experience, when to consider outsourcing customer service, and how virtual service models can be applied.

Speaker: 

  • Mike Clarkin, Senior Vice President of Marketing, Global Contact Centers, SYKES Enterprises

  

Beyond Accountable Care Organizations: Creating the Accountable Care Consumer
Presented by Dell 

Health care reform to date has focused on providers, health plans, and funders of care, but only incremental attention has been paid to the stakeholder at the center of care—the individual consumer.  This session will focus on the future of the consumer, including how data can be leveraged to accelerate genetic analysis and identify targeted treatments for individual patients. The speakers will also examine how health insurers are embracing incentives, data analytics, social media, and mobile health applications, to engage consumers and build a broader partnership for accountable care.  

Speakers: 

  • Robert Teague, MD, Physician Advisor, Dell Services Healthcare & Life Sciences
  • Andy Arends, Practice Leader, Dell Services Healthcare & Life Sciences

 

Connecting to State and Federal Health Insurance Exchanges - Opportunities and Challenges
Presented by hCentive, Inc. 

The upcoming state health insurance exchanges present a new channel for health plans to market their products on a grand scale. However, integrating internal IT systems with disparate state and federal insurance exchange systems is likely to be challenging. The ability to deliver a seamless online insurance shopping experience to millions of consumers will require a reliable solution that can facilitate health plan integration with state and federal exchanges. This session will highlight key requirements for enabling effective collaboration among insurers and different state/federal agencies. The speakers will discuss the scope and magnitude of technology integration tasks necessary to operate in the new Exchange model. You will hear about business strategies and solutions that address the challenges of adequately interacting with state/federal exchanges and minimize the impact of federal rulings to your existing services and technical infrastructure.

Speakers: 

  • Prabhakar Ram, VP, Products, hCentive
  • Gary Schneider, IT Product Manager, Colorado Health Benefit Exchange (COHBE) 
  • Shan Swaminathan, Director - Enterprise Architecture, Delta Dental

 

The Next Wave: Five-Steps for Adapting to Constant Change
Presented by HealthEdge 

The payer industry is currently in the midst of an era of unprecedented upheaval. While this level of change is generally tied to new industry regulations (ICD-10, HIPAA 5010) and the adoption of next-generation healthcare business models (HIEs, P4P, ACOs), it is now clear that this is just the beginning. Payers that want to be successful in the new healthcare economy will need to find ways to leverage modern technology platforms to meet their 21st century business goals. Business as usual is no longer a viable option. Even if an organization is not currently planning on engaging in next-generation business models, it is not immune from the need to evolve. How do you prepare? This session will explore the reality of constant change, and provide a five-step roadmap that payers can use to ensure that they are ready for the new normal.

Speaker: 

  • Ray Desrochers, Executive Vice President, HealthEdge

  

Strategic Solutions for Health Plans: Technologies that Drive Cost Efficiencies, Consumer Satisfaction, and Improved Health Outcomes
Presented by Hewlett-Packard 

In this ever-changing health care environment, health plans must confront evolving and still-uncertain regulatory requirements, tough new competition, tighter controls on administrative costs, and the continued dramatic shift towards the empowerment of healthcare consumers. Surviving and succeeding in this dynamic environment requires health plans to undertake rigorous evaluation and adoption of new business models, new processes, and a promising array of next-generation technologies. This session will address the crucial role technology can and will play in how health plans adapt and succeed, and how next-generation cloud computing and mobility solutions are one promising solution to better engage consumers. These new technologies can help health plans gain efficiencies to provide anywhere/anytime connectivity across their value chain.

Speakers: 

  • Paul Thompson, Commercial Healthcare Strategy Director, U.S. Health & Life Sciences Industry, Hewlett-Packard 
  • Larry Schmidt, Chief Technologist, Americas Health & Life Sciences Industry, Hewlett-Packard 

 

Leveraging Technology and Designing Financial Incentives to Drive Sustainable Behavior Change
Presented by Walgreens 

This session will explain how technology can increase patient access to vital specialty and infusion services while enabling patient health care decisions that improve clinical outcomes and decrease treatment costs. The discussion will primarily focus on how technology is shaping the specialty and infusion pharmacy landscape. The speaker will address how information systems integration across retail and specialty pharmacies can lead to better patient outcomes. The speaker will also highlight how advancements in data analytic techniques can be used to discover savings opportunities benefiting both patient and payer within health plan medical claims. Attendees will also learn how technology enables specialty utilization management programs to influence physician prescribing decisions.

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Alternative Care Delivery and Payment Models that Promote Value, Efficiency, and Quality 
  • How are data analytics being utilized to support payment reform initiatives?
  • What technologies enable companies to maximize population health strategies for better care coordination and member outcomes?
  • What are critical operational considerations for implementing payment reform strategies that improve care for Medicaid populations?

 

Optimizing Your Network to Improve Clinical and Cost Performance
Presented by Optum 

Provider networks are a critical driver of health plan efforts to improve clinical and cost performance.  By developing optimized networks, plans can help physicians and other practitioners move from volume to value and contribute to higher standards of care for their patients.  This session will outline the components of an optimized network and demonstrate best practices in narrow network management.  

 

Moving from Volume to Value: Smart, Point-of-Care Decision Support to Align Payers and Providers
Presented by McKesson Health Solutions 

As the healthcare industry continues the transition to care delivery and reimbursement strategies that recognize value over volume, payers and providers are collaborating in new ways to move discussions into action. Taking a fresh look at how decision support tools used at the point-of-care can open up new avenues for the payer-provider partnership. These tools are now blending an array of clinical and financial information to inform decisions that better enable providers to manage risk for patient populations, while aligning care delivery and care reimbursement in the pursuit of true healthcare value. This session will outline various approaches to enabling point-of-care decision support while defining their underlying technologies.

Speaker: 

  • Matthew Zubiller, Vice President, Decision Management, McKesson Health Solutions

  

Analytics to Support and Evaluate Payment Reform Initiatives
Presented by Truven Health Analytics  

This isn’t the first time around for payment reform. New data and analytic tools now available will improve the opportunity for successfully changing the delivery system. This session will examine how simple models based on robust data can provide a baseline for monitoring, measuring and improving ACO and Bundled Payment performance. You will learn about the tremendous variation in patterns of post acute care following bundle anchor events, including the differences in patterns between commercial and Medicare populations. Also important is the system-to-system variation in readmission rates and use rates of Skilled Nursing Facility, Home Health and Inpatient Rehab services for selected acute payment bundles among peer hospitals. The speakers in the session will also provide insight into emerging methods used to support real-time point-of-care decisions, proactive patient care interventions and retrospective process and system-of-care performance improvement. 

Speaker: 

  • Bob Kelley, Senior Vice President, Center for Healthcare Analytics, Truven Health Analytics

  

Member-Centric Optimization: The Missing Link to Successful Returns on Case and Disease Management Engagement
Presented by SDLC Partners, LLP 

Learn how to maximize your investment in member outreach and care management capabilities by further refining populations based on unique member health risk, their motivations to change and preferred intervention programs that return the most value. This session will provide insight into the missing link regarding case and condition management by going beyond gaps-in-care and cost triggers to include consumer behavioral/preference, outreach effectiveness, and volume/capacity data to augment care plan compliance using the most efficient and effective means necessary (e.g. web/fulfillment, nurse, integrated voice response, etc.). The speakers will provide real-world, practice applications of how to take your health risk data and do another round of automated, member-centric stratification to feed your care management platforms, increase outreach effectiveness and reduce care management cycle times.

Speaker: 

  • Eric Dahlem, Business Transformation Practice Director, SDLC Partners L.P.

 

Accountable Care: Opportunities and Unintended Consequences
Presented by Lumeris 

Speaker: 

  • Mike Long, Chairman and CEO, Lumeris

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Innovative Health Insurance Plan Strategies, Models and Products for a Post-Reform Environment 
  • What are next generation benefits that lower premiums and demonstrate value?
  • How do companies make the transition from wholesale to retail?
  • How can companies succeed in the new state-based, private marketplace?

 

5 Fundaments of HealthCare Economy – Making Commerce Conversational
Presented by PaySpan, Inc. 

As the industry shifts to quality-based reimbursement, payers will need to be able to assemble claims across multiple providers into episodes of care. Payments will be delivered based on the efficacy of patient care quality and desired outcomes, as opposed to the conclusion of a care event. Payers must engage providers in a dialogue about financial and clinical interactions to generate richer data sets and smarter business processes to support conversational commerce. This session will provide deeper insight into the benefits of efficient and effective care, value in the funding and reimbursement flow, and sustainability of the benefits that members depend upon.

Speakers: 

  • Bill Nordmark, Senior Vice President, Sales and Marketing, PaySpan. Inc.
  • Glendon Schuster, Senior Vice President and Chief Information Officer, Centene Corporation

 

10 Investments Health Plans Are Making Now to Compete for Tomorrow's Consumer
Presented by The TriZetto® Group, Inc. 

An estimated 70–100 million Americans will be direct consumers of healthcare. They will expect a frictionless experience very similar to what they experience with retailers like Zappos and Apple. Is your organization ready for this significant transformation? During this interactive session, you will get the latest research on how leading health plans are defining consumerism and more importantly, the 10 foundational investments they are making to create consumer value.  

Speaker: 

  • Eric Grossman, Vice President, Enterprise Strategy, TriZetto 

 

A Vision for U.S. Healthcare’s Radical Makeover
Presented by Cognizant Technologies 

Just as the publishing and music industries were disrupted and rebuilt by powerful transformative levers, the healthcare industry is on the verge of a similar disruptive change that will significantly reshape our experiences and reorient our expectations across the provider and payer value chain. Redistributed accountability and risk, the adoption of Accountable Care Organizations and Patient-Centered Medical Homes, the “retailization” of healthcare, cloud technology, mobility and ‘big data’ – the health care environment is in a state of flux. Despite the momentum behind these market forces, these initiatives alone cannot transform healthcare’s business model, and will generate only incremental improvements in cost reduction, quality and efficiency. Creating a truly sustainable foundation for healthcare will require the industry to eliminate substantial costs, embrace new ways of delivering care and improve the quality of that care.  Success in this rapidly changing world will depend on how well your organization understands where it will fit in the new health ecosystem and how it will achieve that position. Join us for a discussion on rethinking healthcare and the powerful levers that are enabling the reinvention of the industry’s business model. 

Speaker: 

  • Bill Shea, Partner, Healthcare Business Consulting 

  

Retail Consumer Strategies – Making the Shift from B2B to B2C 

With product standardization, new regulatory constraints, and price transparency leveling the playing field, health plans need to refresh their approach to customer outreach and retention. What was once a marketplace anchored in employer-based group health coverage is rapidly moving to an environment driven by individual decision making. The retailization of healthcare means consumers are in control – purchasing health benefits, navigating care delivery, and determining brand preference. The transition from a business-to-business to a business-to-consumer focus can’t wait. This is particularly true in the most reformed market segments – small group, individual medical, and Medicaid. It means quantifying risks and identifying opportunities using a sequenced, well-calculated strategic approach. This session will highlight three critical success factors of an actionable, knowledge-based consumer strategy.

Speaker: 

  • Lindsay Resnick, Chief Marketing Officer, KBM Group: Health Services

 

Winning in the New Reality: Health Plan Strategies for 2013 and Beyond
Presented by Infosys Public Services 

Health plans have been investing in health care reform over the last few years. As the outcome of elections sets the tone for the next four years, how should health plans transform for 2013 and beyond? Health plans need to go beyond business-as-usual actions and realize game-changing innovation to transform health care while optimizing operational costs. Health care reform and the opening of individual markets offer new opportunities but require focused strategies particularly for health insurance exchanges. A few crucial capabilities and a clear roadmap ahead are required to support these strategies. Join us as health plan executives and industry experts examine these initiatives and share practical experiences to navigate the new reality.

Speakers: 

  • Saurabh Agarwal, Associate Vice President & Head of Healthcare, Infosys Public Services
  • Ryan Howells, Vice President, Government Programs, Connecture
  • Maynard McAlpin,President & Chief Executive Officer, DC Chartered Health Plan 
  • Brian Patt, Head of Exchanges, Infosys Public Services
  • Brian Russon, Industry Market Development Director - Health & Human Services, Microsoft
  • Parminder Sethi, Chief Information Officer, DC Chartered Health Plan 
  • Mark Waterstraat, Co-Founder & Chief Strategy Officer, Benaissance

 

Compliance Track: Building Your Compliance Capabilities  
  • How can companies develop and design new products that meet the operational and compliance challenges?
  • How do you manage compliance issues for the small group, large group and self-insured markets?
  • How can companies plan for compliance issues inside and outside Exchanges?

 

Fraud, Waste and Abuse: The Transformative Potential of Data and Collaboration 

The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) recently announced a new and innovative partnership among federal agencies, private entities and state organizations to detect and prevent health care fraud on a national scale. This new initiative holds many new opportunities for health insurance plans. This session will provide an overview of the collaboration and discuss how federal and state agencies intend to leverage private market efforts to combat fraud. In addition, health insurance plans will gain new insights into how data will begin to be shared between public and private organizations for effective detection and enforcement activities. Any health insurance professional who work in an Antifraud, Special Investigations Unit (SIU), Internal Audit, Compliance, or Legal department should not miss this session.

Speakers: 

  • Ted Doolittle, Deputy Director of Center for Program Integrity, CMS
  • Lou Saccoccio, Chief Executive Officer, National Health Care Anti-Fraud Association

 

Leveraging Innovative Electronic Tools for Detecting and Prosecuting Fraud, Waste and Abuse
Presented by LexisNexis 

This session will illustrate how innovative health information technology tools are being used to detect and prevent health care fraud, waste, and abuse. In addition, the session will provide substantive details explaining how the application of social network analytics can aid in discovering collusion and health care fraud. The speaker will discuss real-life situations and cases that show how fraud, waste, and abuse have been detected and prosecuted to illustrate the practical application of the legal and data analytics concepts.

Speaker: 

  • Pam Jodock, Director Commercial Business Development, Health Care Solutions, LexisNexis Risk Solutions

 

Enterprise-Wide Security and Risk Management: Protecting Health Insurance Plan Data  

This session will offer business strategies and system security techniques to prevent data breaches, reduce potential liability for data-related losses, provide sensible guidelines for mitigating data losses, and comply with federal and state legal requirements in the event that personally identifiable information is compromised.

Speakers: 

  • Paul H. Luehr, Managing Director, Stroz Friedberg  
  • Gerard Stegmaier, Wilson, Sonsini, Goodrich & Rosati

 

Wellness Programs and Compliance Considerations 

The establishment of cost-saving programs for wellness or preventive care requires compliance with a variety of existing laws. This session will discuss the primary compliance-related items an employer or plan sponsor must consider and comply with, including: the Americans with Disabilities Act; Genetic Information Nondiscrimination Act; Health Insurance Portability and Accountability Act; and state and local disability discrimination and privacy laws.

 Speakers: 

  • Joyce Walker-Jones, Senior Attorney Advisor, ADA Policy Division, Equal Employment Opportunity Commission 
  • Jerry Noyce, President and Chief Executive Officer, The Health Enhancement Research Organization
  • Brian Gagne, Chief Operating Officer, HealthFitness Corp.

 

Social Media and the Internet in Health Plan Operations 

In this digital age, consumers have become accustomed to – and dependent upon – the use of the Internet and social media in their everyday lives. To meet consumers’ expectations, health insurance companies have turned to social media to increase individuals’ awareness and involvement in their own health care. This session will focus on the new trends in health insurance plans’ interactions with consumers via social media and the Internet, potential pitfalls to using social media in health insurance plan operations, risks that can be introduced to a company’s operations through the use of mobile devices, and practical compliance tips for managing your employees who use the Internet and social media for business purposes. 

Speakers: 

  • Lynde O'Brien, Director of Electronic Media Strategy, Health Care Service Corporation 
  • Timothy C. Zevnik, Privacy Official & Director, HIPAA Program, Molina Healthcare, Inc.

 

Inside/Outside: Compliance Issues for the Exchange Environment 

The Affordable Care Act mandates the creation of health insurance exchanges and several states are already in the process of building these cyber-marketplaces for health insurance products. In 2014, health insurance exchanges will become available to consumers, creating a new and unique online marketplace for purchasing health insurance coverage. This session will focus on what’s in, what’s out, and the compliance considerations for selling insurance products in or out of the Exchange environments. 

Speakers: 

  • Gary E. Bacher, Of Counsel, Mintz Levin & Senior Vice President, ML Strategies  
  • Teresa D. Miller, Acting Director, Office of Oversight, CCIIO, CMS, HHS

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