Networking Breakfasts

Networking Breakfast Sessions  

Thursday, June 21

7:00 am – 8:00 am

5 Fundamentals of the Healthcare Economy
Presented by PaySpan, Inc.
Economic change is an undeniable force across the healthcare industry. The many varied constituents across the industry are moving. Some in concert and many in conflict. To achieve a position of opportunity in an uncertain market, we must seek to understand how changing business processes and new strategies are empowered or threatened by fundamental economic factors. The healthcare economy fundamentals include constituents, interactions, and basic principles to enable strategies that will succeed and create a sustainable market. This session will take a closer look at these fundamentals and provide you with insight into what you need to improve your business model.

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

The Secrets to Getting More Out of Prospective Assessments than Just an Assessment
Presented by Matrix Medical Network
Organizations that are able to get the most out of prospective assessments are able to achieve substantial value for risk adjustment initiatives, increase care optimization and ensure compliance. This session explores the inner workings of this vital part of maintaining a well run Medicare plan and how to gain the most value out of your assessments. This session will examine how to improve care coordination, reduce medical costs, increase member retention, and enhance overall financial management.

  • Christopher Vojta, MD, MBA, MSCE, Managing Partner, Vojta and Associates

Drive Customer Acquisition and Loyalty with Tomorrow’s Consumer:  Delivering the Right Value, at the Right Place, at the Right Time
Presented by The TriZetto® Group, Inc.
In 2014, millions of Americans will be entering the healthcare system as consumers.  Many more are continuing to increase their out of pocket spend on health care services.  Is your organization preparing to compete in this retail market w/ a rich and frictionless experience individual consumers are accustomed to with companies such as Target, Walmart, and Amazon?  During this session, get a glimpse at the latest consumer research on the value drivers that are going to help you create a truly exceptional experience and the big data analytics capabilities needed to make this happen.  The session will feature a health plan executive that will speak to their consumer engagement investments.

  • Eric Grossman, Vice President Enterprise Strategy, The TriZetto® Group, Inc.


From Individual Enrollment to Health Insurance Exchange – Using BPM Technology for BPO Healthcare Services
Presented by PegaSystems, Inc.
Business operations and IT leaders will find great value in hearing from industry experts about the challenges of operating Government Sponsored Health Plans in a multidimensional environment with constantly changing regulations, requiring rapid deployment to a production mode.  Our speakers will demonstrate how companies can reuse and leverage what is consistent across the industry to maximize efficiency, react quickly to changes in the marketplace, and respond to new business needs in near real-time fashion. Our speakers will also discuss how they the reuse of BPM processes and business rules can better align health plan IT initiatives, business strategies, and reform priorities.

  • Robert Dunn, Executive Vice President & Chief Development Officer, TMG Health
  • Keith Dayton, Senior Director, Industry Solutions, Healthcare, Pegasystems                                                                          

3Rs of Financial Management: Reinsurance, Risk Adjustment and Risk Corridors in a Health Insurance Exchange
Presented by Walgreens
With 30 million newly-insured lives entering Health Insurance exchanges in 2014, and traditional risk management tools such as underwriting and pre-existing condition exclusions no longer permitted, health insurers are faced with considerable risk that claims could significantly exceed premiums. CMS has proposed three interlocking methods to help insurers manage this risk, referred to as the "3 Rs": Reinsurance, Risk Adjustment and Risk Corridors. Each of these methods has a place in managing a health insurance exchange. While the formal rules weren’t released until late March, all three methods have been in operation in Massachusetts since the inception of the Massachusetts exchange (the model for the ACA) was introduced in 2006.

  • Ian Duncan, FSA, FIA, FCIA, MAAA, Vice President, Clinical Outcomes and Analytics, Walgreen Co. 

Improving Five-Star Quality Ratings with Data Driven & Member-Centric Strategies
Presented by Inovalon™, the new name of MedAssurant
With 30 clinical measures in scope for 2012 and yearly changes by CMS, measure-specific campaigns will not be effective. This session will discuss strategies such as how to use data analytics to determine which measures to prioritize, which members/providers to target, and how to intervene with optimal ROI. Our speaker will also examine how you can create an integration action plan that is member-specific and takes into consideration Star Ratings improvement, chronic care support, and risk adjustment gaps. In this session, you’ll see how to match the right level of intervention, to the right member, at the right time – maximizing gap closure and minimizing cost, and how to maximize outreach to incorporate NCQA Guideline #39 on Supplemental Data.

  • Kristian Marquez, Senior Director of Clinical & Quality Outcomes, Inovalon™ 

Transforming Payment Accuracy: Developing an Integrated Payment Integrity Strategy to Meet Future Healthcare Demands
Presented by Emdeon  

Fraud, waste and abuse has the attention of pretty much the entire healthcare industry. We all know it needs to be addressed and are taking action. However, the most common industry approach to segmenting the various areas of improper payments really doesn’t maximize a payer’s return on investment or streamline the payment process. In this session, hear from several industry experts and peers within the payer sector on how a holistic view of all improper payment exposure can identify the causal circumstances of overpayments and address a spectrum of issues, whether originally occurring due to processing errors or fraudulent behavior. Expect to come away from this session with actionable ideas that can be applied within your organization, regardless of how far you are along the continuum of building or maintaining a payment integrity function within your business.

  • John Shoemaker, BMA, CFE, CPA, Manager, Financial Investigations Department, Medical Mutual of Ohio
  • Phil Goss, Chief Operating Officer, Trustmark 
  • Dave Cardelle, Senior Vice President of Operations, Payment Integrity Services, Emdeon
  • Kurt Anderson, Senior Vice President of Product Management, Payment Integrity Services, Emdeon


Friday, June 22
7:00 am – 8:00 am

A Data Driven Approach to Personalizing Health Management and Increasing Engagement
Presented by WebMD Health Services
Understanding the importance of managing health risks can have a direct impact on the ability to manage rising health care costs. This session will demonstrate how one company was able to implement a comprehensive health management program aimed at reducing risks, absenteeism, and healthcare costs while also enhancing transparency. The results have been impressive. Since the program launched, the company has seen reductions in moderate and high health risks as well as reductions in healthcare costs. In this session, attendees will learn about a unique, data driven, integrated program model that uses multiple data sources to segment and stratify their population. Learn how one company was able to leverage learning’s and strategies of their internal wellness program and translate them to their larger health plan population.

  • David Passavant, Senior Director, Consumer Innovation, UPMC Health Plan
  • Kim Jacobs, VP of Product and Consumer Innovation, UPMC Health Plan
  • Kevin Bracken, Strategic Account Executive, WebMD Health Services

Five Steps to Market Reinvention: Supporting ACOs, Exchanges and Other Reform Initiatives
Presented by HealthEdge
The healthcare payor market is currently undergoing a period of unprecedented change, and payors are trying to navigate among the various market forces and government regulations. They are searching for new ways to reduce costs, engage their members and support next-generation healthcare business models such as accountable care organizations, health insurance exchanges and value-based healthcare. This session will cover many of the business imperatives facing today’s payors, and it will provide a five-step roadmap that payors can use to evaluate and reinvent their technology infrastructures as they position themselves to achieve their future business goals.

  • Ray Desrochers, Executive Vice President, HealthEdge

Prevailing in a Consumer-Driven Market Improving 
Presented by Optum 
Health plans looking to thrive within today’s rapidly changing healthcare environment will need to develop a comprehensive Consumer Experience Strategy.  Providing basic information through member portals isn’t enough.  To thrive in a reform driven environment requires truly becoming consumer-driven.  This includes understanding membership shifts, becoming creative with benefit design and network features, as well as offering member health, wealth and risk profiles.  It also requires leveraging technology to create an interactive online client experience.  Join our panelists for a lively discussion which leverages their expertise and key learning’s about prospering in an emerging retail marketplace.

  • Andy Eilert, Senior Vice President, Risk Optimization and Growth,  Payer Business, Optum (moderator)
  • Clay Heinz, Vice President of Client Practice, Connextions   
  • Andrew Mackenzie, Chief Marketing Officer, UnitedHealthcare Community and State
  • Sue Watson, Project Manager, Utah Health Exchange, Governor's Office of Economic Development  

Seeing Beyond the Tip of the Iceberg: Analyzing Member Data for Actionable Insight in a Consumer Driven Market
Presented by LexisNexis
The amount of data currently available is more than the human mind is able to organize and use, yet it is far too valuable to ignore. It has been suggested that if the U.S. health care system could use big data creatively and effectively to drive efficiency and quality we could generate annual health care savings of more than $300 billion. It seems we have the data just don’t have the insight. Understanding how to leverage internal and external data sources coupled with deployment of advanced analytics, whether predictive, relationship or linking, is the key to deriving the right insight to drive improvement across your business whether wellness, fraud prevention, or cost containment. The speakers in this session will discuss the value of internal and external data sources available to health plans, and explore technologies that allow health plans to mine data quickly in order to extract timely insight. The session will highlight best practices for leveraging data across wellness/disease management programs; fraud prevention efforts; and cost containment initiatives.

  • Bill Fox, JD, MA, Senior Director, Health Care, LexisNexis Risk Solutions

Effective Strategies for Streamlining Administrative Processes to Meet MLR Requirements
Presented by OpenConnect
Improving business outcomes that drive corporate performance are key initiatives healthcare payer executives must undertake especially in light of the ACA’s Medical Loss Ratio provision. Central to the success of these initiatives is the ability to measure the productivity and effectiveness of people and processes in order to improve healthcare value, lower costs and deliver higher quality service. In this session, senior industry experts will provide actual case study examples that have delivered proven, bottom-line results.

  • Darren Ghanayem, Vice President, Information Systems, WellPoint, Inc.
  • Edward M.L. Peters, Chief Executive Officer, OpenConnect

Up for the Challenge: Engaging Members in Wellness from Start to Finish
Presented by Health Dialog Services Corporation
The payor market is demanding wellness programs that work. But given all of the choices out there, what does that even mean? In this session, learn about an approach to wellness that defines success only by real, lasting behavior change. Hear how this program achieved industry-leading engagement rates through novel techniques that people actually want to use and a customizable structure that molds to fit a plan's objectives.

  • Robert Mandel, MD, MBA, Executive Vice President, Market Development, Health Dialog
  • Henry Albrecht, MBA, CEO & Founder, Limeade 

Accelerating Change: Innovative Solutions to Support Engagement in Health Plan Private and Public Exchanges
Presented by Softheon
As integration challenges with state exchanges take center stage in exchange planning discussions, health reform teams within leading health care payer organizations are focusing their readiness assessment around SHOP, Billing, Enrollment and Appeals Management. Hear from two organizations with operational experience in designing, implementing and supporting the nation’s first state exchange (the Massachusetts Connector). The speakers in this session will examine best practices that will enable successful healthcare payer engagement in public and private exchanges.

  • Eugene Sayan, Principal, Softheon
  • Andy Arends, Practice Leader, Dell