Module I – Refresher

David A. Shore, PhD
Associate Dean and Director, Forces of Change Program
Founding Director, Project Management in Health Care Certificate Program
Harvard School of Public Health

Project Activation Management System (PAMS) Strategic Execution of Project Management in Health Insurance Plans

Now more than ever, new projects and new initiatives need to be completed on time, on budget, and to “spec.” In the early stages, projects fail due to poor project selection and definition as well as lack of alignment among key stakeholders. Nothing is more frustrating than working hard and expending valuable resources only to have your project canceled, fail, or to hear, this isn’t what we wanted. This familiar fate can be avoided through effective project management.

This session introduces the first stage of Dr. Shore’s Project Activation Management System. Participants will learn the first phase in a step-by-step process for moving new ideas forward from project identification and development through to project vetting and approval. This process results in a dramatically higher likelihood of successfully achieving the project management metrics that matter most. This session will emphasize tools, tips, and techniques.

David A. Shore, PhD

Continental Breakfast

Industry Leadership Forum: Perspectives on the Challenges and Opportunities that Lie Ahead

This session will address the many opportunities and challenges facing our health care system, from extending coverage to improving quality and containing costs, and offer perspectives on the immediate priorities for the American health care system. Thought leaders will present perspectives on the direction health care delivery should take over the next decade and how reform efforts will lead to a more effective and efficient delivery system.

Steve ErkenBrack
President & CEO
Rocky Mountain Health Plans

Thomas Croswell
Chief Operating Officer
Tufts Health Plan

Samuel R. Nussbaum, MD
Executive Vice President, Clinical Health Policy & CMO
WellPoint, Inc.

How Health Plans Will Drive Value-based Industry Transformation with Integrated Healthcare Management (IHM)

With the passage of healthcare reform, is it possible for health plans to simultaneously be short-term responsive to required changes resulting from legislation and to be long-term proactive in transforming the industry? This session will illustrate how payers can apply their substantial and unique information assets in a strategic and systematic way to accomplish both.

Jeffrey H. Margolis
Chairman & CEO
TriZetto

Reforming Health Care Financing and Delivery

There is ample evidence that Americans do not receive high enough value care for the enormous and growing share of U.S. GDP devoted to health care. This session will explore the way that health care is financed in the U.S., the effect that the financing system has on health insurance, and the value of health care received. The financing of both public and private insurance has profound implications for the extent and generosity of insurance coverage, for the quality and quantity of health care consumed, and for how the burden of paying for that care is borne. The session will focus on a set of analytical tools that can be used to understand the effects of a wide variety of reform proposals, and will then use those tools to evaluate the effects of popular reform proposals on the cost and quality of the U.S. health care system. The learning objectives for this session are to:

• Understand how health care financing in the U.S. affects the value of care delivered and the goals of finance reform
• Explore the likely effects of reform on insurance coverage
• Develop a set of tools that can be used to evaluate the potential effects of reform on spending and value

Katherine Baicker, PhD
Professor of Health Economics
Department of Health Policy and Management
Harvard School of Public Health

How Health Plans Will Drive Value-based Industry Transformation with Integrated Healthcare Management (IHM)

With the passage of healthcare reform, is it possible for health plans to simultaneously be short-term responsive to required changes resulting from legislation and to be long-term proactive in transforming the industry? This session will illustrate how payers can apply their substantial and unique information assets in a strategic and systematic way to accomplish both.

Jeffrey H. Margolis
Chairman & CEO
TriZetto

The Case For and Against the PMO (Case Study)

This case highlights some of the factors that bear heavily on the effectiveness of a project management office (PMO). In this session, participants will examine the project management office process and develop an understanding of the design and structure of a PMO in a health care organization.

Case to be discussed:
- McFarlan, F.W., M. Keil, and J. Huff, "The AtekPC Project Management Office," Harvard Business School, Case 9-308-049, (Oct. 11, 2007).

David A. Shore, PhD

Developing a Quality Initiative (case study)

The objective of this session is to discuss organizational transformation in the context of a major initiative to focus on quality and patient safety improvement within a health care organization. In this session, we will discuss how health care insurance organizations can play an active role in partnering with health care providers to deliver improved quality of care to their members.

Case to be discussed:
- Sahney, Vinod K., "Mountain Medical Center", October 2002.

Supplemental readings:
- Zhan, Chinliu and Marlene R. Miller, "Excess length of stay.
Charges and mortality attributable to medical injuries during hospitalization." Journal of American Medical Association, October 8, 2003, pp. 1868 – 1874.

Vinod K. Sahney, PhD
Adjunct Professor of Health Policy and Management
Harvard School of Public Health
Former Senior Vice President and Chief Strategy Officer Blue Cross Blue Shield of Massachusetts

Break

The Design and Impact of Market-based Health Policy Reforms

Payment reform is a key element in creating a high-performing health care system. Today’s payment systems reward providers for delivering more care rather than better care. A redefined health system would realign payment incentives toward improving the quality of care through a more patient-centered care model and promote accountability and coordination among providers. In the wake of health care reform implementation, faculty in this session will examine a variety of payment reform initiatives including accountable care organizations, patient-centered medical homes, and pay-for-performance models that realign the payment system to reward excellence and improve patient safety.

Meredith B. Rosenthal, PhD
Associate Professor of Health Economics and Policy
Department of Health Policy and Management
Harvard School of Public Health

Continental Breakfast

Developing and Executing a Quality Strategy

The objective of this session is to discuss organizational transformation in the context of a major initiative to focus on quality and patient safety improvement within a health care organization. The focus of this session is on both development as well as execution of a strategy to improve quality. The role of insurance companies will be discussed.

Case to be discussed:
- Sahney, Vinod K., "Mountain Medical Center", October 2002.

Supplemental Readings:

• Chakravorty, Satya. "Where Process-Improvement Projects Go Wrong." Wall Street Journal, Monday, January 25, 2010, pp. R6

Assignment: Please read the case and come to discuss the following questions:

A. What is the role being played by key leaders in improving quality at Mountain Medical Center?
B. How likely is it that Mountain Medical Center will achieve its quality goals?
C. Why do most quality improvement programs fail?
D. What is the role health insurance companies can play in improving quality of care offered to their members?

Vinod K. Sahney, PhD
Adjunct Professor of Health Policy and Management
Harvard School of Public Health
Former Senior Vice President and Chief Strategy Officer Blue Cross Blue Shield of Massachusetts

Break

Implementing National Health Reform: Some Lessons from Massachusetts

The 2006 Massachusetts health reform law provided much of the framework for the national Patient Protection and Affordable Care Act in 2010. With a four-year head start on implementation of reform, what lessons does the Massachusetts experience hold for other states and the nation? How has the Exchange worked? How have consumers and health insurers responded to the requirement that everyone purchase health insurance? What steps is Massachusetts taking to deal with costs?

Nancy Turnbull, senior lecturer in health policy and associate dean for educational programs at HSPH, has been actively involved in implementing health reform in Massachusetts, including serving as the consumer representative on the board of the Massachusetts Health Insurance Connector, the state's exchange. She will talk about the successes and challenges of expanding coverage in Massachusetts and implications for national reform.

Nancy Turnbull
Senior Lecturer in Health Policy
Associate Dean for Educational Programs
Harvard School of Public Health

Improving Organizational Performance

The objective of this session is to discuss the importance of creating a culture of operational excellence in a health care organization. What role can insurance companies play in reducing the cost of health care?

Supplemental Readings:

• Coye, Molly Joel. "No Toyotas in Health Care: Why Medical Care Has Not Evolved to Meet the Patient' Needs" Health Affairs. Vol. 20, No. 6, pp. 44-58.
• Mechanic, Robert E. and Stuart H. Altman. "Payment Reform Options: Episode Payment Is a Good Place to Start." Health Affairs, January 27, 2009.

Vinod K. Sahney, PhD

What Have We Learned and Where Do We Go from Here? Insights and Take-away Messages

David A. Shore, PhD