All major reimbursement models — Medicare Advantage, MACRA/MIPS, Managed Medicaid, and even large group commercials — are driven increasingly by quality metrics that measure clinical outcomes, proxy outcomes and process effectiveness. Many regulatory and governing bodies including NCQA, CMS, ONC et. al. publish new measures and updated/modifications to existing measures on a frequent basis. The improvement of clinical, IT and administrative processes to optimize performance against these measures has become a core competency that payers and providers must upgrade continuously.
Payer Medical Management, Operations and IT teams work constantly to enable compliance with implementation deadlines for these multiple measure sets, many of which have a robust set of HEDIS metrics at the core. Teams analyze and interpret the measure specifications, preparation roadmaps, and submission requirements in order to develop compliance plans across multiple source and destination systems.
The webinar will cover how health plans can move to the level of best practices with regard to managing diverse clinical, non-clinical and other contractual quality measures.
Jeffrey Springer, CitiusTech
Jeff drives the product management and strategy in various areas of healthcare, from payer to provider, clinical to financial, analytics to transactional at CitiusTech. In his over 18 years of healthcare industry experience, Jeff has worked with leading healthcare technology vendors including Siemens, Medecision, McKesson and CareScience. He also founded the first payer-provider contract management company in the country.
Jeff holds a Mechanical Engineering Degree and an MBA from University of Pennsylvania – The Wharton School where he graduated as a Palmer Scholar (top 5%).
Frank Ingari, Growth Ally
Frank Ingari has served the consumer, healthcare and information technology industries for the past 35 years and has been part of governance and leadership teams in 5 IPOs. As CEO at Essence Healthcare, he led the first Medicare Advantage plan to achieve 5 Stars without owning a physician network. He also co-founded Best-in-Class Value-Based Care Service Provider Lumeris, before moving on to lead collaborative network NaviNet.
Ingari graduated from Cornell University, concentrating in American Literature and American Foreign Relations, graduating summa cum laude. He is a member of the Board at BMC HealthNet, a top 10 Managed Medicaid plan, and serves on the Presidential Advisory Board of the Berklee College of Music.