Leveraging Analytics to Drive Value-Based Reimbursement

  • October 17, 2016
  • 2:00 PM – 3:00 PM ET
  • Online

Tremendous change is occurring in healthcare as government and private payers work to shift to value-based care and the various types of operational and reimbursement models that support it. This transition is exerting many pressures, necessitating adjustment and learning by all stakeholders.

In this session, experts from SCIO Health Analytics will discuss impacts of the shift from fee-for-service to value-based reimbursement and other complex treatment and payment arrangements.

Specific topics will include:

  • The movement toward integrated care across the continuum and its impact on risk for payment errors, abuse and fraud.
  • Common concerns such as shifting site of care, overcoding and overbilling for preventive or diagnostic services as well as the legal and regulatory implications.
  • Best practices and ideas on how payers can use predictive analytics to identify patterns of care, referrals and behaviors that appear to be problematic and merit review.

Webinar participants will learn:

  • Discuss the impact of regulations in the new world of ACA and value-based reimbursement in context of the growth of integrated delivery networks and shifting risk.
  • Detail common areas providers might use to make up for lost reimbursement.
  • Understand how payers can use analytics to detect areas meriting review and action, such as patterns of referrals that appear to be financially driven rather than in the members’ best interests.

Who should attend: Executives from health plans of any size, especially roles involved in cost containment, fraud/waste/abuse identification, value-based reimbursement, analytics, and/or risk adjustment.


Rose Higgins mugRose Higgins, President, North America, SCIO Health Analytics
With over twenty five years in healthcare, Ms. Higgins brings considerable experience and expertise in working with both payers and providers in addressing the challenges of a changing healthcare landscape. Prior to joining SCIO Healthcare Analytics, Ms. Higgins was the SVP & GM for Population and Risk Management at McKesson, Ms. Higgins led the cross portfolio strategies for McKesson Technology Solutions (MTS) related to accountable care, population health and engagement management and execution of the company’s Population Management strategy. Ms. Higgins has been central to the exploration and development of solutions that address emerging market opportunities specifically those addressing the challenges posed by healthcare reform and a rapidly evolving technology landscape.

As President, North America at SCIO Healthcare Analytics, Ms. Higgins is responsible for P&L management including new analytics, services, technology, program and product development, financial planning, operating and capital budgeting, and customer relations.
Ms. Higgins has a B.S.N Degree in Nursing from Duquesne University and a Masters of Public Management from Carnegie Mellon University.


Rodger Smith mugRodger Smith, Senior Vice President, Payer Solutions, SCIO Health Analytics
Rodger has over 16 years of operational and industry experience in healthcare, handling matters involving provider contracting, claims operations, provider and member dispute resolution, industry regulation, fraud, waste and abuse investigation, and Payment Integrity. After receiving a juris doctorate from New York University School of Law, he was in private practice as a commercial litigator for 8 years. At that point, he joined the legal team of a large regional health plan, Oxford Health, where he led the Special Investigations Unit as well as a group tasked with addressing systemic overpayments, which together increased results by over 300% during his tenure, saving the company over $50 million. After its acquisition by United Health Group, Rodger was responsible for fraud, waste & abuse in United’s Northeast region.

Rodger has served in key roles at SCIO, including running payment integrity operations, developing SCIO’s analytic capabilities in the Payment Integrity and Network & Provider areas, solutioning for clients and prospects of the Payment Integrity Service Programs that represent the most significant portion of the business, and as a strategic account manager for several of SCIO’s largest clients.