Network-Enabled Payer and Provider Collaboration for Population Health

  • October 24, 2016
  • 12:00 PM – 1:00 PM ET
  • Online
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As reimbursement increasingly shifts from fee-for-service to more value- and risk-based models, and as the data is emerging to actually support these models, the traditional perceptions of the zero-sum game between providers and payers is making way for opportunities for true collaboration. As both groups share increasing incentives to achieve better health outcomes at lower costs, the question now becomes how will they effectively work together? Lines are blurring between the roles that payers and providers play in managing patient care. And as we move towards a more consumer-driven healthcare marketplace, members expect (and demand) that information flows seamlessly across all members of their care teams. How will providers and payers begin to collaborate more and use information sharing as a competitive advantage?

Based on over ten years of experience supporting a variety of the most successful value-based care networks, which include hospital-led ACOs and CINs, physician-led ACOs and POs, and venture-backed and next generation MSOs, as well as collaborating with forward thinking health plans, athenahealth will explore what we see as the key building blocks of successful care networks and the critical role that data and patient-centered services play in connecting providers, patients, health plans and other care partners to drive effective population health management.

What participants will learn:

  • Adding to the friction preventing collaboration between payers and providers is an inability to effectively share trustworthy, complete information whether in the provider workflows, for risk adjustment or STARs results, for example, rather than a significant misalignment of incentives between the entities.
  • Overworked providers are struggling to make sense of quality and care gap data received from regional and national payers in a multitude of different formats and frequencies, while health plans are working to keep up with an ever changing regulatory market and consumer pressures without clear industry standards
  • Moving to risk requires that providers invest capital, they don’t have, in staff, technology, and services. Although they largely prefer to remain independent, this dynamic is further contributing to physicians choosing hospital employment to survive the transition. Payers can make investments in such expenses to help providers stay independent, while achieving the goals of the joint value-based contracts.
  • Key building blocks, backed by a lightweight, untethered patient-centered service, are essential to enable collaborative population health management
    • Connect and manage data to provide transparency into patient care and reimbursements.
    • Connect care teams, across multiple care settings, to data and to each other, enabling effective care coordination.
    • Connect patients to their data and to care teams, empowering them to participate in their care.
    • Connect partners to our data, care teams, and patients to accelerate network time to value.

Who should attend: Decision makers at Health Plans and fully integrated health care companies focused on driving quality and cost outcomes across populations


Speakers:


Jessica Richard Mug newJessica Richard, Solution Design Lead, Emerging Markets and Services
Jessica joined the solution design group at athenahealth in January 2015, focused on the innovation and growth of population health management and national health plan services.  She is responsible for partnering with the enterprise strategy, sales and technical teams to create solutions that drive health care collaboration for health plans, medical groups, health systems and other key stakeholders in the health care industry.  These services include population health, co-care management and clinical data exchange for risk adjustment, STARs, HEDIS and other Medicare or value-based contracting requirements.

Prior to joining athena, Jessica held various roles at Aetna; most recently as Chief of Staff to the National Head of Business Development for Aetna’s Accountable Care Solutions, building value base reimbursement collaborations across the nation.  Previously, she worked on special projects for the Chief Underwriter and the Healthcare Reform Project Management Office.  She also held responsibility for over $1.5B in SG&A management as a member of the Financial Management and Planning team.  During her time at Aetna, Jessica led the Finance Intern Program and a local chapter of the generational diversity employee resource group.

Jessica has her MBA in finance and venture management and BS in finance and economics from the University of Connecticut.

Caitlin Reiche mugCaitlin Reiche, Director of Performance, athenahealth, Inc.
Caitlin Reiche is Director of Performance at athenahealth, Inc., headquartered in Watertown, Massachusetts. athenahealth is a health information technology company that provides web-based electronic health record, care coordination, revenue cycle management, and patient engagement services to physician groups.

Ms. Reiche leads the Performance Management of athenahealth’s Network Services, the company’s cutting-edge services for care coordination across disparate care environments, vendor systems, providers, and patients. In this capacity Caitlin manages a team that helps clients succeed against value based contracts through the development of playbooks and services and performance management against those playbooks. Caitlin has also been instrumental in the formation of the company’s Population Health and Payer Solution Design function, a team that partners with sales executives and product teams to develop effective offerings for clients.

Prior to joining athenahealth, Ms. Reiche managed a value-based healthcare initiative at Partners Healthcare and Harvard Business School, in which she used Time-Driven Activity Based Costing to develop a cost model and bundled payment for Total Knee Replacements at Brigham & Women’s Hospital. She received her Master’s in Health Policy and Management from Harvard University School of Public Health. She graduated magna cum laude from Middlebury College with a degree in Psychology.