Population Health Management Innovations – Aligning Payers and ACOs

  • July 12, 2016
  • 2:00 PM – 3:00 PM ET
  • Online
about

Provider reimbursements are rapidly moving from fee-for-service arrangements to value-based payments, emphasizing quality outcomes and appropriate management of the total population. Managing these dynamics is now part of the new care management ecosystem for patient-centered medical homes and accountable care organizations (ACOs). Payers, providers and now pay-viders have organized themselves in innovative ways that foster improved outcomes at the lowest cost. ACOs must now incorporate advanced analytics and care management capabilities to enhance the health status of consumers while maintaining relevant opportunities in revenue optimization.

The introduction will include a level set of the current opportunities, and acknowledge which geographies are experiencing a rapid evolution of these models. One of the leading ACOs will provide insights into their current and evolving population health capabilities. We will conclude with best practices to help align the various entities to deliver the best outcomes at the lowest cost, with the highest customer satisfaction.

Webinar participants will learn:

  • Current state of value-based payment and the emerging entities of PCMHs and ACOs
  • Payer, ACO and PCMH capabilities integration as it relates to population health
  • Current and future state ACO transformation strategies and results to date
  • Best practices in aligning payer and ACO capabilities as the market evolves

Who should attend: Health care executives and decision makers from payers, health care systems and accountable care organizations who are responsible for the various aspects of population health management. More specifically leaders responsible for strategy, care management, quality, network management, consumer engagement and outcomes.


Speaker:


Tom KloosTom Kloos, Executive Director, Atlantic MSO serving Optimus Healthcare Partners ACO and Atlantic ACO
Dr. Thomas H Kloos MD is Vice President Atlantic Health System, President Atlantic ACO, and Executive Director of the Atlantic MSO, a Management Services Organization which supplies management services to both the Atlantic ACO and Optimus Healthcare Partners ACO.  The two ACO’s serve both the MSSP program and commercial relationships and encompass over 80,000 attributed Medicare beneficiaries and over 200,000 commercial attributed beneficiaries.  He currently is a board member of the National Association of Accountable Care Organizations (NAACOS).

He was the past president of Optimus Healthcare Partners ACO and Vista Health System IPA.  On the payer side, he was a Trustee and past Board Vice President of the Affiliated Physicians and Employers Health Plan a self-funded MEWA plan in NJ.  Dr. Kloos is a board certified Internal Medicine practitioner in Warren NJ,  previously NCQA certified in Diabetes Care,  and was a  NCQA recognized  level  3 Patient Centered Medical Home(PCMH). He graduated from the University of Louisville Medical School in 1979.

Jerry OsbandDr. Jerry Osband, Chief Medical Officer, EXL
Dr. Osband currently serves as the Chief Medical Officer for EXL, where he is responsible for setting clinical strategies, clinical process oversight and engaging clients in portfolio based opportunities. He is a seasoned physician executive whose senior level positions include Chief Medical Officer and Chief Operational Officer for nationally recognized health care management and technology organizations.

He has extensive experience in providing clinical and administrative guidance to software application development for care management, core administration, and value based incentives and reimbursement products used in commercial, Medicare and Medicaid programs. Dr. Osband has developed, implemented and managed quality improvement and analytics programs in multiple care delivery environments. He has provided independent consulting services for several major TPAs and a nationally recognized data management and guidelines organization.  His clinical background is inclusive of 18 years of clinical practice with associated clinical academic positions for teaching family medicine residents and nurse practitioners.

Jim DolstadJim Dolstad, Chief Actuary, EXL
As EXL’s Chief Actuary, Jim is responsible for working directly with clients to improve their operational performance and clinical outcomes, identify opportunities to lower their health care spending, and develop measurements and strategies to effectively compete in the rapidly changing environment resulting from Healthcare reform. Jim is also involved in the build out of an already robust analytics practice by developing product suites around operational performance, consumerism and total population management.

Prior to joining EXL, Jim was the Chief Actuarial Officer for Carewise Health where he played an active role on the Executive team. During his ten years at Carewise he was heavily involved in consultatively working the clients, as well as numerous aspects of the business including operational performance, clinical outcomes, product management, sales and analytics. Jim spent the first 20 years of his career providing actuarial and benefit consulting to very large employers, as well as insurers and reinsurers.

Scott McFarlandScott McFarland, Senior Vice President and General Manager, EXL
Scott McFarland joined EXL in 2015 as their Senior Vice President and General Manager of EXL Healthcare’s Population Health Solutions division. Scott’s perspectives and points of view are especially interesting as he provides mission-critical consulting and contingency planning focused on ACOs and ACO models for many top-tier healthcare payers and providers including identifying untapped markets, launching into new channels, re-developing existing products, differentiating ACO products from the competition, and preparing appropriate product development and marketing plans for ACO market entry.

In addition, he and his teams conduct pre-launch audits for ACO readiness and compliance for select clients. Scott came to EXL Healthcare with executive leadership experience from both providers and payers, including the Hawaii Health Systems Corporation, where he served as CEO, Cleveland Clinic, and Healthways. Scott earned a Bachelor of Science from Purdue University and a Doctor of Jurisprudence from the Drake University Law School.