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Managed Care Success

Virtual Conference  |  November 16 - 18, 2021  |  3:30 - 5:00 PM ET Daily

Tuesday, November 16

3:30 - 4:10 PM ET

Flavors of Risk: Making Sense of the Menu of Risk Sharing Arrangements

We're all either in or entertaining some kind of risk-bearing arrangement, whether it's insurance-, utilization-, performance- or technically based.

This session will survey the wide variety of flavors in risk arrangements below, and tie each one back to tangible programs and examples in the real world. The session will include commentary on both quantitative and qualitative considerations. You'll hear and be able to ask questions about:

  • Specialized fee-for-service schedules
  • Shared savings
  • Shared savings and losses
  • Care management and other fees
  • Per member per month & partial capitation
  • Lump sums, bundles and episodes
  • Full capitation

Tim Courtney, Director, Senior Consulting Actuary, Wakely
Kelsey Stevens, Director, Senior Consulting Actuary, Wakely

4:20 - 4:40 PM ET

Moving from a Commodity to a Partner: HEDIS Scores – Understand How MA is Measuring You 

HEDIS quality scores are very important to MA plans, and are used to differentiate among post acute providers in terms of patient volume and preferred network status. Understand how MA uses HEDIS and you have more clarity on improving your status.

Bryce Henson, VP Value Based Programs, Access Companies

4:40 - 5:00 PM ET

Moving from a Commodity to a Partner: Pre-Acute Hospital Diversion Program for MA Plans 

The financial savings to MA plans of admitting some patients directly to the SNF are unmistakable – as is the financial upside to SNFs.  This session explores how to initiate such a program in your organization.

Brian Cloch, Co-Founder, Innovative Health
Scott Sarran, Chief Medical Officer for MoreCare

Wednesday, November 17

3:30 - 4:10 PM ET

Payer Panel: MCO Expectations in Value-Based Payment

Three payers describe their expectations of PAC providers when it comes to “value creation” and the prospect of performance-based bonus payments. They’ll describe what great provider performance looks like (and what it doesn’t) as well as how payers measure clinical superiority, data aptitude, risk-readiness, and other intangible qualities. 

Erik Johnson, SVP, National Practice Lead, Value Based Care, Optum
Nick Stupakis, VP, Home and Community Services, Highmark Health
Jamie Swann, Director, Special Programs, Anthem

4:20 - 5:00 PM ET

Perspective from Both Sides of the Payer/Provider Fence

Contracting with MA can be downright frustrating. Provider executives with prior MCO leadership experience will share their thoughts on the current state of payer/provider interplay, specifically:

  • What are the performance imperatives at MA Plans?
  • Consequently, how do they think?
  • How should you contract with them, and who should you contract with?

Timothy Hanold, CEO, Care Advantage
Lynn Rosenbach, CEO Home Care and Hospice, VP Post Acute, Banner Health
Dan Savitt, President & CEO, Visiting Nurse Service of New York

Thursday, November 18

3:30 - 4:10 PM ET

Using Technology to Partner with MCOs and Take on More Risk

Managed care organizations want to be assured providers are partners in quality clinical management before they are willing to share risk. Learn what MCOs are looking for from an SNF partner and how to use technology to track appropriate metrics for a better foothold in contracting with managed care plans. Next, hear from a hospice consortium that is using technology to provide on-demand care and the out-the-box step that will begin the journey to full-risk contracts.

​​​​​​​Anthony Evans, President, Pure Healthcare​​​​​​​
Margaret Latrella, MSN, APN-C, Director of Quality and Clinical Services, St Joseph's Health Partners, Clinically Integrated Network
Phyllis Wojtusik, EVP of Health System Solutions, Real Time Medical Systems


A4:20 - 5:00 PM ET  |   Concurrent Sessions 

Provider Success Stories: Home and Hospice Care

Hear from two providers crafting win-win financial solutions with MA plans. The first presentation will highlight innovative frameworks and successful care delivery models between a leading post-acute provider and vertically integrated managed care organizations. You'll learn about proven strategies that reduce cost, optimize healthcare utilization, improve access, and enhance outcomes across a growing value-based care continuum.

Stacy Baldwin, VP Clinical Innovation & Strategy, Charter Healthcare Group
Ryan Iwamoto, President & Co-Founder, 24 Hour Home Care
Gavin Ward, Director of Strategic Partnerships, 24 Hour Home Care


A SNF Road Map to Prevent MCO Bad Behavior

Gain an inside look at the internal business drivers of Managed Care Organizations and how to utilize readily available tools to leverage those drivers to secure a better agreement (or fix a bad one), including whom to approach, language to use, and how to spot red flags.  Understand the value of having a VP of MCO Billing & Revenue Cycle manage MCO relationships at the SNF level to significantly increase revenue and avoid massive write-offs.

Chad Bogar, Managing Partner, sb2

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