Thursday, October 26, 2017 • 5:30 p.m. – 7:30 p.m.
Thriving in a Value Based Health Environment: Concrete Steps to Develop Patient Focused and Financially Rewarding Care Delivery Innovations
When appropriately designed, the current shift to value based reimbursement allows healthcare organizations to compete based on their ability to provide high quality and low-cost care that patients value. To address this challenge many healthcare organizations have successfully developed programs designed to deliver this type of high value care. These programs typically focus around the needs of a
specific segment of a patient population. The most successful programs are artfully crafted to address clinician preferences for providing outstanding care, patient desires for convenience and affordability, and detailed nuances of payment contracts to optimize reimbursement. The complexities of value-based healthcare reimbursement provide tremendous opportunities for organizations that develop thoughtful strategies to provide highly demanded care in a financially sustainable structure.
In this workshop, we will interactively review case studies of innovative healthcare programs that have effectively created higher quality care and improved financial outcomes. This discussion will illustrate the concrete steps to develop programs and innovations that will enable your organization to thrive in a value-based environment.
ABOUT THE WORKSHOP LEADERS:
Nick Creten, FSA, MAAA is a Consulting Actuary at Milliman. Nick’s primary area of expertise is in supporting provider organizations with targeting the goals laid out in the “Triple Aim”: better care for individuals, better health for populations, and lower per capita costs. Specific emphasis in this area includes providing analytic and financial support for population health program design and management, assessing and projecting population risk, benchmarking cost and utilization, and developing viable strategies for providers shifting to value based payments. His work has included strategy surrounding alternative payment models (APMs) and risk-based contracting. He has significant expertise in the
development, assessment, and implementation of predictive models. His experience has focused on risk adjustment as well as disease management analytics, early warning claims prediction, rising risk modeling, consumer data based modeling, and operations optimization. His risk adjustment knowledge includes detailed technical understanding, risk adjustment operational capabilities, financial accounting practices, and strategic implications to succeed in a risk adjusted market.
Nick has extensive ACA pricing experience including small group and individual rate development in over 40 states. His experience includes the development of market risk estimates, credibility and pooling adjustments, induced utilization factors, and area factors. He is also well versed in small group self-funded pricing, risk rating, financial reporting, and strategy.
Mason Roberts, MBA, BS is an Actuarial Assistant at Milliman. Mason focuses on supporting provider organizations addressing the challenges and opportunities presented by the current US healthcare shift to value based reimbursement. His focus is a passion for developing financially sustainable programs that address the underlying social determinants present in health system populations, to help reduce barriers to positive health outcomes. Mason has been involved in projects focused on behavioral health and public health, including certifying rates for Behavioral Health Organizations. He has also performed considerable research on public health and how it has been impacted by payment reform models. Mason has also assisted with the pricing and filing of individual and small group products for commercial health insurance plans. This work has included expansion application filings with additional solvency requests, pro forma financial development, market analysis, and benefit plan design.