Saint Francis HealthCare Partners
10th Annual Conference
Accountable Care Organizations: Learn from the Leaders
Thursday, November 17, 2011
Hartford Marriott Farmington
Keynote Speakers:
Elliott Fisher, MD, MPH, Director for Population Health and Policy at The Dartmouth Institute for Health Policy and Clinical Practice
Dr. Fisher is the James W. Squires, MD Professional at Dartmouth Medical School and Director for Population Health and Policy at The Dartmouth Institute for Health Policy and Clinical Practice. He received his undergraduate and medical degrees from Harvard University and completed his internal medicine residency and public health training at the University of Washington. He is the director of the Dartmouth Atlas of Health Care and a member of the Institute of Medicine of th National Academy of Sciences.
His research has focused on exploring the causes of the two-fold differences in spending observed across U.S. regions and health care systems, on understanding the consequences of these variations for health and health care, and on the development and testing of approaches to performance measurement and payment reform that can support improvement. The research revealed the most of the differences in spending are due not to difference in health status, preferences, prices or poverty, but rather to greater use of discretionary services, such as the use of the hospital as a site of care and specialist referrals or diagnostic tests that would not have been ordered in lower spending regions. The findings that per-capita spending--on these services -- is essentially uncorrelated with either quality or health outcomes highlighted the potential opportunity to improve the efficiency of U.S. health care.
His current policy work has focused on advancing the concept of "Accountable Care Organizations" (ACOs) and includes co-directing, with Mark McClellan, a joint Brookings-Dartmouth program to advance ACOs through research, coordination of public and private initiatives and the creation of a learning collaborative that includes several pilot ACO sites across the U.S.
Mark Shields, MD, MBA, Senior Medical Director for Advocate Physician Partners
Dr. Mark Shields holds the position of Senior Medical Director for Advocate Physician Partners and Vice President of Medical Management for Advocate Health Care. In this role Mark oversees all clinical functions related to 3,900 physician aligned with the twelve Advocate hospitals. Mark has been in this role since the start of APP's Clinical Integration program in 2004. He has over 25 years experience in management roles with medical groups, insurance companies, hospitals and integrated delivery system.
Prior to joining Advocate Physician Partner, Mark held the position of Chief Medical Officer for Kaleida Health in New York, was the Chief Medical Officer at Dreyer Medical Clinic, Consulting Medical Director of HMOI and President and Co-Founder of a primary care group.
Speakers:
Lauren E. Williams, RN, BSN, Vice President, Medical Operations, ConnectiCare
Lauren is the Vice President, Medical Operations at Farmingron, Connecticut-based ConnectiCare is regional managed care organization providing both individual and group health and Medicare Advantage products in Connecticut. Prior to joining ConnectiCare in 1992, Lauren was an assistant head nurse in oncology at Yale New Haven hospital, and a Regional Clinical Manager for a home infusion company. She is a results-oriented, high-engery healthcare executive with 20 years of successful managed care leadership experience in planning, developing and executng medical management initiatives including utilization, case and disease management programs, appeals, vendor integration and oversight, accreditation and risk management. Her passions include quality initiative in medical management related to integration of care, promoting health literacy, and cultural competence.
Lauren sits on the executive board of directors for both the American Red Cross Connecticut Region and Qualidigm, a nationally recognized consulting and research Company and the Medicare Quality Improvement Organization (QIO) for Connecticut. She aslo serves on the Professional Advisory Committee for Interim Healthcare of Farmingon, CT.
Thomas R. Cooke, Senior Vice President Business Development, Aetna
As Senior Vice President Business Development at Aetna Thomas is responsible for collorating with provider partners to build Accountable Care Organizations.
Prior to Aetna he served as Vice President, Business Development at Optium Insight/Axoloti responsible for building network of 3rd party relationships to re-sell Optum Insight Solutions and adding third party application to their solution stack.
Peter N. Bowers, MD, Medical Director Payment Innovation, Anthem Blue Cross/Blue Shield
Dr. Bowers is Medical Director Payment Innovation at Anthem Blue Cross/Blue Shield.
Some of Dr. Bower's selected accomplishments including; Regional Vice President, Medical Director for Anthem National Accounts. Responsible for clinical delivery of client specific solutions for over 2 million ANA members and clinical leadership to support retention and growth of large multistate ASO clients. Lead Medical Director for Connecticut marketplace providing strong core competencies in sales support, cost of quality care, clinical leadership for network management and transparency initiatives. National Quality Forum-Member of Steering Committee for National Voluntary Consensus Standards for Adult Immunizations. Blue Cardiac Centers of Clinical Excellence-Clinical leadership provided to HealthCore in the evaluation and development of measures demonstrating improved quality and cost outcomes. America's Health Insurance Plans Execuitve Leadership Program for Medical Directors (ELP-MD). Career in development program sponsored by AHIP fostering the next generation of leadership in healthcare with empasis on business acumen, leadership skill development and public health.
Dr. Bowers graduated from University of Connecticut School of Medicine in Farmington, Connecticut in 1991. He graduated from Colby College, Waterville, ME, Cum Laude, Biology in 1987 with a BA.
Robert P. Hockmuth, MD, Senior Medicl Executive, New England Region, CIGNA HealthCare
As Senior Medical Executive for New England Dr. Hockmuth is responsible for all of the clinical, quality, health improvement and statutory functions in the New England market. He is engaged with the provider community as well as the existing employer groups working to improve the health of their employees.
Dr. Hockmuth is Board Certified in Family Medicine. He joined CIGNA in 1997 with the acquisition of Healthsource, a three million life HMO, where he held various positions within the medical management and administrative areas as well as the Board of Directors beginning in 1989.
Dr. Hockmuth graduated from the University of Massachusetts in Amherst in 1978 and from Tufts University School of Medicine in 1982 with honors. He did research at Tufts Medical School and Harvard University while a medical student in the departments of Micro and Molecular Biology. He also was an active clinical volunteer at The Pine Street Inn, a clinic for the homeless in Boston, from 1978 to 1982. He then completed an Internship and Residency in Family Medicine at Eastern Maine Medical Center where he was Chief Resident. He served four years practicing in the National Health Service Corps in a medically underserved area in rural Maine and then practiced in New Hampshire for six years. Dr. Hockmuth was an active volunteer at the Portland Free Clinic in Portland, Maine up until 2007.
Dr. Hockmuth has served as a clinical instructor on the teaching staffs of the University of Massachusetts, Tufts, Harvard and Dartmouth Medical Schools, teaching students and residents.
Bob Mahoney, Partner, Revenue Cycle Technology, PricewaterhouseCoopers, LLP
Bob is a Partner with over 25 years of healthcare experience in the areas of revenue cycle, coding evaluations, clinical documentation services, payment systems, distressed hospital, corporate compliance, litigation support, mergers and acquisitions, third-party reimbursement, coding reviews, financial accounting and reporting and feasibility studies. Bob is the Northeast market Leader fo Provider ICD-10 initiatives. Bob also led the firm's national SMART Coding Compliance practice for 7 years. He has conducted numerous revenue enhancement/revenue cycle engagements, including: cash acceleration, DNFB management, claims review and account receiveable reduction; the development and implementation organization-wide financial turnaround plans; and audits of the financial statements for hospitals, long-term care facilities and healthcare related organizations.
Josh Cahn, Director, Revenue Cycle Technology, PricewaterhouseCoopers, LLP
Josh is a Director of PwC's Health Industries Advisory Practice and he helps lead the firm's Revenue Performance Management Practice in the northeast market. Josh has experience with all facets of Revenue Performance Management. His recent consulting engagements have been at both academic medical centers and community hospital settings focusing on ICD-10 Assessment, Comprehensive Revenue Cycle improvements, Clinical Documentation Improvement Programs, Shared Service Initiatives, Cash Acceleration, Net Revenue Enhancement, Denial Management, and Revenue Cycle Information Systems Enhancements. His experience includes: Comprehensive Revenue Cycle Redesign Assessment and Implementation; Revenue Cycle Enhancement Strategic Plan for cash Acceleration, Incremental Net Revenue Enhancement Strategies and Cost to Collect Improvement; Denial Management Assessment and implementation of Rejection and Denial Management Improvement Program; managed A/R Outsourcing strategy development, outsourcing strategy implementation and vendor management protocols; Internal Audit Revenue Cycle Control Review; Assessment including Patient Access; DNFB/Unbilled Claim Management, AR Reduction, Denial Management, Reimbursement, Charge Capture, HIM, Operations and Managed Care Contracting.
Eric Wetherell, Manager, Finance and Operations, PricewaterhouseCoopers, LLP
Eric is a Manager in the Hartford office of the Finance and Operations practice at PricewaterhouseCoopers' Health Industries Practice. Eric has over 22 years experience leading health care projects, including feasibility study engagements related to both FHA 242 insured and non-FHA 242 insured financings, as well as in developing financial models that assist with evaluating financial and strategic long-range plans for the hospitals. Eric has recently been involved in several ICD-10 assessments, as well as hospital operational improvement engagement teams involved in identifying and implementing process enhancements to improve the financial results for these hospitals. He has been involved in several due diligence engagements for the evaluation of hospital affiliations. Additionally, Eric was the Project Manager for the establishment of various alignment models between physician practice and hospitals, and led several engagements related to the development of plants to rebuild the reequiped hospitals in New Orleans that were devastated by effects of Hurricane Katrina.
Steve Schelhammer, Chief Executive Officer, Phytel
Steve joined Phytel as Chief Executive Officer in August of 2008, he immediately began executing his strategic vision of positioning Phytel as the premier company empowering physician-led health improvement. By leveraging its innovative array of automated products and data registries, Phytel is working to strengthen the physician-patient relationship, optimize the impact of office encounters, and extend the physician's influence beyond the walls of his or her practice.
Besides leading Phytel, Steve is also a member of the board of directors of the American Medical Group Foundation, which advocates on behalf of coordinated care. Additionally, he is on the executive committee of the Patient-Centered Primary Care Collaborative, a multi-stakeholder organization that works for the advancement of the patient-centered medical home.
Under Steve's leadership, Phytel is building the information services and technology-based solutions necessary to enable provider-led population health improvement on a single integrated communications platform. He believes this new opportunity is the most exciting and meaningful of his career because it promises to empower physicians to lead population health improvement - a key component of a high-performing, sustainable healthcare system.
Rodd Padden, Vice President Solutions Management, Allscripts
Rodd Padden is the Vice President of Solutions Management at Allscripts and is in charge of product strategy across the Allscripts product portfolio. Working closely with the Allscripts client base, Rodd is developing Allscripts’ ACO strategy including new product solutions, packages, and partnerships
Rodd has over 20 years of healthcare experience and started his Allscripts career as the Senior VP and Chief Operating Officer of Canopy Systems, which was acquired by Allscripts in 2006. Prior to joining Canopy and Allscripts, Rodd was the Vice President for Product Management at The MEDSTAT Group, a leading healthcare information company which is now a part of Thomson Healthcare. At MEDSTAT, Rodd was responsible for creating the Outcomes Analyst product line and directing the development of the Disease Staging methodology. He also previously worked for the St. Michael Hospital in Milwaukee where he led strategic planning and quality management. Rodd received his undergraduate degree from the University of Wisconsin in Madison and received his MBA from Northwestern University’s Kellogg School of Management.
William Taylor, M.D., M.P.H., Associate Regional Administrator and, Director, Division of Quality Improvement, Boston Regional Office, Centers for Medicare & Medicaid Services
Dr. Taylor is a physician in the Boston Regional Office of the Centers for Medicare & Medicaid Services (CMS). As Director of the Division of Quality Improvement, Dr. Taylor works with 16 Quality Improvement Organizations and 5 End-Stage Renal Disease Networks. These are the principal organizations that provide the protection of Medicare rights and improve quality for the Medicare program.
Earlier, Dr. Taylor worked at the Centers for Disease Control and Prevention (CDC) and a state Medicaid program. Dr. Taylor practiced as an emergency room physician then pursued a career in public health, prevention, and health care quality. He received his medical degree from Case Western Reserve University, his public health degree from the University of California at Berkeley, and completed a fellowship in health economics at the University of Pennsylvania. He isboard-certified in Public Health and Preventive Medicine.
Kimberly E. Troland, Esquire, Robinson & Cole LLP
Kimberly Troland has been with Robinson & Cole since 2008. Kimberly represents hospitals academic medical centers, physician-hospital organizations, and physician groups in a wide varity of regulatory and transactional matters, with particular emphasis on: payor contracting, including negotiating complex risk arrangements; Stark, Anti-Kickback law, and other fraud and abuse law compliance; health information privacy and security matters under state law and HIPPAA, including data breaxch counseling; health information technology matters including structuring and acquisition of electronic health record technology and advice regarding Medicare/Medicaid Meaningful Use Incentive Program requirements; accountable care organizations, including guidance on Medicare Shared Savings Program and Pioneer ACO Model, and advice on general corporate matters including governance issues ande compliance.