Accountable Care Organization Summit
Accountable Care Organization Summit
Accountable Care Organization Summit
Accountable Care Organization Summit
Accountable Care Organization Summit
Accountable Care Organization Summit

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Thursday, June 9, 2016

(Preconference registration optional)
7:00 a.m. Registration Commences
9:00 a.m.

Welcome & Introductions

S. Lawrence Kocot, JD, LLM, MPA
Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG; Former Senior Advisor to the Administrator, CMS, Washington, DC (Chair)

    Speaker Bio

    Larry Kocot is a Principal at KPMG, working within the Healthcare and Life Sciences practice in the Washington, DC, office. Mr. Kocot is also the National Leader of the Center for Healthcare Regulatory Insight. Mr. Kocot provides strategic advice to businesses on health care transformation and counsels a wide range of companies on regulatory matters relating to public health care programs, including Medicare and Medicaid.
    Presentation Material (Acrobat)
9:10 a.m.

Panel I: MACRA, MIPS, and APMs: Getting There from Here

Paul N. Casale, MD, MPH
Executive Director, NewYork Quality Care ACO; Former Chief, Division of Cardiology, Lancaster General Health, New York, NY

    Speaker Bio

    Paul N. Casale, MD, MPH is a cardiologist and Executive Director of NewYork Quality Care, the ACO of New York-Presbyterian ? Columbia ? Weill Cornell. He is Associate Director of Population Health at Weill Cornell Medicine and Columbia University Medical Center and Vice President of Population Health Management at New York-Presbyterian.

    Dr. Casale serves on the Physician-Focused Payment Model Technical Advisory Committee and the NQF MAP Clinician Workgroup. Dr. Casale is a member of the Board of Trustees of the American College of Cardiology.

    Dr. Casale is a graduate of Weill Cornell Medical College. He completed his internal medicine residency at NewYork-Presbyterian/Weill Cornell Medical Center and his fellowship in cardiology at Massachusetts General Hospital and Harvard Medical School. He received a Master of Public Health at Harvard T.H. Chan School of Public Health. He is board certified in Internal Medicine, Cardiology and Interventional Cardiology.

Harold D. Miller
President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform, Pittsburgh, PA

    Speaker Bio

    Harold D. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy center that facilitates improvements in healthcare payment and delivery systems. Miller is a nationally-recognized expert on healthcare payment and delivery reform; he has given invited testimony to Congress on how to reform healthcare payment, has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms, and has written many widely-used reports on healthcare payment and delivery reform. Miller is one of eleven appointed members of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress in 2015 to advise the Secretary of Health and Human Services on the creation of alternative payment models. Miller also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University.

Frank Opelka, MD, FACS
Medical Director, Division of Advocacy and Health Policy, American College of Surgeons; Former EVP of Health Care and Medical Redesign, Louisiana State University System, New Orleans, LA

    Speaker Bio

    Dr. Opelka is a physician executive who serves as the medical director of the American College of Surgeons in Washington DC and as the Executive Vice President for LSU. He is a professor of Surgery. He currently serves as the chair of the AMA's Physician Consortium for Performance Improvement, chairs the NQF's Consensus Standards Advisory Committee, and founded and chairs the Surgical Quality Alliance convening over 20 surgical specialties.

    He leads an LSU statewide effort using "big data" in a clinical data warehouse which provides rich analytics for quality improvement, real time clinical decision supports, feeds for MOC reporting and outputs for national specialty data registries.

    Dr. Opelka reviews for five international journals and is a published colorectal surgeon.
    Presentation Material (Acrobat)
10:10 a.m.

Panel II: Impact of Market Consolidation: Providers and Payers

Leigh Oliver, JD
Partner, Hogan Lovells LLP, Washington, DC

Presentation Material (Acrobat)

Joshua H. Soven, Esq.
Partner, Gibson, Dunn & Crutcher LLP; Vice Chair, ABA Antitrust Section's Federal Civil Enforcement Committee; Former Chief, Litigation I Section, Antitrust Division, US Department of Justice, Washington, DC

    Speaker Bio

    Joshua H. Soven is a partner in the Washington, D.C. office of Gibson, Dunn & Crutcher, LLP. His practice focuses on government antitrust investigations, antitrust litigation, and counseling on competition issues. He represents clients before the Antitrust Division of the Department of Justice, The Federal Trade Commission, and in the federal courts.

    Mr. Soven was Chief of the Litigation Section of the Antitrust Division of the Department of Justice. In this role, he directed numerous investigations and litigation challenges including United States v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2010) and United States v. Dean Foods (E.D. Wis. 2011), Mr. Soven also served as a trial attorney in the Antitrust Division's Networks and Technology Enforcement Section where he led many investigations including United States v. First Data/Concord EFS (D.D.C. 2003).

Christine White, JD, MPH
Vice President - Legal Affairs, Northwell Health; Chair, Antitrust Practice Group, American Health Lawyers Association; Former Senior Staff Attorney, Federal Trade Commission, New York, NY
11:05 a.m.

Panel III: How Will New Payment Models Co-exist with Old Fraud and Abuse Laws?

Troy Barsky, Esq.
Partner, Crowell & Moring; Former Director, Division of Technical Payment Policy, Center for Medicare and Medicaid Services; Former Program Integrity Group, CMS Division, Office of the General Counsel, US Department of Health and Human Services, Washington, DC

    Speaker Bio

    Troy Barsky is a partner in Crowell & Moring's Washington, D.C. office and a member of the firm's Health Care Group, where he focuses on health care fraud and abuse, and Medicare and Medicaid law and policy. Troy counsels all types of health care entities, including hospitals, group practices, and health plans on the physician self-referral law (Stark Law) and the Anti-Kickback Statute, innovative healthcare delivery models, such as Accountable Care Organizations (ACOs), and Medicare & Medicaid payment and coverage policy. He also defends clients seeking resolution of government health care program overpayment issues or fraud and abuse matters through self-disclosures and negotiated settlements with the U.S. Department of Justice, U.S. Health & Human Services Office of the Inspector General and the Centers for Medicare & Medicaid Services (CMS).

Vicki Robinson, Esq.
Senior Counselor for Policy, Office of the Inspector General (OIG), US Department of Health and Human Services, Washington, DC

    Speaker Bio

    Vicki L. Robinson is Senior Counselor for Policy at the Office of Inspector General of the United States Department of Health and Human Services (OIG), where she advises the Inspector General, as well as OIG and HHS staff and officials, on legal and policy issues related to integrity and oversight of health care reform programs, including insurance market reforms and transformations in payment and delivery of health care. She previously served as the OIG's Senior Advisor for Health Care Reform and as Chief of the Industry Guidance Branch (IGB) in the Office of Counsel to the Inspector General (OCIG). As IGB Chief, Ms. Robinson was responsible for reviewing business arrangements for compliance with the fraud and abuse laws, preparing advisory opinions, drafting safe harbor regulations, and providing guidance to industry and government stakeholders on the anti-kickback statute, safe harbor regulations, and other fraud and abuse authorities, including the Stark law. Prior to joining OIG, Ms. Robinson was in private practice in Washington, D.C. Ms. Robinson is a graduate of Harvard Law School and Stanford University. She currently serves on the Board of Directors of the American Health Lawyers Association. She has also served on the Governing Council of the Health Law Section of the American Bar Association. Ms. Robinson is a frequent speaker on health care fraud and abuse topics.

Howard J. Young, Esq.
Partner, Morgan, Lewis & Bockius LLP; Former Senior Attorney and Deputy Branch Chief, Office of Inspector General, US Department of Health and Human Services, Washington, DC

    Speaker Bio

    Howard Young, a Partner in the Morgan Lewis Health Care Practice and is a nationally recognized leader with over 23 years of focused fraud and abuse defense, regulatory and compliance matter experience. Mr. Young counsels a wide variety of health care providers and suppliers including hospitals, home health agencies, large and small hospice organizations, physician groups and pharmacies. He regularly advises clients on HHS Office of Inspector General (OIG) exclusion matters, including litigation, Medicare and Medicaid contractor and OIG audits, compliance program matters, corporate integrity agreement matters, internal investigations, self-disclosures, qui tam False Claims Act defense, health care regulatory and transaction matters. From 1997 to 2002, Howard was a Senior Counsel and Deputy Branch Chief with the Office of Counsel to the Inspector General, where he coordinated extensively with CMS and DOJ on the resolution of civil and criminal health care fraud and other program integrity matters.
Noon Preconference Focus Session Adjournment

Thursday, June 9, 2016

Noon Joint ACO Summit, Bundled Payment Summit and Pharma Managed Markets Summit Keynote Luncheon
12:20 p.m.

Keynote Address/Discussion: Centers for Medicare and Medicaid Services Perspective on Payment Reform

Patrick H. Conway, MD, MSc
Deputy Administrator for Innovation and Quality and Chief Medical Officer, Director, Center for Medicare and Medicaid Innovation and Office of Clinical Standards and Quality, Center for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD

    Speaker Bio

    Patrick Conway, MD, MSc, is the CMS Acting Principal Deputy Administrator and Deputy Administrator for Innovation and Quality & CMS Chief Medical Officer.

    Dr. Conway is also Director of the Center for Medicare and Medicaid Innovation (CMMI) at CMS. The CMS Innovation Center is responsible for testing numerous new payment and service delivery models across the nation that reward quality and value.

    In 2014, he was elected to the National Academy of Medicine Institute of Medicine (IOM) recognizing individuals who have demonstrated outstanding professional achievement. Election to the IOM is considered one of the highest honors in the fields of health and medicine.
    Presentation Material (Acrobat)
1:15 p.m. Transition Break

1:30 p.m.

Welcome, Introduction and Keynote Address

Mark McClellan, MD, PhD
Director, Robert J. Margolis Center for Health Policy and Margolis Professor of Business, Medicine and Health Policy, Duke University; Former CMS Administrator and FDA Commissioner, Washington, DC

    Speaker Bio

    Mark McClellan, MD, PhD, is the Robert J. Margolis Professor of Business, Medicine, and Policy, and Director of the Duke-Margolis Center for Health Policy at Duke University with offices at Duke and in Washington DC.

    Dr. McClellan is a doctor and an economist, and his work has addressed a wide range of strategies and policy reforms to improve health care, including payment reforms to promote better outcomes and lower costs, methods for development and use of real-world evidence, and approaches for more effective drug and device innovation. Dr. McClellan is a former administrator of the Centers for Medicare & Medicaid Services (CMS) and former commissioner of the U.S. Food and Drug Administration (FDA), where he developed and implemented major reforms in health policy. He was also a Senior Fellow at the Brookings Institution and a professor of economics and medicine at Stanford University.
2:00 p.m.

Panel I: Effective Practice Transformation from the Top Down

Peter A. Gross, MD
Chairman, Hackensack Alliance ACO Board of Managers, Executive Vice-President and Chief Medical Officer, Hackensack University Medical Center, Hackensack, NJ

    Speaker Bio

    Peter A. Gross, MD is Chair, Board of Managers of Hackensack Alliance ACO, at Hackensack University Medical Center, Hackensack, NJ. The ACO is certified by NCQA. Dr. Gross is Professor of Medicine at Rutgers New Jersey Medical School, Newark, NJ. He is past chair of the Infectious Diseases Society of America's Practice Guidelines Committee and a former member of the IDSA Council. He was project director for The Robert Wood Johnson Foundation's grant Pursuing Perfection: Raising the Bar for Healthcare Performance. He chaired the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) Pneumonia Clinical Advisory Panel and the Sentinel Event Advisory Group. He is past president of Society of Healthcare Epidemiologists of America (SHEA). He chaired the Food and Drug Administration's (FDA) Drug Safety and Risk Management Advisory Committee. He serves as a member of the Board of the National Association of ACOs (NAACOS). He has over 250 publications.
James A. Rice, PhD, FACHE
Managing Director and Senior Advisor, Governance & Leadership Practice, Integrated Healthcare Strategies; Former President, The Governance Institute, Minneapolis, MN

    Speaker Bio

    Jim Rice, PhD, FACHE is the Managing Director & Practice Leader of the Governance & Leadership practice of Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc. He focuses his consulting work on strategic governance structures and systems for high performing, tax-exempt health sector organizations and integrated care systems; visioning for health sector and not-for-profit organizations; and leadership development for physicians and medical groups.

    Dr. Rice holds master's and doctoral degrees in management and health policy from the University of Minnesota. He has received the University of Minnesota School of Public Health Distinguished Alumni Leadership Award, a National Institute of Health Doctoral Fellowship, a US Public Service Trainee in Hospital Management, a Bush Leadership Fellowship at the National University of Singapore, and the American Hospital Association's Corning Award for excellence in hospital planning. He is a Fellow in the American College of Healthcare Executives (ACHE).
    Presentation Material (Acrobat)
Craig Swanson, MBA, CPA
Founder and President, Insignia Health, Minneapolis, MN

    Speaker Bio

    Craig is co-founder and President of Insignia Health. Insignia partners with leading health systems, hospitals, insurers, public health providers and pharmaceutical companies around the world to help individuals become more active self-managers of their health and healthcare.

    As health activation increases -- as measured the Patient Activation Measure® (PAM®) -- individuals experience fewer health crises and generate lower healthcare costs. Over 250 independent research studies have validated PAM and shown that increased activation translates into better health outcomes.

    Prior to Insignia Health, Craig co-founded Definity Health and served as Chief Financial Officer, Strategy and Corporate Development Lead and Head of Operations.
    Presentation Material (Acrobat)
Bruce Bagley, MD
Senior Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association; Former President and CEO, TransforMED; Former Medical Director for Quality Improvement, American Academy of Family Physicians, Kansas City (Moderator)

    Speaker Bio

    Bruce Bagley, MD, is currently serving as Senior Advisor to the Professional Satisfaction and Practice Sustainability effort at the American Medical Association. He is also serving as Senior Advisor to the American Association for Physician Leadership on the newly minted Lx Solutions project to bring enhanced strategic physician leadership to organizations of all sizes. Bagley is a nationally known leader in performance measurement, quality improvement and office practice redesign. He recently served as president and CEO of TransforMED, a wholly owned subsidiary of the American Academy of Family Physicians. TransforMED was instrumental in helping primary care practices across the Country enhance their effectiveness, efficiency and capability. Bagley continues to advocate for the importance of primary care as the foundation of a redesigned U.S. health care system.
3:00 p.m. Break
3:30 p.m.

Panel II: Partnerships for Accountable Care Innovation

Chuck Beeman, MBA
Vice President, Population Health Service Organization, Florida Hospital, FL

    Speaker Bio

    Chuck Beeman is the Vice President of Analytics at Florida Hospital Healthcare System. He is a seasoned fortune 500 executive who has more than 18 years' experience in delivering technology solutions for the HealthCare, Finance, and Technology industries.

    Most recently at WellCare, a 12 billion dollar health plan serving Medicaid and Medicare members, Chuck was responsible for improving processes to support quality of care, reducing turnaround time to deliver care gaps, providing analytics to build a high performance network, implementing the HIE strategy, successfully completing the ICD 10 conversion and delivering on a Big Data environment. Prior to WellCare, Chuck led the product development team for SysArc Infomatix to support risk assessment for Commercial, Construction and Consumer lending.

    Chuck has an MBA and a Bachelor of Commerce from the University of Madras. He also has a Post-graduate diploma from NIIT (National Institute of Information Technology) in Software Development and a Lean Sigma certification from the Purdue University. Chuck also serves on the board of the First Tee of Tampa Bay.
Seth Frazier, MBA
Chief Transformation Officer, Evolent Health; Former Chief Transformation Officer, Geisinger Health System, Arlington, VA

    Speaker Bio

    Seth oversees Evolent Health's client transformation practice. He works with a wide range of health systems, academic medical centers, payers and alliances from New England to California to develop and optimize value based strategy and operations. He most recently served as the Chief Transformation Officer for the Geisinger Health System prior to joining Evolent. His responsibilities included providing business leadership to large-scale innovation projects within the health system (e.g., Geisinger Accelerated Performance Program) and external consulting for Geisinger Ventures. Prior to Geisinger, Seth was Senior Vice President, Strategic Services for The Children's Hospital of Philadelphia (CHOP). Seth led CHOP's national contracting for tertiary services, proton therapy development initiative, and strategic plan development and management. Before assuming the strategic services role, Seth had executive responsibilities for CHOP-affiliated Children's Health Net, a pediatric managed care organization that developed and managed a globally capitated PCP network under contract with the dominant regional HMO. Seth came to CHOP after a 9-year consulting career with a large national health care firm. His practice areas included clinical resource management, managed care, service line strategy, hospital redesign and strategy. He holds an MBA from the Wharton School as a Kaiser Fellow and a BA (Honors) in Economics from Haverford College.
Stuart Levine, MD, MHA
Chief Executive Officer and President, Medical Innovations, Inc.; Assistant Professor, UCLA School of Medicine, Assistant Professor Stanford School of Medicine, Los Angeles, CA

    Speaker Bio

    Dr. Stuart Levine is the CEO and President of Medical Innovations Inc., a health consulting firm for which he is the founder. He is an operating advisor to some of the largest and most successful private equity firms in health care including Clayton, Dubilier and Rice, Francisco Partners and ChicagoPacific Founders.

    Dr. Levine is an Assistant Professor of Internal Medicine and Psychiatry at the University of California, Los Angeles David Geffen School of Medicine as well as resident expert on Population Health.

    Dr Levine was also recently appointed assistant Clinical Professor of Internal Medicine at Stanford University School of Medicine and has been active in their teaching programs around population health and future of medicine since 2014.
Stephen Rosenthal, MS, MBA
Senior Vice President, Population Health Management, Montefiore Health System, President and Chief Operating Officer, Montefiore's Care Management Organization, Yonkers, NY (Moderator)

    Speaker Bio

    Stephen Rosenthal is the Senior Vice President, Population Health Management for Montefiore's Integrated Delivery System and he is also the President and COO of CMO The Care Management Company, LLC (CMO), a wholly owned for-profit subsidiary of Montefiore Medical Center that Mr. Rosenthal designed and has grown from the ground up to a 1,100-employee organization, that manages an insurance premium portfolio of over $2.6B covering over 400k lives.
4:30 p.m.

Panel III: Maximizing the Impact of Bundles and Accountable Care Together

Marc Berg, MD, PhD
Principal and National Lead of Government, Healthcare Transformation, KPMG; Former Professor in Health Policy and Management, Erasmus University, Rotterdam, Washington, DC

    Speaker Bio

    Marc Berg leads KPMG's national Government Health Care Transformation group, and is Global Center of Excellence member for Outcome Measurement and Payment Reform. He pioneered the introduction of measuring value of care for defined populations, working for governments and payers, building upon an integrated set of claims data, patient-reported outcome measures and clinical data. He has developed and helped implement several national delivery- and payment reform programs for governments and commercial payers, including New York State. He is a former Professor of Health Policy and Management and has published widely on health care information management, quality management and payment reform.
    Presentation Material (Acrobat)
Erin Smith, JD
VP of Policy and Government Affairs, naviHealth; Former Director, Division of Technical Model Support, and Lead, Bundled Payments for Care Improvement (BPCI) Initiative, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, DC

    Speaker Bio

    Prior to taking a role at PACCR, Erin served as the Director of the Division of Technical Model Support at CMS in the Center for Medicare and Medicaid Innovation, where she led the team that implements the Bundled Payments for Care Improvement initiative and develops new bundled payments models. Prior to CMS, Erin was a tobacco control policy analyst at the World Health Organization. More recently, Erin served as a Senior Manager at Avalere Health, where she provided strategic insights into Medicare fee-for-service payments and innovative payment policies, with particular insight into the development and operationalization of alternative payment models.
Winthrop F. Whitcomb, MD, MHM
Chief Medical Officer, Remedy Partners, Cofounder and Past President, Society of Hospital Medicine, Darien, CT

    Speaker Bio

    Win Whitcomb, MD, MHM, is Chief Medical Officer of Remedy Partners, an ?episodes of care? company, where he oversees all aspects of the clinical enterprise, and the intersection between clinical, technology, and business.

    Prior to joining Remedy, Dr. Whitcomb led the development and implementation of several bundled payment programs at Baystate Health in conjunction with its commercial health plan and the Center for Medicare and Medicaid Innovation. A practicing hospitalist for over twenty years, Win has led the development of the hospitalist specialty since 1994, when he assumed leadership of the nation?s first 24/7 on-site hospitalist program.
Francois de Brantes, MBA
Executive Director, Health Care Incentives Improvement Institute, Newtown, CT (Moderator)

    Speaker Bio

    Francois de Brantes is the Executive Director of the Health Care Incentives Improvement Institute, a not-for-profit that develops and implements new models that create better incentives for patients, physicians and hospitals in order to achieve greater affordability and quality of health care. Francois has also authored many papers and articles on the role of incentives in health care and how to improve them. His latest book, The Incentive Cure, describes how reformed incentives could change the dialogue between patients and providers on the costs of health care.
    Presentation Material (Acrobat)
5:30 p.m. Adjournment and Networking Reception

Go to Agenda:
Day 1 | Day 2

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