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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ACO SUMMIT PRESENTATIONS
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SIXTH NATIONAL ACCOUNTABLE CARE ORGANIZATION (ACO) SUMMIT
AGENDA: PRECONFERENCE
Wednesday, June 17, 2015

PRECONFERENCE: LEGAL AND OPERATIONAL ISSUES IN ACO DEVELOPMENT
12:30 p.m.


Welcome and Opening Remarks

S. Lawrence Kocot, JD, LLM, MPA
Visiting Fellow, Economic Studies, The Brookings Institution, Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG, Former Senior Advisor to the Administrator, CMS, Washington, DC (Moderator)

    Speaker Bio

    Larry Kocot is a Principal at KPMG, working within the Health Care 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 and counsel to companies on regulatory matters relating to public health care programs, including Medicare and Medicaid. He has served as counsel to a wide range of corporations and associations on a variety of different matters, including investigations by the FTC, DOJ, SEC, and state attorneys general, as well as on qui tam and other litigation. Additionally, Mr. Kocot has represented companies in audits and other disputes with the federal government, advised companies on the development of business arrangements to assure compliance with federal and state fraud & abuse laws, and counseled organizations on the development and formation of accountable care organizations.

    Mr. Kocot is a former Senior Advisor to the Administrator of the Centers for and Medicaid Services (CMS) at the U.S. Department of Health and Human Services. In this capacity, he was involved in a wide range of health care policy issues and operations related to Medicare and Medicaid. Notably, Mr. Kocot was a key member of the management and operations team responsible for pharmaceutical, pharmacy, and pharmacy benefit management (PBM) issues, including the launch and operation of the Medicare Prescription Drug Benefit (Part D). More specifically, he led the development of pharmacy and long-term care pharmacy policy under the Part D program; guided CMS efforts to design and develop new systems functionality for providing beneficiary information to providers in real time at the point of sale; designed and launched CMS initiatives on pharmacy quality and pharmacy quality alliances; developed outreach, communications, and partnership programs with the pharmacy and pharmaceutical communities, including the creation and launch of the Web-based publication Medicare RxUpdate; and supervised pharmaceutical delivery and data management during and after Hurricane Katrina.

    Prior to joining KPMG, Mr. Kocot practiced law at Epstein Becker Green, PC, and Dentons, US LLP. Kocot is currently a visiting fellow in the Economic Studies Program at the Brookings Institution, where he was also Deputy Director of the Engelberg Center for Health Care Reform at Brookings from 2007-2013. Mr. Kocot was a fellow in International Security Studies at the Center for Strategic and International Studies (CSIS), and an adjunct fellow at CSIS for several years thereafter. Before his government service, Mr. Kocot was Senior Vice President and General Counsel at the National Association of Chain Drug Stores, where he was responsible for all legal matters and represented the industry before Congress, state legislatures, and state and federal regulatory agencies.
12:40 p.m.


The FTC's Health Care Enforcement Program and Implications for ACOs

Julie Brill, Esq.
Commissioner Federal Trade Commission; Former Senior Deputy Attorney General and Chief of Consumer Protection and Antitrust, North Carolina Department of Justice; Former Assistant Attorney General for Consumer Protection and Antitrust, Vermont, Washington, DC

    Speaker Bio

    Julie Brill was sworn in as a Commissioner of the Federal Trade Commission on April 6, 2010. She has been named "one of the 50 most powerful people in health care." She advocates for effective antitrust enforcement in the health care, and she wrote the Commission's unanimous decision in ProMedica, dissolving the merger of two hospitals in Toledo, Ohio. Prior to becoming a Commissioner, Ms. Brill was the Senior Deputy Attorney General and Chief of Consumer Protection and Antitrust for the North Carolina Department of Justice. Before that, Commissioner Brill served as an Assistant Attorney General for Consumer Protection and Antitrust for the State of Vermont for over 20 years. Commissioner Brill graduated, magna cum laude, from Princeton University, and from New York University School of Law.

Robert F. Leibenluft, Esq.
Partner, Hogan Lovells; Former Assistant Director, Health Care, Bureau of Competition, Federal Trade Commission, Washington, DC

    Speaker Bio

    Bob Leibenluft is a partner at Hogan Lovells in Washington, D.C. where he works exclusively on antitrust matters in the health care sector. In the mid-1990s, Bob served as Assistant Director for Health Care in the FTC' s Bureau of Competition, where he supervised the FTC/DOJ Policy Statements that first addressed clinical integration. Bob is an inaugural fellow of the American Health Lawyers Association, former chair of the ABA Antitrust Section' s Health Committee, Board Chair of HCI3 (the parent company of Prometheus Payment. and Bridges to Excellence), and teaches a course on health care antitrust at George Washington University Law School.

Douglas C. Ross, Esq.
Partner, Davis Wright Tremaine LLP, Former Attorney, Antitrust Division, United States Department of Justice, Seattle, WA

    Speaker Bio

    Mr. Ross is an officer of the ABA' s Antitrust Section and delegate appointed by the Section to the ABA' s House of Delegates. He is a past chair of the Section' s Health Care Industry Committee and a past chair of the Antitrust Practice Group of the American Health Lawyers Association. Mr. Ross is an adjunct faculty member at the University of Washington Law School, where he teaches the antitrust course as well as a seminar on competition in health care. He is a member of the Bureau of National Affairs' Health Law Advisory Board and is listed by Chambers USA in Commercial Litigation.

    Before entering private practice, Mr. Ross spent three years at the Antitrust Division. He received his J.D. from Columbia Law School, where he was a Harlan Fiske Stone Scholar, and his B.A. from Tufts University, where he graduated summa cum laude in economics.
1:40 p.m.


The Evolving Role of the Office of Inspector General in Alternative Payment Models

Troy A. Barsky
Partner, Health Care Group, Crowell & Moring, 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).

Kim Brandt, JD
Chief Oversight Counsel, U.S. Senate Finance Committee, Majority Staff, Washington, DC

    Speaker Bio

    Kimberly Brandt serves as Chief Oversight Counsel for the U.S. Senate Finance Committee where she has served on Committee staff since January 2011. In her role on the Committee, Kim coordinates oversight activities for the full range of Finance Committee issues including tax, treasury, trade, Social Security and healthcare. Her professional experience includes Medicare fraud and abuse detection and prevention; program safeguard contractor oversight; data analysis, medical review and accreditation; provider and supplier enrollment; error rate measurement for Medicare and Medicaid; and enforcement oversight of CMS' administrative actions (including suspensions, overpayments and civil monetary penalties). Prior to joining the Finance Committee staff, Kim was a Senior Counsel at Alston & Bird in Washington, D.C. advising clients on compliance and fraud and abuse issues.

Vicki Robinson, Esq.
Senior Counselor for Policy, Office of the Inspector General (OIG), United States 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.
2:30 p.m.


Considerations for Promoting Patient Engagement

William A. Hensel, MD
Member, Triad HealthCare Network Operating Committee; Director, Cone Health Family, Medicine Residency Program; Professor, Department of Family Medicine, University of North Carolina School of Medicine, Greensboro, NC

    Speaker Bio

    Dr. William Hensel is Professor of Family Medicine at the University of North Carolina Department of Family Medicine and Program Director for the Cone Health Family Medicine Residency Program in Greensboro, North Carolina. He is a founding member of the operating committee of Triad HealthCare Network, which, to date, has been the most successful ACO in North Carolina. He is also a founding member of the executive council of Cone Health Medical Group, which consists of physicians employed by Cone Health, and serves as chair of the Cone Health Ethics Committee.

Terri L. Postma, MD, CHCQM
Medical Officer, Performance-Based Payment Policy Group, Center for Medicare, Centers for Medicare & Medicaid Services (CMS), Baltimore, MD

    Speaker Bio

    Dr. Terri L. Postma is a neurologist and currently serves as Medical Officer in the Center for Medicare (CM) at the Centers for Medicare & Medicaid Services (CMS). Just prior to joining CMS, she completed a public policy fellowship with the Senate Finance Committee during the health care reform debate of the 111th Congress. Following the fellowship, Dr. Postma took up her post at CMS where she advises leadership on policy issues related to Medicare' s payment systems and value-based purchasing initiatives, in addition to serving as lead for the Shared Savings Program.

Kelly Taylor, RN, MSN, CCM
ACO Director of Quality & Care Management, Mercy ACO, Des Moines, IA

    Speaker Bio

    Kelly Taylor, RN, MSN, CCM is the Director of Quality & Care Management for the Mercy ACO in Des Moines, IA., which currently includes over 105 participant organizations with over 1,800 providers serving over 117,000 patients throughout urban and rural Iowa. She is responsible for the development, implementation and evaluation of the ACO' s statewide care management program. Kelly also is privileged to serve as the only Iowan chosen for CMS' Innovation Advisors Program.

    Kelly has over 25 years of experience in the areas of case management, disease management, and quality improvement in both the ambulatory and payer settings.
3:15 p.m. Break
3:30 p.m.


Regulatory Burdens on Payment and Performance

Peter Basch, MD
Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health; Visiting Scholar in Health IT Policy, The Brookings Institution, Washington, DC

    Speaker Bio

    Dr. Basch is a practicing general internist in Washington, DC, and the Medical Director for Ambulatory EHR and Health IT Policy for MedStar Health. He is a Visiting Scholar in Health IT Policy at the Center for Health Policy at the Brookings Institution and a Senior Fellow in Health IT Policy at the Center for American Progress. Dr. Basch is the current chair of the Medical Informatics Committee for the American College of Physicians, and represents the ACP at the Physicians' EHR Coalition. Dr. Basch has been recognized as one of the Top 25 Clinical Informaticists by Modern Healthcare, is a recipient of the Physician Informatics Leadership Award by HIMSS, and was named by Beckers CIO Magazine as one the 26 Smartest People in Health IT.

Danielle A. Lloyd, MPH
Vice President, Policy & Advocacy, Deputy Director DC Office, Premier healthcare alliance, Washington, DC

    Speaker Bio

    Danielle Lloyd is the vice president for policy and advocacy as well as deputy director of the Washington, DC office of the Premier healthcare alliance. Premier, Inc. (NASDAQ: PINC) is a leading healthcare improvement company, uniting an alliance of approximately 3,400 U.S. hospitals and 110,000 other providers to transform healthcare.

    Danielle leads Premier's policy analysis and development. She is a national expert on federal healthcare quality and payment polices impacting hospitals, outpatient facilities and physicians, such as value-based purchasing and alternative payment models. Lloyd works with the U.S. Congress, White House, healthcare policymakers, and other major stakeholders involved in healthcare policy and regulation. She also plays a leading role in Premier's large-scale provider collaboratives and Premier's non-profit research arm, the Premier Research Institute.

    Danielle is an active volunteer for Sibley Memorial Hospital's Patient & Family Advisory Council and Quality & Safety team. She is from Los Angeles, has a bachelor's degree from the University of Pennsylvania and has a master's degree in public health from the University of California, Berkeley.

Robert M. Wah, MD
Immediate Past President, American Medical Association, Global Chief Medical Officer, Computer Sciences Corporation, Former First Deputy National Coordinator, Office of the National Coordinator for Health Information Technology, HHS, McLean, VA

    Speaker Bio

    Robert M. Wah, MD, is the immediate past president of the American Medical Association, the first Asian-American with that distinction.

    A reproductive endocrinologist and obstetrician-gynecologist, Dr. Wah practices and teaches at the Walter Reed National Military Medical Center and the National Institutes of Health in Bethesda, Maryland.

    A nationally known leader in digital health technology, Dr. Wah is chief medical officer for Computer Sciences Corporation and is a regular among Modern Healthcare magazine's "50 Most Influential Physician Executives."

    Previously, he served as associate chief information officer for the Military Health System and was the first Deputy National Coordinator and Chief Operating Officer at the Department of Health and Human Services. There, he helped direct the Office of National Coordinator in its pursuit of securing electronic medical records for all Americans.

    An AMA House of Delegates member for 17 years, Dr. Wah previously was chair of the AMA Board of Trustees and the AMA Council on Long Range Planning and Development.

    He has served on the faculties of the Harvard Medical School, the University of California, San Diego, and the Uniformed Services University of the Health Sciences.

    Born and raised in Oregon, Dr. Wah has a degree in chemistry from the University of Oregon and an MD from the Oregon Health Sciences University. And he's a graduate of the Advanced Management Program at Harvard Business School.

    He completed his residency at the National Naval Medical Center in Bethesda and a reproductive endocrinology fellowship at Harvard in the Brigham and Women's Hospital in Boston. Dr. Wah served more than 23 years on active duty as a captain in the U.S. Navy Medical Corps.
4:05 p.m.


Current State of ACO Analysis

Michael E. Chernew, PhD
Leonard D. Schaeffer Professor of Health Care Policy, Director of the Healthcare Markets and Regulation (HMR) Lab, Department of Health Care Policy, Harvard Medical School, Boston, MA

    Speaker Bio

    Michael Chernew, Ph.D. is the Leonard D. Schaeffer Professor of Health Care Policy at Harvard Medical School. Dr. Chernew' s research activities focus on several areas, most notably the causes and consequences of growth in health care expenditures, payment reform, and Value Based Insurance Design (VBID). He is a member of the Congressional Budget Office' s Panel of Health Advisors and of the Institute of Medicine Committee on National Statistics. He is the former Vice Chair of the Medicare Payment Advisory Commission, an independent agency established to advise the U.S. Congress on issues affecting the Medicare program. In 2010, he was elected to the Institute of Medicine of the National Academy of Sciences. Dr. Chernew earned his undergraduate degree from the University of Pennsylvania and a doctorate in economics from Stanford University.

David B. Muhlestein, PhD, JD
Senior Director of Research and Development, Leavitt Partners, LLC, Salt Lake City, UT

    Speaker Bio

    David Muhlestein is Senior Director of Research and Development at Leavitt Partners. He directs the study of accountable care organizations through the LP Center for Accountable Care Intelligence and leads the firm's quantitative evaluation of health care markets. He is an expert in using policy analysis, predictive modeling and applied analytics to understand the evolving health care landscape and his insights have been quoted by publications such as The Wall Street Journal, The Seattle Times and Modern Healthcare. He completed his PhD and JD at The Ohio State University and his undergraduate at Brigham Young University.

Michael Taggart, FSA
Actuary, Standard & Poors Indices, President, Empyrean Benefit Solutions, Inc., Houston, TX

    Speaker Bio

    Michael Taggart is an actuary and the market leader for the S&P Healthcare Cost Indices. Michael has extensive experience in the healthcare field, having been with AonHewitt, where he was the national practice leader for Healthcare Analytics and also with Mercer, where he was the healthcare practice leader for the Southwest Region. From 1998 to 2004, Michael was President and co-founder of Synhrgy HR Technologies, a startup firm providing technology and benefit administration services to large employers. Synhrgy was acquired by Mercer in 2004. Michael is also a Fellow of the Society of Actuaries.
4:50 p.m.


Wrap-Up and Concluding Remarks

S. Lawrence Kocot, JD, LLM, MPA
Visiting Fellow, Economic Studies, The Brookings Institution, Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG, Former Senior Advisor to the Administrator, CMS, Washington, DC

    Speaker Bio

    Larry Kocot is a Principal at KPMG, working within the Health Care 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 and counsel to companies on regulatory matters relating to public health care programs, including Medicare and Medicaid. He has served as counsel to a wide range of corporations and associations on a variety of different matters, including investigations by the FTC, DOJ, SEC, and state attorneys general, as well as on qui tam and other litigation. Additionally, Mr. Kocot has represented companies in audits and other disputes with the federal government, advised companies on the development of business arrangements to assure compliance with federal and state fraud & abuse laws, and counseled organizations on the development and formation of accountable care organizations.

    Mr. Kocot is a former Senior Advisor to the Administrator of the Centers for and Medicaid Services (CMS) at the U.S. Department of Health and Human Services. In this capacity, he was involved in a wide range of health care policy issues and operations related to Medicare and Medicaid. Notably, Mr. Kocot was a key member of the management and operations team responsible for pharmaceutical, pharmacy, and pharmacy benefit management (PBM) issues, including the launch and operation of the Medicare Prescription Drug Benefit (Part D). More specifically, he led the development of pharmacy and long-term care pharmacy policy under the Part D program; guided CMS efforts to design and develop new systems functionality for providing beneficiary information to providers in real time at the point of sale; designed and launched CMS initiatives on pharmacy quality and pharmacy quality alliances; developed outreach, communications, and partnership programs with the pharmacy and pharmaceutical communities, including the creation and launch of the Web-based publication Medicare RxUpdate; and supervised pharmaceutical delivery and data management during and after Hurricane Katrina.

    Prior to joining KPMG, Mr. Kocot practiced law at Epstein Becker Green, PC, and Dentons, US LLP. Kocot is currently a visiting fellow in the Economic Studies Program at the Brookings Institution, where he was also Deputy Director of the Engelberg Center for Health Care Reform at Brookings from 2007-2013. Mr. Kocot was a fellow in International Security Studies at the Center for Strategic and International Studies (CSIS), and an adjunct fellow at CSIS for several years thereafter. Before his government service, Mr. Kocot was Senior Vice President and General Counsel at the National Association of Chain Drug Stores, where he was responsible for all legal matters and represented the industry before Congress, state legislatures, and state and federal regulatory agencies.
5:00 p.m. Adjournment

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