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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FIFTH NATIONAL ACCOUNTABLE CARE ORGANIZATION (ACO) SUMMIT
AGENDA: PRECONFERENCE
Wednesday, June 18, 2014

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


Introduction and Overview

S. Lawrence Kocot, JD, LLM, MPA
Visiting Fellow, Engelberg Center for Health Care Reform, The Brookings Institution; Member of the Firm, Health Care and Life Sciences, Epstein Becker Green; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC (Moderator)

    Speaker Bio

    Larry Kocot, J.D., LL.M, M.P.A, is deputy director of the Engelberg Center for Health Care Reform and a visiting fellow in the Economic Studies program at the Brookings Institution. He is examining the challenges of access, quality and financing that face the U.S. health care system. He is also Senior Counsel at Dentons, U.S. LLP. Mr. Kocot previously served as a senior advisor to the administrator of the Centers for Medicare & 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, he was a key member of the management and operations team responsible for the national launch and operation of the Medicare Prescription Drug Benefit (Part D). Mr. Kocot has served as a member of Virginia's Commonwealth Health Research Board (CHRB) from 2002-2012 and was chairman from 2005-2008. Prior to his government service, Mr. Kocot was senior vice president and general counsel of a national pharmacy trade association. He has also served as a fellow at the Center for Strategic and International Studies (CSIS) where he participated in a wide range of policy studies. Mr. Kocot has been active in the start-up and management of a number of small businesses, including a management and legal consulting company, a pharmacy data and technology company and a pharmacy benefits management company. Mr. Kocot was interim CEO and is currently a member of the Board of Directors of the Partnership for a Healthier America. He also serves on the Board of Directors of ICF International, Inc. (NASDAQ:ICFI). Mr. Kocot received his BA and MPA degrees from the University of Massachusetts at Amherst. He earned his JD and LLM degrees at the Georgetown University Law Center.
12:40 p.m.


FTC v. St Luke's Health System: Implications for ACOs

David A. Ettinger, Esq.
Partner and Leader, Antitrust and Trade Regulation Practice Group, Honigman Miller Schwartz & Cohn, Detroit, MI

    Speaker Bio

    David Ettinger was lead counsel for Saint Alphonsus in Saint Alphonsus v. St. Luke's. Mr. Ettinger has led Honigman's Antitrust and Trade Regulation practice for more than 30 years. He has represented clients in health antitrust matters in more than 30 states, and has successfully acted as lead counsel in a wide variety of major matters, including: A successful defense of a merger against Justice Department challenge; a successful defense of one of the foundational cases on IPA and HMO antitrust liability; a successful defense of a number of intensive "second request" investigations of hospital and physician mergers and acquisitions; and defense of many government investigations of hospitals, physician groups and health care networks.

    Mr. Ettinger has written and spoken before national audiences on health antitrust topics on a regular basis for more than 20 years.

Martin Gaynor, PhD
Director, Bureau of Economics, Federal Trade Commission; E.J. Barone Chair Professor of Economics and Health Policy, Carnegie Mellon University, Washington, DC

    Speaker Bio

    Martin Gaynor is the Director of the Bureau of Economics at the Federal Trade Commission. He is on leave from Carnegie Mellon University, where he is the E.J. Barone Professor of Economics and Public Policy. His research focuses on competition and antitrust policy in health care markets. He has written extensively on this topic, testified before Congress, and advised the governments of the Netherlands and the United Kingdom on competition issues in health care. Dr. Gaynor received his B.A. from the University of California, San Diego in 1977 and his Ph.D. from Northwestern University in 1983.

Ben Keith
Partner, Sidley Austin LLP, Chicago, IL

    Speaker Bio

    BEN KEITH is a partner in Sidley Austin's Healthcare practice in Chicago. His practice focuses on litigation, investigations, and counseling involving antitrust, unfair and deceptive trade practices, and healthcare fraud and abuse issues. Among his recent engagements, Ben represents branded pharmaceutical manufacturers in antitrust class action lawsuits and government investigations concerning alleged misconduct resulting in delays in the availability of generic versions of branded drug products. He also represents health systems, hospitals, and physician practices in antitrust lawsuits and government investigations challenging mergers and acquisitions, joint ventures, and the formation of narrow provider networks. In addition to his controversies practice, Ben also counsels leading health care systems, provider groups, and trade associations on compliance with federal and state competition laws.

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.
1:30 p.m.


Considerations for ACOs in Consolidating Markets

Robert A. Gerberry, Esq.
Associate General Counsel, Summa Health, Akron, OH

    Speaker Bio

    Robert Gerberry is Associate Counsel at Summa Health System. Since joining Summa in 2002, Mr. Gerberry has provided counsel on all aspects of health care law with a focus on strategic and transactional projects, including mergers and acquisitions, affiliations, joint ventures, and physician alignment initiatives. Prior to joining Summa, Mr. Gerberry practiced with the law firms of Calfee, Halter & Griswold LLP and McDonald, Hopkins LLP in Cleveland, Ohio. Mr. Gerberry also serves as Adjunct Faculty at the Case Western Reserve School of Law teaching the Law of Health Care Organizations and Finance and Health Care Transactions.

Gene Lindsey, MD
President and Chief Executive Officer Emeritus, Atrius Health and Harvard Vanguard Medical Associates, Wellesley, MA

    Speaker Bio

    Dr. Lindsey is Emeritus President and CEO of Atrius Health. Before retirement he was President and CEO of Atrius and also of its largest affiliate, Harvard Vanguard Medical Associates. Before serving as CEO he had been Chairman of the Board of Directors for Atrius Health and Chairman of the Board of Directors for Harvard Vanguard Medical Associates. Dr. Lindsey joined Harvard Vanguard Medical Associates in 1975 and practiced cardiology and internal medicine at the Kenmore, Wellesley and West Roxbury Harvard Vanguard practices. He served on the board of Harvard Community Health Plan/Harvard Pilgrim Health Care from 1991 to 2000. Dr. Lindsey received his medical degree from Harvard Medical School. In retirement Dr. Lindsey continues to write, serves as a senior adviser to Simpler Healthcare, Navigant Consulting, sits on the boards of Guthrie Health and VNA Care Network and Hospice and is a sought-after speaker on the healthcare topics of payment reform, accountable care organizations, practice innovation, quality and efficiency.

Douglas A. Hastings, Esq.
Partner and Chair Emeritus, Epstein, Becker & Green; Past President, American Health Lawyers Association, Washington, DC

    Speaker Bio

    DOUG HASTINGS, Chair Emeritus of Epstein Becker Green, is a nationally recognized health care transaction lawyer and advisor on health system change. Since 2001, he has been closely involved at the national level with efforts to improve the quality and cost efficiency of the U.S. health care system, and is known for his role in the launch of account6able care organizations in both the public and private sectors. Mr. Hastings served on the Board on Health Care Services of the Institute of Medicine (IOM) from 2003 to 2011 and on the IOM's Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care from 2010 to 2013. He is a Past President and Fellow of the American Health Lawyers Association.
2:30 p.m.


Tools for Moderating Anticompetitive Behavior

Andrea Caballero
Program Director, Catalyst for Payment Reform, Los Angeles, CA

    Speaker Bio

    Andréa Caballero is currently the Program Director for Catalyst for Payment Reform. Andréa comes to CPR with over 15 years of experience in the health care industry. In the 2 plus years she's been at CPR, she has led several significant projects, including the release of the first ever National Scorecard on Payment Reform, and a National Compendium on Payment Reform. In addition to tracking and quantifying progress in payment reform, she also leads CPR's work on health care price transparency, bundled payment, and general delivery system reform.

    Prior to joining CPR, Andréa served as Vice-President, Enterprise and Health Services Policy for UnitedHealth Group. In that capacity, she worked on a range of health care policy issues at the state and federal levels. Andréa was previously a member of PacifiCare's Public Affairs team as the Director of State Government Relations and a Regional Legislative Manager at Humana in Wisconsin.

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

    Speaker Bio

    Douglas C. Ross is a partner in the Seattle office of Davis Wright Tremaine. He concentrates his practice in antitrust and litigation, representing clients under investigation by the Federal Trade Commission, the Antitrust Division of the Department of Justice, and various state attorneys general.

    Mr. Ross is an officer of the ABA's Antitrust Section and a past chair of the Section's Health Care Industry Committee. He is the past chair of the Antitrust Practice Group of the American Health Lawyers Association and 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 Tufts University, where he received his B.A. summa cum laude in economics.

Joshua H. Soven, Esq.
Partner, Gibson, Dunn & Crutcher, LLP; Former Chief, Litigation Section, Antitrust Division, US Department of Justice; Former Attorney Advisor to Chairman, Federal Trade Commission, 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).
3:15 p.m. Break
3:30 p.m.


MSSP Financial Results: Who Did Well and Why?

Kelly A. Conroy
Chief Executive Officer, Palm Beach Accountable Care Organization; Co-founder and Founding Board Member, Florida Association of ACOs, West Palm Beach, FL

Daniel McCabe, MD
Chief Executive Officer, Arizona Connected Care, Tucson, AZ

    Speaker Bio

    Daniel McCabe MD is the CEO of Arizona Connected Care (AZCC). He was with the organization since its formation stages in 2010 and 2011. AZCC now has one hospital and 380 physicians and growing. Was Board Chairman of Finance since it first started risk contracting in 2012. Is responsible for two Commercial and two Medicare contracts (24,000 lives) and is negotiating at the present time for 3 new contracts. Dr. McCabe was in active clinical practice for 28 years while an executive for multispecialty group practices. In the past, he successfully managed under a PHO's 22,000 full risk lives over a 4 year period.
4:15 p.m.


Random Variation and Risk Adjustment

Francois de Brantes, MS, MBA
Executive Director, Health Care Incentives Improvement Institute, Newtown, CT

    Speaker Bio

    As Executive Director of HCI3, Mr. de Brantes is responsible for setting and implementing the strategy of the organization. This includes supervising the implementations of Bridges To Excellence and Prometheus Payment pilots, leading the development of new programs, and designing incentive efforts for employers, health plans and provider organizations.

    Previously, Mr. de Brantes was the Program Leader for various healthcare initiatives at GE Corporate Health Care Programs, responsible for developing the conceptual framework and the implementation of GE's Active Consumer strategy.

    Mr. de Brantes attended the University of Paris IX - Dauphine where he earned a MS in Economics and Finance. After completing his military service as a platoon leader in a Light Cavalry Regiment, he attended the Tuck School of Business Administration at Dartmouth College, where he graduated with an MBA.

Derek DeLia, PhD
Associate Research Professor, Center for State Health Policy, Rutgers University, New Brunswick, NJ

    Speaker Bio

    Derek DeLia (Ph.D., Cornell University) is an Associate Research Professor at the Rutgers Center for State Health Policy. He also teaches Health Economics and Econometrics in the Rutgers Economics Department.

    His research focuses on the economics of hospitals and health centers; emergency medical care; healthcare access among the poor, uninsured, and minorities; health insurance coverage; and performance measurement in Accountable Care Organizations (ACO's).

    In 2009, Dr. DeLia led the organization of a national research conference on the integration of Emergency Medical Services (EMS) with broader health services research and health policy. He has served on several scientific review panels for the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

    Dr. DeLia has presented research and provided policy analysis for the U.S. Dept of Health and Human Services (DHHS), the Congressional Budget Office (CBO), the Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), and the NJ Dept of Health and Senior Services (NJDHSS). He also served on the NJ Healthcare Access Study Commission and a Subcommittee of the Governor's Commission on Rationalizing Health Care Resources.

Paul Weygandt, MD, JD, MPH, MBA, CCS
Vice President, Physician Services, JA Thomas & Associates, Johnstown, PA
4:50 p.m.


Wrap-Up and Concluding Remarks

S. Lawrence Kocot, JD, LLM, MPA
Visiting Fellow, Engelberg Center for Health Care Reform, The Brookings Institution; Member of the Firm, Health Care and Life Sciences, Epstein Becker Green; Former Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services, Washington, DC

    Speaker Bio

    Larry Kocot, J.D., LL.M, M.P.A, is deputy director of the Engelberg Center for Health Care Reform and a visiting fellow in the Economic Studies program at the Brookings Institution. He is examining the challenges of access, quality and financing that face the U.S. health care system. He is also Senior Counsel at Dentons, U.S. LLP. Mr. Kocot previously served as a senior advisor to the administrator of the Centers for Medicare & 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, he was a key member of the management and operations team responsible for the national launch and operation of the Medicare Prescription Drug Benefit (Part D). Mr. Kocot has served as a member of Virginia's Commonwealth Health Research Board (CHRB) from 2002-2012 and was chairman from 2005-2008. Prior to his government service, Mr. Kocot was senior vice president and general counsel of a national pharmacy trade association. He has also served as a fellow at the Center for Strategic and International Studies (CSIS) where he participated in a wide range of policy studies. Mr. Kocot has been active in the start-up and management of a number of small businesses, including a management and legal consulting company, a pharmacy data and technology company and a pharmacy benefits management company. Mr. Kocot was interim CEO and is currently a member of the Board of Directors of the Partnership for a Healthier America. He also serves on the Board of Directors of ICF International, Inc. (NASDAQ:ICFI). Mr. Kocot received his BA and MPA degrees from the University of Massachusetts at Amherst. He earned his JD and LLM degrees at the Georgetown University Law Center.
5:00 p.m. Adjournment

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Day 1 | Day 2




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