November 7-8, 2022 // Hyatt Regency, Chicago
Payer Issues Roundtable
thank you to our sponsorS
Patients are demanding more from payers, providers and physicians than ever before to create a seamless healthcare journey. Health insurers are evolving to care for populations, increase access and leverage data for a personalized patient experience. They are also seeking value-based partnerships with health systems and organizations to redefine healthcare for the next generation. Becker's Healthcare is welcoming top executives from insurance companies and health systems for the first time ever to an exclusive event focused on shaping the future of care delivery. Attendees can expect lively conversations about new types of health plans, hospital at home, behavioral health, price transparency and more. Join executives from Cigna, Blue Cross Blue Shield, Stanford Health Care, Kaiser Permanente and more in Chicago for this unique two-day event.
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Discussion Topics: • The Evolution of New Types of Health Plans • What It Means to Be a Virtual-First Health Plan • What Patients and Employers Will Demand Next from Health Plans • The Less-Than-Straight Journey to Value-based Care: Where are We Now, What's Helping, What's Hurting? • Hospital-Payer Contract Negotiations and Price Transparency: Changes to Watch For • The Next Iteration of Behavioral Health, Virtual Care and More: Insurer CMOs Weigh In • Top Priorities for Payer Executives Today • Elevating Health Equity: Best Ideas and Strategies • Digital Transformation of Health Plans and IT on the Horizon • The Rise of 'Pay-viders': What Works and What Doesn't for Health System-Owned Health Plans
AGENDA
• Speaker Name, Designation, Title, Organization • Speaker Name, Designation, Title, Organization • Speaker Name, Designation, Title, Organization • Speaker Name, Designation, Title, Organization • Moderated by Moderator Name, Designation, Title, Organization
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Sponsored by
• Thomas Grote, Chief Executive Officer, Banner|Aetna • Paul Scaglione, Chief Growth Leader, Trustmark Health Benefits • Carrie Kincaid, Senior Vice President, Market Development, Priority Health • Moderated by Riz Hatton, Writer/Reporter, Becker's Healthcare
The Evolution of New Types of Health Plans
Panel Discussion
• Peter McCauley, MD, CPE, Medical Officer, Cigna • Jaime Murillo, MD, Senior Vice President and Chief Medical Officer, UnitedHealth Group • Seun Ross, PhD, RN, Executive Director, Health Equity, Independence Blue Cross • Tim Ashe, Chief Clinical Officer, WellSky • Moderated by Brian Zimmerman, AVP, Client Content and Strategy, Becker's Healthcare
Elevating Health Equity: Best Ideas and Strategies
9:35 - 10:15 AM Ct
• Derek Jeter, Former Shortstop for the New York Yankees; 5-Time World Series Champion & 14-Time MLB All-Star
Keynote Interview
Keynote Session
3:45 PM CT
• Robert Groves, MD, Executive Vice President and Chief Medical Officer, Banner|Aetna • John Bulger, DO, MBA, Chief Medical Officer, Geisinger Health Plan • Paul Merrild, President, HealthSparq & Kyruus • Moderated by Molly Gamble, Vice President, Becker's Healthcare
The Rise of 'Pay-viders': What Works and What Doesn't for Health System-Owned Health Plans
• Gracelyn McDermott, Vice President, Marketing, Sales and Business Development, Kaiser Permanente • Ceci Connolly, President and Chief Executive Officer, Alliance of Community Health Plans • Michael Drescher, Vice President, Payer Strategy, XSOLIS • Moderated by Jakob Emerson, Insurance Editor, Becker's Healthcare
Top Priorities for Payer Executives Today
1:50 - 2:30 PM CT
Networking Lunch
1:10 - 1:45 PM CT
• Don Antonucci, Chief Executive Officer, Providence Health Plan • Paul Merrick, Co-Chairman, Chief Physician Executive, Duly Health and Care • Lyell K. Jones, Jr., Professor of Neurology; Enterprise Medical Director, Mayo Clinic Contracting and Payer Relations, Mayo Clinic • Megan Schmidt, Senior Vice President, Employer Solutions, Priority Health • Moderated by Gregory LeGrow, Executive Director, Payer Product Strategy, athenahealth
• Speakers TBA
What Patients and Employers Will Demand Next from Health Plans
12:30 - 1:10 PM ct
• Hasan Shanawani, MD, Medical Director, Blue Cross Blue Shield of Michigan • Elizabeth De Pirro, MD, Medical Director, Presbyterian Complete Care and Hospital at Home • Julia Crist, Vice President, Operations, Home and Community Services, Allina Health • Robert Wieland, Chief Executive Officer and Chief Medical Officer, Allina Health | Aetna • Moderated by Laura Dyrda, Vice President Editor-in-Chief, Becker's Healthcare
What 'Hospital at Home' Means for Payers, Hospitals and Health Plans
11:45 AM - 12:25 PM ct
• Ken Cohen, MD, FACP, Executive Director, Translational Research Optum Care • Amy Acker, Vice President, Network and Provider Operations, CommuniCare Advantage • Lori Guinane, Senior Manager, Network Performance, Aetna • Moderated by Nancy Cocozza, Senior Advisor, Payer Solutions, Real Time Medical Systems
The Less-Than-Straight Journey to Value-based Care: Where Are We Now, What's Helping, What's Hurting?
Tuesday 11.8.22
Monday 11.7.22
networking breakfast
8:30 - 9:30 AM CT
• Steven Abramson, Senior Vice President and Chief Market & Payor Relations Officer, Upstream Health • Gary May, Vice President, Managed Care, Stanford Health Care and Stanford Medicine Children’s Health • Moderated by Alan Condon, Editor in Chief, Becker's Healthcare
Hospital-Payer Contract Negotiations and Price Transparency: Changes to Watch For
10:20 - 11:00 AM ct
• Darren Wethers, Chief Medical Officer, Atrio Health Plans • James LeClair, Director, Behavioral Health, Group Health Cooperative of South Central Wisconsin • Rodrigo Cerdá, MD, MPH, Senior Vice President, Health Services and Chief Medical Officer, Independence Blue Cross • Moderated by Paige Haeffele, Writer/Reporter, Becker's Healthcare
The Next Iteration of Behavioral Health, Pharmacy, Virtual Care and More: Insurers Weigh In
12:00 pM CT
• Monica Berner, Chief Clinical Officer, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas • Sean Cavanaugh, Chief Commercial Officer, Chief Policy Officer, Aledade, Inc. • Chris Day, President, Value Based Solutions, Anthem, Inc. • Moderated by Jonas Goldstein, Vice President, Strategy and Commercial, Vim
Where Value-based Care is Headed in the Next 5 Years
12:00 - 12:40 PM cT
12:00 - 12:40 PM ct
Sponsors
• Darren Wethers, Chief Medical Officer, Atrio Health Plans • James LeClair, Director, Behavioral Health, Group Health Cooperative of South Central Wisconsin • Rodrigo Cerdá, MD, MPH, Senior Vice President, Health Services and Chief Medical Officer, Independence Blue Cross • Moderated by Paige Haeffele, Writer/Reporter, Becker'sHealthcare
• Jim McDonnell, SVP Growth Payer Market, Olive • Tina Cornell-Miller, MD, Sr. Director, Healthcare Services Business Performance, Florida Blue • Tina Cummings, Vice President, Clinical Operations & Performance, Florida Blue
Authorization Transformation: Moving Decision Making to the Point of Care
workshop
9:35 - 10:15 AM ct
• Peter McCauley, MD, CPE, Medical Officer, Cigna • Jaime Murillo, MD, Senior Vice President and Chief Medical Officer, Optum Labs • Seun Ross, PhD, RN, Executive Director, Health Equity, Independence Blue Cross • Tim Ashe, Chief Clinical Officer, WellSky • Moderated by Brian Zimmerman, AVP, Client Content and Strategy, Becker's Healthcare
9:35 - 10;15 am CT
Opening Networking Break
11:30 - 11:45 AM CT
Cocktail Reception
4:50 - 6:50 PM CT
11:00 AM - 12:00 PM cT
• Madhavi Kasinadhuni, Vice President of Market Strategy, New Century Health • Logan Bauer, Director of Manufacturer Partnerships, IPG • Armando Colon, Business Economics & Systems Operations Management, Physicians of Winter Haven, DBA Day Surgery Center • Brandi Cunningham, RN, BSN, MBA, MHA,CASC, Manager of Operations, SCA Health
Leaders and First Movers Weigh in: Progress and Pitfalls in Optimizing your Site of Care Shift Strategy
Peter McCauley MD, CPE, Medical Officer, Cigna
speakers
Speakers and full agenda coming soon.
panelists
Robert Groves MD, Executive Vice President and Chief Medical Officer, Banner|Aetna
Darren Wethers Chief Medical Officer, Atrio Health Plans
Ceci Connolly President and Chief Executive Officer, Alliance of Community Health Plans
Gary May Vice President, Managed Care, Stanford Health Care and Stanford Medicine Children’s Health
Lisa White Director, Value-Based Partner Transformation
Ken Cohen MD, FACP, Executive Director, Translational Research Optum Care
Steve Anderson Vice President, Hospital Contracting and Network Administration, Blue Cross Blue Shield of Michigan
Amy Acker Vice President, Network and Provider Operations, CommuniCare Advantage
Steven Abramson Senior Vice President and Chief Market & Payor Relations Officer, Upstream Health
Seun Ross PhD, RN, Executive Director, Health Equity, Independence Blue Cross
John Bulger DO, MBA, Chief Medical Officer, Geisinger Health Plan
Chris DeRienzo MD, MPP, Senior Vice President and System Chief Medical Officer, WakeMed Health & Hospitals
Lori Guinane Senior Manager, Network Performance
Hasan Shanawani MD, Medical Director, Blue Cross Blue Shield of Michigan
Charles Rosen Prof. of Surgery, Div. of Transplantation; Medical Dir., Dept. of Contracting and Payer Relations, Mayo Clinic
Paul Merrick Co-Chairman, Chief Physician Executive, Duly Health and Care
Gracelyn Mcdermott Vice President, Marketing, Sales and Business Development, Kaiser Permanente
James LeClair Director, Behavioral Health, Group Health Cooperative of South Central Wisconsin
Elizabeth De Pirro MD, Medical Director, Presbyterian Complete Care and Hospital at Home
Mario Schlosser Chief Executive Officer, Oscar
Paul Scaglione Chief Growth Leader, Trustmark Health Benefits
Carrie Kincaid Senior Vice President, Market Development, Priority Health
Deb Muller Chief Executive Officer, Avera Insurance Division
Don Antonucci Chief Executive Officer, Providence Health Plan
Speaker Name MD, Title and Organization1
Rodrigo Cerdá MD, MPH, Senior Vice President, Health Services and Chief Medical Officer, Independence Blue Cross
Special Guest Keynote
Jaime Murillo MD, Senior Vice President and Chief Medical Officer, UnitedHealth Group
Thomas Grote Chief Executive Officer, Banner|Aetna
Nancy Cocozza Senior Advisor, Payer Solutions, Real Time Medical Systems
Tim Ashe Chief Clinical Officer, WellSky
Monica Berner Chief Clinical Officer, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas
Sean Cavanaugh Chief Commercial Officer, Chief Policy Officer, Aledade, Inc.
Robert Wieland Chief Executive Officer and Chief Medical Officer, Allina Health | Aetna
Paul Merrild President, HealthSparq & Kyruus
Kiki Louis President, Oscar Medical Group
Lyell K. Jones, Jr. Professor of Neurology; Enterprise Medical Director, Mayo Clinic Contracting and Payer Relations, Mayo Clinic
Gregory LeGrow Executive Director, Payer Product Strategy, athenahealth
Julia Crist Vice President Operations, Home and Community Services, Allina Health
Ruth Williams-Brinkley President, Kaiser Foundation Health Plan of the Mid-Atlantic States
Michael Drescher Vice President, Payer Strategy, XSOLIS
Derek Jeter Former Shortstop for the New York Yankees; 5-Time World Series Champion & 14-Time MLB All-Star
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Matthew Cox, Chief Financial Officer of Spectrum Health System
Carlos Bohorquez, Chief Financial Officer of El Camino Health
Eugene Woods, President and CEO at Atrium Health
Kari Cornicelli, Executive Vice President and CFO of Phoenix Children's
Kevin Croston, CEO at North Memorial Health
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Payer Issues Roundtable // November 7-8, 2022 // Hyatt Regency, Chicago Under 15 spots remain! This event is closed to non-provider and non-payer attendee registrations. Registrants must be employed by a healthcare provider or payer organization. Please contact Haley Jones at hjones@beckershealthcare.com for sponsorship information if you'd like to participate.
GuideWell had a vision to build a best-in-class, innovative, and affordable UM model that drove outstanding member and provider experience. However, their current UM process left them with limited access to their data and traditional “one size fits all” programs that restricted their ability to innovate. They set out to challenge the status quo and take back control of their UM programs by deploying AI-powered technology to transform their member and provider experience. Join us to learn more about how GuideWell utilized a first-of-its kind AI solution to move prior auth approvals to the point-of-care and hear how they optimized their provider and network strategies to deliver a superior member experience
Tina Cummings Vice President, Clinical Operations & Performance, Florida Blue
featured session sponsored by
Tina Cornell-Miller Sr. Director, Healthcare Services Business Performance, Florida Blue
Dr. YiDing Yu Chief Product Officer and Chief Medical Officer, Olive
Vim is a point of care connection platform that connects external payer data to existing workflows directly in provider EHRs. Health plans and care providers of every size – from independent practices to integrated delivery systems – use Vim to connect data and care across the health ecosystem. Vim’s applications drive enhanced provider and patient experience, operational efficiencies, and accelerated performance on value-based care. Learn more at: https://getvim.com/
EVENT SPONSORS
WellSky is a technology company leading the movement for intelligent, coordinated care. Our software, analytics, and services power better outcomes and lower costs for stakeholders across the care continuum. WellSky payer solutions help health plans, government organizations, and other risk-bearing entities coordinate care. Our provider footprint and technology solutions allow payers to optimize care delivery efficiency, reduce healthcare costs, and bolster member engagement and satisfaction. Learn more at: https://wellsky.com/
Real Time Medical Systems is the industry-leading, KLAS Rated, HITRUST Certified Interventional Analytics solution that turns post-acute EHR data into actionable insights. Serving healthcare organizations nationwide, Real Time improves value-based outcomes by reducing hospital admissions, minimizing post-acute length of stay, accurately managing reimbursements, detecting early signs of infectious disease, and advancing care coordination through post-acute data transparency. Learn more at: https://realtimemed.com/
We help people make smarter healthcare choices by partnering with health plans to provide members with cost and quality information about doctors, hospitals, and medical services, based on their individual benefits.
Capital Rx is built around the mission of changing the way prescription drugs are priced and patients are serviced. A health technology company daring to reimagine the pharmacy benefits industry, Capital Rx is executing on that mission through its Clearinghouse Model® - the first equitable framework for drug pricing.
Amwell is a leading digital care delivery platform in the United States and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell believes that digital care delivery will transform healthcare. The Company offers a single, comprehensive platform to support all digital health needs from urgent to acute and post-acute care, as well as chronic care management and healthy living. With over a decade of experience, Amwell powers digital health solutions for over 2,000 hospitals and 55 health plan partners with over 36,000 employers, covering over 80 million lives. For more information, please visit https://business.amwell.com/.
Enlace Health™ solves healthcare from the inside out, fixing healthcare at its core and making value-based care a reality. The Connected World of Enlace empowers payers, providers, and patients to participate together in an economically sound environment. The Enlace solution is the only end-to-end infrastructure that bridges the gap between the current, chaotic system and an orderly healthcare world. Enlace always meets clients where they are, creating solutions based on need and maturity in value-based care. Enlace is Sustainable Healthcare, Delivered.
Medecision® is a digital care management company whose solutions and services are used by leading health plans and care delivery organizations to support more than 42 million people nationwide. Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision, seamlessly connects the healthcare ecosystem to powerful data and insights that drive meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. Aveus, Medecision’s professional services division, helps business leaders solve complex challenges and drive better performance, leaving organizations more capable. To learn more about Medecision, visit medecision.com.
athenahealth creates innovative healthcare technology that connects clinicians, patients, payers, and partners in differentiated ways. Our electronic health records, revenue cycle management, and patient engagement tools allow anytime, anywhere access, driving better financial outcomes for our customers and enabling our provider customers to deliver better quality care. In everything we do, we’re inspired by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. For more information, please visit www.athenahealth.com.
New Century Health is a leader in specialty care management, with special focus on oncology, cardiology, and advance care planning. New Century Health partners with specialty providers and health plans to provide them with clinical decision and population health management tools to ensure that cancer and cardiology patients receive the highest quality, most affordable care. New Century Health has been URAC-accredited in Health Utilization Management since 2011 and received NCQA accreditation in Utilization Management in June 2020. New Century Health is a wholly owned subsidiary of Evolent Health. To learn more about New Century Health, please visit newcenturyhealth.com.
XSOLIS is a platform, data science and solutions innovator serving health plans, hospitals and payer organizations nationwide to create a more efficient healthcare system. Through its purpose-built solutions and industry-leading AI, XSOLIS breaks down healthcare silos to accelerate data-driven decision making and collaboration across a connected network of providers and payers. CORTEX®, its AI-driven technology platform, is the first and only solution to use real-time predictive analytics to continuously assign an objective medical necessity score and assess the anticipated level of care for every patient. CORTEX eliminates waste through the science of data using automation, transparency and objective insights to ensure appropriate care settings, enabling more efficiency across the healthcare system.
Olive is the automation company creating the Internet of Healthcare. The company is addressing healthcare’s most burdensome issues through automation — delivering hospitals, health systems and payers increased revenue, reduced costs, and increased capacity. People feel lost in the system today and healthcare employees are essentially working in the dark due to outdated technology that creates a lack of shared knowledge and siloed data. Olive is driving connections to shine new light on healthcare processes, improving operations today so everyone can benefit from a healthier industry tomorrow.
At Janssen, we're creating a future where disease is a thing of the past. We're the Pharmaceutical Companies of Johnson & Johnson, working tirelessly to make that future a reality for patients everywhere by fighting sickness with science, improving access with ingenuity, and healing hopelessness with heart. We focus on areas of medicine where we can make the biggest difference: Cardiovascular, Metabolism, & Retina; Immunology; Infectious Diseases & Vaccines; Neuroscience; Oncology; and Pulmonary Hypertension.
Reveleer is a healthcare technology company that uses Machine Learning and Intelligent Automation to empower payers in all lines of business to take control over their Risk Adjustment and Quality Improvement programs. The Reveleer platform enables payers to independently execute and manage every aspect of provider outreach, retrieval, coding, abstraction, and reporting – all under one platform. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer also assists payers with full record retrieval and review services to support financial performance and improved member outcomes.
Fitbit Health Solutions, now part of the Google family, works with payers, partners and employers to empower people to live healthier lives. Fitbit’s personalized health and wellbeing experience easily integrates into a wide variety of health interventions and wellbeing programs - including embedded health plan benefits, condition management point solutions, research studies and corporate wellness programs - and helps to extend and enhance their impact by driving higher participation levels, increasing physical activity, and helping to improve weight loss and diabetes outcomes.
Mindstrong is a virtual mental health platform that reduces total cost of care and improves member outcomes by combining proven science, state-of-the-art technology, and dedicated care teams.
EIS is a digital insurance platform that enables insurers to innovate and operate like a tech company: fast, simple, agile. Our platform of core systems and solutions allows insurers to lead with speed, accelerate innovation, create engaging experiences, and connect to a vast ecosystem of insurtech and emerging technologies. Visit EISGroup.com.
Post Acute Analytics enables healthcare providers and payers to improve patient outcomes while reducing the total cost of care. Anna™, the real-time post-acute care management platform from Post Acute Analytics, leverages machine-learning, a turnkey integration engine, and evidence-based guidelines to deliver real-time clinical insights to clinical teams. We work with partners across the health care continuum, including some of the largest health plans, health systems, and physician groups in the United States.
Health plans are under increased pressure to implement new approaches to contain medical expenses on behalf of their members. One area uniquely ripe for innovation and cost savings in 2023 and beyond: Ambulatory Surgery Centers (ASCs). We’ll discuss lessons learned from health plan and ASC partnerships to implement a site-of-care model that leads to lower total episodic care costs and more affordable, high-quality care. Panelists will discuss developing a mission-aligned reimbursement and contracting strategy, and the unique enablers required to drive successful site-of-care shift and device optimization for high-cost surgical procedures.
Madhavi Kasinadhuni Vice President of Market Strategy, New Century Health
Logan Bauer Director of Manufacturer Partnerships, IPG
Armando Colon Business Economics & Systems Operations Management, Physicians of Winter Haven, DBA Day Surgery Center
Brandi Cunningham RN, BSN, MBA, MHA,CASC, Manager of Operations, SCA Health
