Recording and written materials of AIS's Webinar on July 21, 2010

Accountable Care Organizations: Strategies for Health Plans and Providers

Although some Accountable Care Organizations have already been operating in the private sector, the new Medicare ACO pilot created by the health reform law has generated intense interest from both providers and payers in developing similar programs in their own areas. But how should ACOs be structured between private insurers and groups of providers? How should savings be calculated? And how can payers and providers start preparing now to launch ACO programs soon?

Sponsored by Atlantic Information Services, Inc., publisher of AIS’s Health Reform Week, Medicare Advantage News and Health Plan Week

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ACOs are intended to help the U.S. health system transition to a value-based reimbursement model under which groups of hospitals, physicians and other providers share in the savings stemming from providing more patient-centered, high-quality care and achieving better outcomes. But there is a lot to learn about these exciting new opportunities ... and many pitfalls to make sure you avoid.

Hear two experts — The Regence Group’s senior medical director and a physician executive at an IPA involved in several ACO pilots — describe current ACO models and identify what health plans and providers can do now to prepare for the brave new world of ACOs that lies ahead. You will get reliable answers to these key questions:

 

Speakers

JOE GIFFORD, M.D., is senior medical director for Regence BlueShield, a Washington state division of The Regence Group. Dr. Gifford is a frequent speaker on innovation in health care at national conferences and leadership events. He has executive experience in the information technology sector as well as on both the provider and payer side of health care. Prior to joining Regence, Dr. Gifford co-founded QuickCompliance, a health care Internet media company now part of the Discovery Channel, and served as director of product management at ChannelPoint, a software company founded by engineers from Sun Microsystems that is now controlled by The TriZetto Group. Dr. Gifford has authored a variety of publications in clinical research and health care services, and has created online training programs for many large organizations, including CMS and the Department of Defense. He received his clinical training at the University of Washington Hospitals after receiving his M.D. from the University of California at San Diego.

PHILIP GAZIANO, M.D., serves as one of the medical directors and executive board members for Hampden County Physician Associates, LLC (HCPA), a 90-provider multispecialty group practice in Springfield, Mass. He is also the president and CEO of the newly formed Accountable Care Associates, LLC (ACA), where he is the medical director for the managed Medicare programs, medical director for the case management and chronic disease management services and head of the provider networks (which include more than 700 physicians), and oversees the data warehouse and analytics. Dr. Gaziano is on staff at Mercy Medical Center and Baystate Medical Center, both in Springfield, Mass., and he is the president of the medical staff at Mercy Medical Center. Dr. Gaziano developed infrastructure for HCPA and the new ACA including for case management, disease management, coding, data management, and dedicated hospital rounding programs. He has helped his group provide managed care services in global capitation programs for more than 12 years, and he helped HCPA become the first in the state to be delegated for their own disease management program serving Medicare Advantage patients. Under his direction, network quality, efficiency, and member satisfaction measures continue to improve. The HCPA and ACA networks now manage care for over 19,000 members in global capitation (ACO-type) programs. Dr. Gaziano did his undergraduate training and earned his medical degree at West Virginia and completed his residency and geriatrics fellowship training at Baystate Medical Center in Springfield, Mass., part of Tufts University School of Medicine in Boston. He holds an appointment as Assistant Clinical Professor of Medicine with Tufts University Medical School.

Moderator: Jill Brown, executive editor at AIS

• Health plan CEOs, CFOs, chief operating officers, product development and sales and marketing executives, government affairs and provider relations directors, contracting executives, medical and clinical service directors, and market researchers
• Medical group and hospital administrators and contracting directors
• Benefits executives at large employers
• Insurance brokers and agents
• Pharmaceutical and PBM executives and marketing directors
• Attorneys, consultants and actuaries