2013
The Texas Association of Health Plans
TAHP Managed Care CONFERENCE & TRADE SHOW
The Texas Association of Health Plans Conference Guide
The Texas Association of Health Plans
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
P L A T I N U M
G O L D
S P O N S O R S
S P O N S O R S
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PAGE 2
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
Table of Contents: Letter from the Executive Director........................................................ page 7 Conference Agenda........................................................................pages 8-10 Westin Riverwalk Floor Plans.............................................................. page 10 Trade Show Floor Plan........................................................................ page 11 Speaker Profiles...........................................................................pages 10-21 Letter from the President of the Board of Directors............................ page 24 2013-2014 Board of Directors............................................................ page 25 2013-2014 TAHP Members................................................................ page 27 About the 2014 Conference..........................................................pages 28-29 About the Conference Sponsors..................................................pages 30-39 About the Exhibitors............................................................................ page 41
The Texas Association of Health Plans (TAHP) is a statewide trade association representing effectively all health plans (Commercial, Medicaid, CHIP and Medicare) doing business in Texas and is committed to improving access, value and quality of care throughout Texas. Utilizing legislative advocacy, education and collaboration with other member organizations, TAHP brings together industry leadership to develop answers to critical health care issues in the state. For more information, please visit www.tahp.org or call (512) 476-2091.
The Texas Association of Health Plans
PAGE 3
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The Texas Association of Health Plans (TAHP) is a statewide trade association representing virtually all (Commercial, Medicaid, CHIP and Medicare) health plans doing business in Texas and is committed to improving access, value and quality of care throughout ProgenyHealth is a leading provider of care management solutions for premature and medically complexeducation newborns.and collaboration with Texas. Through legislative advocacy, For over a decade, we have worked with NICU providers in
other organizations, bringstotogether industry leadership all 50member states, delivering healthyTAHP outcomes their Health Plan members.
Our award-winning program promotes appropriate utilization, improves access, educates family members and reduces costs.
to develop answers to critical health care issues in the state. For more Contact us today to discuss how we might partner with your Health Plan.
information, please visit www.tahp.org or call (512) 476-2091. Stop by our booth #32 for more information.
The Texas Association of Health Plans
www.progenyhealth.com Marcia Wasserman • Senior Strategic Accounts Executive• 484-362-6566 • mwasserman@progenyhealth.com
The Texas Association of Health Plans Managed Care Conference and Trade Show 2013
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2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
The Texas Association of Health Plans
Dear Friends, Welcome to the 2013 Texas Association of Health Plans, Managed Care Conference and Trade Show. Thank you for your attendance and participation with this year’s event. As part of the largest gathering of health plan executives in the state, I invite you to take this time to engage in an informative look into the issues that shape our health care market. Our conference is designed to offer insight into significant developments in our industry and provides a venue for discussing important topics that are certain to dominate trends and public debate in the months and years ahead. I offer a special thanks to our sponsors, new and returning, whose participation in the conference highlights their commitment to TAHP and demonstrates their dedication to managed care principles – providing affordable access to quality care. On behalf of all TAHP member health plans, I extend our appreciation to the impressive panel of experts from across the country, providing a high level and enlightening perspective on issues of the day. Thank you for your interest, attendance and support. Enjoy the conference!
Regards, David Gonzales Executive Director Texas Association of Health Plans
PAGE 7
2013
TAHP Managed Care
The Texas Association of Health Plans
E V E N T Start
CONFERENCE & TRADE SHOW
A G E N D A :
October 13 - 16, 2013
End
Pre Conference - Sunday, October 13, 2013 4:00pm
5:30pm
Early Registration
5:30pm
7:30pm
Fiesta on the Patio & Dessert River Cruise Spondored by: Outreach TransitionCare
(River Foyer)
(Olivares - River Level)
Conference Starts - Monday, October 14, 2013 8:00am
4:00pm
Registration Desk Open
8:00am
9:00am
Morning Coffee & Continental Breakfast Sponsored by: Natera
(Navarro Foyer)
(Madero Ballroom Level)
9:00am
9:50am
10:00am
10:50am
10:50am
11:00am
Opening Keynote
Ross Ramsey, Executive Editor and Co-Founder of The Texas Tribune (Hidalgo - Ballroom Level)
Plan Overpayment Recovery - Regulatory and Legal Insights
PCMH – The Practice Perspective Dawn Tice, Director of Quality Improvement, University of Pennsylvania’s Clinical Care Associates (Zapata - Ballroom Level)
JoAnn Dalrymple, Partner, Jackson-Walker, LLP (Villa - Ballroom Level)
Break
Succeeding in the New Health Insurance Reform Environment -Employer Insights
PCMH - What’s Working and What’s Not Dawn Tice, Director of Quality Improvement, University of Pennsylvania’s Clinical Care Associates (Zapata - Ballroom Level)
11:00am
11:50am
12:00pm
1:15pm
Lunch - Sponsored by Caregiver Homes a division of Seniorlink
12:00pm
1:30pm
TAHP Board Lunch - Private
1:30pm
2:20pm
2:30pm
3:30 pm
3:30pm
4:00pm
6:30pm
7:30pm
7:30pm
8:30pm
Alicia Haff, CEO, Haff Consulting Services ACA Compliance (Villa - Ballroom Level)
(Hidalgo - Ballroom Level) (Encino - Lobby Level)
The Unintended Consequences of Health Reform – Regulatory Realities Nick Thompson, Vice President , Regulatory Affairs, UnitedHealth Group (Villa - Ballroom Level)
NCQA Update
Trudy DeWitt, Manager, HEDIS Policy, NCQA (Zapata - Ballroom Level)
A Legislative and Regulatory Perspective of Industry Trends
Multiple Sclerosis: Disease Overview and Managed Care Considerations
Barbara Levy, VP and General Counsel, Pharmaceutical Care Management Association (Villa - Ballroom Level)
Edward J Fox, MD, MD, PhD, FAAN Director, Multiple Sclerosis Clinic of Central Texas Clinical Assistant Professor University of TX Medical Branch, Round Rock, TX (Zapata - Ballroom Level)
Break - Sponsored by CVS Caremark (Villa Foyer—Ballroom Level)
Welcome Reception in Exhibit Hall (Navarro - Ballroom Level)
Platinum Sponsor Dinner - By Invitation Only (Olivares - River Level)
PAGE 8
2013
TAHP Managed Care
The Texas Association of Health Plans
E V E N T Start
CONFERENCE & TRADE SHOW
A G E N D A :
October 13 - 16, 2013
End
Tuesday, October 15, 2013 8:00am
3:00pm
8:00am
9:00am
8:00am
9:00am
Registration Desk Open
(Navarro Foyer - Ballroom Level)
Medical Director Breakfast - By Invitation Only (Madero - Ballroom Level)
Breakfast Buffet
(Villa & Zapata - Ballroom Level)
The Golden Age of Government-Sponsored Health Programs…With Strings Attached 9:00am
9:45am
John Gorman, Executive Chairman, Gorman Health Group (Hidalgo - Ballroom Level)
11:00am
Moderator: David Gonzales, CEO/Executive Director, TAHP Panel: Allan Einboden, CEO, Scott & White Health Plan, Dr. Esteban Lopez, MD, President of the San Antonio Region for BCBSTX, Ken Malcolmson, Regional CEO at Humana, Tom Quirk, Chief Executive Officer, UnitedHealthcare Operations Texas and Oklahoma (Hidalgo - Ballroom Level)
CEO Panel
9:45am
“State of the Payor” Market Trends 11:10am
12:00pm
12:00pm
1:30pm
1:30pm
3:30pm
1:45pm
2:50pm
Understanding the Complexity of the Exchange Population
Ray Desrochers, Executive Vice President, HealthEdge (Villa - Ballroom Level)
Mark Heit, Beacon Health Strategies (Zapata - Ballroom Level)
Lunch in the Exhibit Hall (Navarro - Ballroom)
DSHS Meeting - By Invitation Only
David L. Lakey, M.D. Commissioner, Texas Department of State Health Services (Carranza - Ballroom Level)
Medicaid Interactive Update – Milestones, Priorities & Opportunities
Prompt Pay - Prior & Emerging Trends Michael Klein, Partner, Sedgwick L.L.P. (Zapata - Ballroom Level)
Chris Traylor, Chief Deputy Commissioner, HHSC (Villa - Ballroom Level)
Legislative Panel
3:00pm
5:30pm
4:00 pm
7:00pm
Moderator: Tom Bond, Greenberg Traurig Panel: Representative Kenneth Sheets, Representative John Smithee, Representative Chris Turner, Senator Larry Taylor, Senator Carlos Uresti (Hidalgo - Ballroom Level)
VIP Reception - By Invitation Only Featuring Randy Cordero Flamenco Guitarist Sponsored by: Le Fleur Transportation and Palladian Health (Olivares Room - River Level)
7:00pm
8:00pm
8:30pm
10:30pm
Dinner
(Navarro - Ballroom Level)
Howl At The Moon - Dueling Piano Bar (111 W. Crockett Street)
PAGE 9
2013
TAHP Managed Care
E V E N T Start
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
A G E N D A :
October 13 - 16, 2013
End
Wednesday, October 16, 2013 Breakfast Buffet
8:30am
9:45pm
9:30am
10:00am
CEO Meet & Greet - By Invitation Only
9:45am
10:00am
Break
(Navarro B - Ballroom Level)
with Julia Rathgeber, TDI Commissioner
Regulatory Panel
Moderator: Pati McCandless, BCBSTX
10:00am
11:30am
Texas Department of Insurance Panelists:
Katrina Daniel, Senior Associate Commissioner, Life Health and Licensing Doug Danzeiser, Deputy Commissioner, Regulatory Matters Jan Graeber, Deputy Commissioner (Hidalgo - Ballroom Level)
CONFERENCE ENDS An application for accreditation of this conference has been submitted to the MCLE Committee of the State Bar of Texas and is pending. CME accreditation is also subject to final accreditation approval. Executive Conference Room
Ballroom Level
T H E W E S T I N R I V E R W A L K San Antonio
Executive
Navarro (Main Ballroom) B A
Madero Carranza
Villa
Elevators
Hidalgo Prefunction
La Babia
Foyer
Terrace Grand Staircase to Lobby
La Babia Terrace
Paseo Del Rio - The Riverwalk
Business Center Boardroom Business Center
Lobby Level Front Desk
Entry Foyer
Cafecito Gift Shop Elevators
Camino Real
Lobby
Encino Sabino
San Antonio is the hotbed of history and tourism in Texas. Home to the Alamo, the River Walk, the Mission Trail, the Spurs, and scores of other attractions, San Antonio welcomes thousands of fun-seeking visitors every year.
Zapata
Navarro Prefunction
Hidalgo (Junior Ballroom)
Enjoy river or city views in one of the 473 oversized guestrooms and 65 suites that are decorated in a style that is reminiscent of historic Texas. Recharge in the state-of-the-art Westin Gym or relax with a soothing spa service.
Offices
Loggia I
Loggia II Elevator to Riverwalk
El Rincon De Maria
Grand Staircase to Ballroom Level
Lantana
Goraz
River Level
River Foyer
Olivares Zocca Restaurant
Zocca Patio
PAGE 10
Zocca Bar
Access to Riverwalk Elevator to Lobby
Olivares Patio
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
T R A D E
S H O W
F L O O R
P L A N :
SERVICE CORRIDOR
5
12
13
14
21
22
29
4 BANQUET PANTRY
6
11
15
20
23
28
7
10
16
19
24
27
8
9
17
18
25
26
30
3
31
2
32
1
33
COATS
NAVARRO
FOYER
NAVARRO PREFUNCTION
44
43
42
41
40
39
38
37
36
35
34
DOWN TO FIRST FLOOR
EXHIBITOR
15
Sequenom Laboratories
30
Medical Transportation Management, Inc.
1
Shield HeathCare
16
Alere
31
HealthLOGIX
2
LogistiCare
17
ONYX Pharmaceuticals
32
ProgenyHealth
3
Coram Inc.
18
Treo Solutions
33
Block Vision
4
Emdeon
19
Daiichi-Sankyo
34-35
5
Verinata Health
21
HealthEdge
36
MedImmune
6
Valeritas
22
Novartis
37
Novo Nordisk
7
Sunovion Pharmaceuticals
23
Biogen Idec
38
3m Health Information Systems
8
Varis, LLC
24
Sanofi
39
Krames StayWell
9
MedeAnalytics
25
Access2Care, LLC
40
MedSolutions
10
Sandata Technologies
26
PerformRx
41
Merck
11
Pfizer Vaccines
27
Business Ink
42
Medco Medical Supply
12
Vertex Pharmaceuticals
28
Carenet Healthcare Services
43
Gilead Sciences
13
Forest Pharmaceuticals
29
Envision Pharmaceutical Services
44
Navitus Health Solutions
BOOTH
PAGE 11
Centene Corporation
Delivering Transportation Management that Works!
www.logisticare.com
2013
TAHP Managed Care
C O N F E R E N C E
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S P E A K E R
P R O F I L E S :
Tom Bond
Doug Danzeiser
Tom Bond is Chair of GreenbergTraurig’s National Governmental Affairs Practice and Co-Chair of the Insurance Regulatory and Transactions Practice. He focuses his practice on insurance and regulatory law in Texas and on a national basis. His clients include insurance holding companies, life, health and property liability companies, trade associations, reinsurers, health maintenance organizations, title underwriters and agencies, corporate insurance agencies, commercial insured, and the insurance regulators of other states. Tom has managed a number of insurance industry strategic initiatives at the Texas legislature in the areas of workers compensation, health insurance and managed care, credit and specialty lines coverages, broking and regulated transactions, and insurance regulation and taxation.
Doug Danzeiser is the Manager of Regulatory Matters in the Life, Accident and Health Section of the Texas Department of Insurance’s Regulatory Policy Division, taking that position in March of 2007. Prior to that, he was the team leader of the Life, Health & HMO team in the Enforcement Division of the Department.
JoAnn Dalrymple JoAnn Dalrymple is a litigation partner with Jackson Walker, L.L.P. She represents benefit plans, plan administrators and fiduciaries, employers and insurers in ERISA, Medicare and Medicaid, and other federal and state law benefit disputes in litigation and arbitration. Her litigation practice also involves defense representation in class action and complex litigation, arbitration of complex business disputes, and administrative law proceedings. She has extensive experience in litigating disputes on behalf of health plans under ERISA and the Texas Prompt Pay Laws and has obtained multiple favorable rulings interpreting these federal and state laws. JoAnn also counsels her insurance and benefit plan clients on contracting matters; HIPAA, “prompt pay” and other industry-related federal and state law compliance; and protection of trade secret information.
Katrina Daniel Katrina Daniel is the Associate Commissioner for the Life, Accident and Health section at the Texas Department of Insurance, overseeing the regulation of life, annuity, accident and health insurance, and related coverages offered by insurance companies Ms. Daniel graduated from Texas Woman’s University School of Nursing with a Baccalaureate in Science and has completed coursework for a Master of Public Health from the University of Texas School of Public Health. She is also a registered nurse.
Doug has been an attorney for the state since 1994, working for the Texas Attorney General before coming to TDI in 2000. Doug obtained his law and undergraduate degrees from the University of Texas at Austin.
Ray Desrochers Ray Desrochers is Executive Vice President at HealthEdge, a software company that provides the award-winning HealthRules product suite, a next generation claim processing and benefit administration, business intelligence and portal solution for payors. A recognized healthcare technology thought leader, Ray has been a frequent speaker at technology events and conferences around the world. Before Amicore, Ray was a Worldwide Vice President at Keyware, where he was responsible for creating a new product strategy and vision, and for successfully delivering their next-generation authentication platform and applications to the market. Ray’s past experience also includes executive roles at Anchorsilk, where he was responsible for launching a new organization and a hosted e-commerce product suite, and at Webhire, where he was part of the management team that led the company through a successful IPO. A graduate of the University of Massachusetts, Ray has been a frequent speaker at technology events and conferences around the world.
Trudy DeWitt Trudy DeWitt is a Manager in Policy-Measures in the Product Delivery Division of the National Committee for Quality Assurance. In her current position, Mrs. DeWitt supports the development of the Healthcare Effectiveness Data and Information Set (HEDIS) measures and is the project manager of the Disease Management Technical Specifications. Mrs. DeWitt represents the policy perspective on several NCQA projects including the Physician Quality Reporting System and Laboratory Panel. She also works closely with other staff members in responding to NCQA customers and constituents through the Policy Clarification Support system and in developing Frequently Asked Questions. Mrs. DeWitt received her Bachelor of Science degree in Health Service Administration from James Madison University.
PAGE 13
Advancing Therapeutics, Improving Lives.
For more than 25 years, Gilead has been committed to developing medicines that address areas of unmet medical need for people around the world. Our portfolio of medicines and pipeline of investigational drugs include treatments for HIV/AIDS, hepatitis, serious respiratory and cardiovascular conditions, cancer and inflammation. Every day we strive to transform and simplify care for people with life-threatening illnesses.
For more information, please visit www.gilead.com. Š 2013 Gilead Sciences, Inc.
2013
TAHP Managed Care
C O N F E R E N C E
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S P E A K E R
P R O F I L E S :
Allan F. Einboden
John Gorman
Allan F. Einboden joined Scott & White Health Plan (Health Plan with 240,000 members) in June of 2000 as the COO. Mr. Einboden was appointed President and Chief Executive Officer of the organization in March of 2004 with responsibility for the overall success of the company. He is responsible for executing the strategic plan by working with division directors and affiliated operating entities to ensure effective operation of the health plan. In this capacity, Mr. Einboden has many opportunities to consult with various areas within the organization to effect positive changes that will ensure the continued success of Scott & White Healthcare. During his tenure, Scott and White Health Plan has enjoyed record financial success and diversified its operations exponentially.
Under John’s leadership, Gorman Health Group has become the leading professional services and solutions firm for governmentsponsored health care, providing thought leadership and expert strategic, operational, and technology-based solutions in its 17 years of continuous operations and growth. John’s work focuses on government health programs strategy, cultural transformation within healthcare companies, governance, and turnaround of distressed health plans.
Prior to joining Scott & White Health Plan, Mr. Einboden was the Chief Operations Officer for Primary Health in Boise, Idaho. He was responsible for developing and managing the company’s technology infrastructure, improvement and development of new and existing health care products, and administration functions such as claims, customer service, contracting, and compliance. Prior to joining Primary Health, Mr. Einboden was a Director for Intergroup Healthcare Corporation (a HealthNet subsidiary) based in Tucson, Arizona with 400,000 members. Mr. Einboden serves on many boards both professionally and at the community level.
Edward Fox Dr. Fox is Clinical Associate Professor, The University of Texas Medical Branch, Austin, Texas and the Director of the Multiple Sclerosis Clinic of Central Texas, Round Rock, Texas. Dr. Fox is renowned in the area of multiple sclerosis and, in 2003, was named to the Volunteer Hall of Fame by the Lone Star Chapter of the National Multiple Sclerosis Society, an organization for which he serves on the Clinical Advisory Committee. Since 2004, he has served as a faculty member at The University of Texas Medical Branch. Additionally, Dr. Fox conducts extensive research in the field of multiple sclerosis, including the study of pharmaceutical agents and their mechanisms of action, as well as methods of managing multiple sclerosis as it progresses.
John and the Gorman team have led the development and launch of several entrepreneurial ventures in both software and business process outsourcing in government health programs. John speaks at dozens of industry and investment community conferences each year, reaching thousands of senior health care executives with his predictions about the evolving governmentsponsored managed care market. He is regularly quoted in the trade press and the national media, including The New York Times and The Wall Street Journal, and serves on the editorial advisory boards of several industry publications. Prior to founding his own company in 1996, John served as Assistant to the Director of HCFA’s Office of Managed Care, where he provided day-to-day management and served as the external liaison for the Medicare and Medicaid managed care programs.
Jan Graeber Jan Graeber is Director and Chief Actuary of the Rate and Form Review Office of the Texas Department of Insurance. Ms. Graeber graduated from The University of Texas at Austin with a Bachelor of Business Administration in actuarial science. She is a member of both the Society of Actuaries and the American Academy of Actuaries. Ms. Graeber joined the Texas Department of Insurance in 1994 and has extensive experience in the review and analysis of Medicare supplement and Medicare select rates and refund calculations, longterm care initial rates and rate increase filings, HMO rate and rating methodology filings, accident and health rate increases, small group rating requirements, calculations demonstrating compliance with the Standard Nonforfeiture Law for Life Insurance and Annuities, collection and analysis of credit life and credit accident and health data, and with the development and recommendation of credit life and credit accident and health presumptive rates. Most recently, Ms. Graeber has been extensively involved with the implementation of the Affordable Care Act and serves as the agency’s Rate Team Lead and Market Reform Team Lead.
PAGE 15
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2013
TAHP Managed Care
C O N F E R E N C E
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S P E A K E R
P R O F I L E S :
Alicia Haff
Michael Klein
Alicia J. Haff has been practicing law in Texas since 1997. She also obtained her General Lines Insurance License in the State of Texas in 2007 to further assist employers and insurance brokers in handling employee benefit matters. She obtained her Bachelor of Arts in History from Trinity University and her Juris Doctorate from the University of Texas School of Law in Austin. Alicia’s primary practice from 1997 through 2010 was in the realm of commercial litigation - defending slip and falls to employment disputes to contractual disagreements.
Michael Klein has an extensive practice that includes experience in general commercial litigation, environmental litigation, class action litigation, trade secret litigation, construction litigation, fair housing act litigation, health care litigation, managed care litigation, ERISA, governmental investigations and civil investigative demands, premises and employer liability matters, consumer protection litigation, personal injury litigation, general tort, insurance coverage issues, insurance bad faith and professional malpractice matters. Mr. Klein has tried over forty matters to final award or judgment in his career, including fair housing act lawsuits in both state and federal courts, and numerous premises liability matters involving construction site accidents, physical assaults and sexual assaults.
In June of 2010, Alicia left her partnership at Curney, Garcia, Farmer, Pickering & House to pursue a more proactive practice focused on assisting employers in avoiding or at least preparing for potential employee lawsuits and governmental audits. To that end, Alicia opened Haff Consulting Services, LLC, a full service Human Resources Auditing Company focused on assisting employers in assessing their employment practices and improving their human resource procedures. Alicia’s primary goal is to help employers comply with regulations and to protect themselves from or prepare for potential employment litigation.
Mark Heit Mark Heit is Beacon’s Vice President of Strategy and Development. In this role, Mr. Heit oversees Beacon’s development of new partnerships with health plans, with a particular focus on publically-sponsored programs. Mark is actively working across the country with local and national health plan clients that are building new integrated products for the dual eligible and other disability populations. Mr. Heit joins Beacon with 10 years of experience in the public healthcare market. Prior to joining Beacon in 2011, Mark was most recently a Principal at Sellers Dorsey, where he worked with stakeholders across the healthcare industry. During his time at Sellers Dorsey, Mr. Heit consulted with the Texas Health and Human Services Commission (HHSC) on early 1115 waiver design, and led efforts to develop new federal funding mechanisms for Texas’s academic medical centers.
Mr. Klein has represented numerous high-tech companies in matters ranging from trade secret litigation to premises liability matters. Mr. Klein has also represented large healthcare and insurance clients in governmental investigations, declaratory judgment actions and injunctive matters involving the State of Texas, the Texas Department of Insurance and the Texas Department of Health.
Barbara Levy Barbara Levy is Vice President and General Counsel for the Pharmaceutical Care Management Association. In this capacity, she provides legal advice to PCMA’s senior management and oversees PCMA’s outside legal resources. Ms. Levy also directs PCMA’s state affairs activity providing policy, lobbying, and ally development support to the Association’s member companies. She also represents the Association’s interest before state intergovernmental organizations.
Ms. Levy has over 20 years experience in the health insurance industry. Prior to joining PCMA, she served as Legislative Director and Counsel for State Affairs for the Health Insurance Association of America (HIAA). She also spent more than seven years at Aetna where she worked in both legal and government Prior to his time in consulting, Mark worked for the Massachusetts affairs positions. She is also a veteran of the Florida and New Medicaid program (MassHealth), where he served as a financial analyst for the Office of Purchasing Strategy, and later as Chief of Staff Jersey Departments of Insurance. to the Medicaid Director. During this time, he was a member of the Ms. Levy earned her Bachelor of Arts and Juris Doctor degrees team responsible for negotiation and approval of the Commonwealth’s from the University of Florida. $1.34 billion 1115 waiver renewal, which became the foundation for its groundbreaking healthcare reform program in 2006.
PAGE 17
2013
TAHP Managed Care
C O N F E R E N C E
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S P E A K E R
P R O F I L E S :
Esteban López
Pati McCandless
As a regional president, Dr. Esteban López serves as liaison to the Blue Cross and Blue Shield of Texas (BCBSTX) Plan president for operations in the San Antonio area, including community investments, medical policy, health care management, sales, and account management.
Pati McCandless is the Executive Director for Government Relations at Blue Cross Blue Shield of Texas. Prior to her current position, Pati was Of Counsel at Greenberg Traurig where she represented a variety of clients before the Texas Legislature and Texas state agencies with a primary focus on insurance and managed care.
Dr. López joined BCBSTX in 2013. Previously, Dr. López worked as a practicing physician with nearly every hospital system in the San Antonio community. He is a member of the Bexar County Medical Society, the San Antonio Pediatric Society, as well as the Texas Medical Association. He also belongs to the American Medical Association (AMA) and is a Fellow of the American Academy of Pediatrics. In addition, Dr. Lopez has served as a clinical assistant professor at the University of Texas (UT) Health Science Center at San Antonio as well as a Scholar for the National Health Service Corp where he worked in an underserved community of San Antonio’s Westside.
Pati has over 20 years of legal and legislative experience related to insurance and managed care issues in Texas. She currently serves on the Executive Committee and board of the Texas Association of Business and on the board of the Texas Health Insurance Pool. She previously served as a President and Board member of the Texas Association of Health Plans. Pati received her law degree from New York Law School and a BS in Journalism from Texas A & M University.
Dr. López is dual board certified in both internal medicine and pediatrics and received his training at the UT Health Science Center at Houston. He holds degrees from the University of California at Santa Cruz and Michigan State University’s College of Human Medicine, in addition to a Master in Business Administration from a combined program at the University of Texas at Dallas and UT Southwestern School of Medicine.
Ken Malcolmson Ken Malcolmson is CEO of Humana’s West Central Region, where he is responsible for the overall management and strategic planning for the company’s commercial health benefit products in a 18-state region. A graduate of Southern Methodist University, Malcolmson previously served as Humana’s market president with responsibilities for commercial operations in Dallas-Fort Worth, Austin, and Houston. Prior to that he held executive posts at Express Scripts, CIGNA Health Care of Texas, and Towers Perrin; he began his career in 1974 at Aetna Life Insurance Co.
Tom Quirk Tom Quirk serves as Chief Executive Officer of UnitedHealthcare operations in Texas and Oklahoma. Tom has more than 25 years of experience in the health care finance and insurance industry that includes hands-on experience in financial underwriting, physician and hospital contracting, sales and business development. Tom was appointed by Governor Rick Perry to the Board of Directors of the Texas Institute of Health Care Quality and Efficiency. In addition, he sits on the Boards of the Texas Association of Business, American Heart Association of Tarrant County and The Research and Education Institute for Texas Health Resources. Tom began his health care career in 1986 in Hartford with Aetna and later joined Travelers where he managed large account business in the Southwest until UnitedHealthcare acquired the company’s health care operations in 1995.
Ross Ramsey Ross Ramsey is executive editor and co-founder of The Texas Tribune and continues as editor of Texas Weekly, the premier newsletter on government and politics in the Lone Star State, a role he’s had since September 1998. Before joining Texas Weekly, Ramsey was associate deputy comptroller for policy with the Texas Comptroller of Public Accounts, also working as the agency’s director of communications. Prior to that 28-month stint in government, Ramsey spent 17 years in journalism, reporting for the Houston Chronicle from its Austin bureau and for the Dallas Times Herald, first on the business desk in Dallas and later as the paper’s Austin bureau chief. Prior to that, as a Dallas-based freelance business writer, he wrote for regional and national magazines and newspapers. Ramsey got his start in journalism in broadcasting, working for almost seven years covering news for radio stations in Denton and Dallas.
PAGE 19
Watson is now Actavis Watson Pharmaceuticals and the Actavis Group are now united globally as Actavis (NYSE: ACT). Actavis markets more than 40 brand pharmaceutical products, primarily in the U.S. We are focused on leadership in Urology and Women’s Health. Internationally, we are expanding our Specialty Brands business in Canada and Latin America, and pursuing opportunities to expand in other key markets. We are also committed to developing and marketing biosimilars products in Women’s Health, Oncology and other therapeutic categories, and currently have a portfolio of 5 biosimilar products in development.
Actavis - Building a Leadership Position in Specialty Pharmaceuticals www.Actavis.com
www.Actavis.com
2013
TAHP Managed Care
C O N F E R E N C E
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S P E A K E R
P R O F I L E S :
Nick Thompson
Dawn Tice
Mr. Thompson currently serves as the Senior Vice President of Regulatory Affairs for UnitedHealth Group, Inc. His primary responsibilities include adivsing senior management on state regulatory matters and overseeing state regulatory affairs and NAIC activities for UHG’s regulated subsidiaries.
Dawn Tice is the Executive Director of Practice Performance and Quality for Mainline Health, a network of hospitals & health centers in the Philadelphia area. She was the previous Director of Quality Improvement, University of Pennsylvania’s Clinical Care Associates in Radnor, PA. She is also a Quality Improvement Consultant for the PA Academy of Family Physician Foundation, Harrisburg, PA. In the past, Dawn was a Quality Improvement Coach supporting Primary Care transformation to Patient Centered Medical Homes for more than 40 practices participating in Pennsylvania’s Chronic Care Initiative, a Collaborative led by the Governor’s Office for Health Care Reform.
Prior to joining UHG, Mr. Thompson was a senior partner with the Mitchell Williams law firm where he represented clients on general administrative and insurance regulatory specific matters before various federal and state regulatory bodies, the National Association of Insurance Commissioners (NAIC) and National Conference of Insurance Legislators (NCOIL). Mr. Thompson is also a former insurance regulator, advisor and legislative assistant to a governor. Mr. Thompson earned his Juris Doctor from the University of Arkansas School of Law and his Bachelor of Arts degree in Political Science from the University of Arkansas. He is a member of the Arkansas and American Bar Associations, the Federation of Regulatory Counsel, Inc., and a board member of the Arkansas Comprehensive Health Insurance Pool, the Arkansas Life and Disability Insurance Guaranty Association, the California Life and Health Insurance Guarantee Association, and the Connecticut Life and Health Guarantee Association.
Dawn received her formal clinical training as a Registered Nurse at West Chester University, and completed her business degree from Eastern University, St. David’s, both located in Pennsylvania. Her experience collaborating with healthcare organizations and industry stakeholders drives her expertise in the areas of care management and coordination, delivery system redesign using LEAN methodologies, pay-for-performance, the Chronic Care Model, and Patient Centered Medical Home transformation.
Chris Traylor Chris Taylor is chief deputy commissioner of the Texas Health and Human Services Commission. Traylor most recently served as commissioner for the Texas Department of Aging and Disability Services, the agency that regulates long-term services and nursing homes, provides state services for people with disabilities and oversees state programs for aging Texans.
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The Solution for Managing Medical Transportation � improve quality & HEDIS scores � credentialed transportation networks — local & national � progressive technology & reporting � appropriate utilization & cost management
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
The Texas Association of Health Plans
Dear Health Care Colleagues, Our health care system continues to evolve and the role of the health insurance industry is more expansive than ever. The health insurance marketplace is open for business and managed care organizations will soon cover almost all Medicaid and CHIP recipients in the our state, in addition to coverage provided by Commercial and Medicare managed care organizations. Now is the time to seize the opportunity to show our customers, providers and stakeholders that we are better than ever. We need to demonstrate at every opportunity the value of health plans to the State of Texas - from improving health outcomes, to bringing cost efficiencies to the delivery system and to the economic benefits we bring with doing business in the state. I look forward to TAHP being the catalyst for that message this year. Many thanks for joining us this week to kick off the year. Enjoy the conference!
Holly Munin Incoming President TAHP Board of Directors
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2013
TAHP Managed Care
2 0 1 3 - 2 0 1 4
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
B O A R D
O F
Aetna Health, Inc
FIRSTCARE
FrankK@aetna.com
ddent@firstcare.com
Kris Frank, Director, State Government Affairs - West
D I R E C T O R S
Darnell Dent, President & CEO
Amerigroup Texas, Inc.
Memorial Hermann Health Solutions, Inc.
meredith.delk@amerigroup.com
stephanie.rogers@memorialhermann.org
Meredith Delk , SVP Government Relations
Stephanie Rogers, Director, MHealth
AmeriHealth Mercy Family of Companies
KS Plan Administrators
Jamie.melendez@amerihealthmercy.com
Marnie.Matheny@kelsey-seybold.com
Jamie Melendez, Director of Corporate Public Relations
Marnie Matheny, President, KelseyCare Advantage Operations
Blue Cross Blue Shield Texas
Parkland Community Health Plan
ron_taylor@bcbstx.com
Timothy.Bahe@phhs.org
Ronald Taylor, Vice President & General Counsel
Tim Bahe, Executive director
CHRISTUS Health Plan
Molina Healthcare of Texas
Anita.fluharty@christushealth.org
craig.bass@molinahealthcare.com
Anita Pluharty Leal, Executive Director
Craig Bass, MHT President
CIGNA/HealthSpring
Sendero Health Plans, Inc.
marc.alcedo@cigna.com
David.lamkin@senderohealth.com
Marc Alcedo, State Government Affairs
Dave Lamkin, President and CEO
Community First Health Plan
Scott & White Health Plan
ggieseman@cfhp.com
bbrodersen@swmail.sw.org
Greg Gieseman, President & CEO
Blake Brodersen, Asst. Gen. Counsel-Reg .Affairs
Community Health Choice
Superior Health Plan/Centene
Ken.Janda@chchealth.org
hmunin@centene.com
Ken Janda, President and CEO
Holly Munin, CEO Foster Care and SVP Administration
Cook Children’s Health Plan
Seton Health Plan
Bob.watkins@cookchildrens.org
sgarcia6@seton.org
Bob Watkins, President
Sylvia Garcia, Director of Government Programs
El Paso First Health Plan
Texas Children’s Health Plan
fdominguez@epfirst.com
cmborn@texaschildrens.org
Frank Dominquez
Chris Born, President
Driscoll Children’s Health Plan
UnitedHealth Group
mary.peterson@dchstx.org
chris_cronn@uhg.com
Mary Dale Peterson, M.D., President/CEO
Chris Cronn, VP State Government Affairs
Humana
WellCare Health Plans, Inc.
jaghamalian@humana.com
frank.heyliger@wellcare.com
Jenny Aghamalian, Regional Director of Public Affairs
Frank Heyliger, President
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“She tells me all the time
I’m so happy.
she loves being home with us.” Laina cares for her 91-year-old mother, diagnosed with dementia, at home. Laina took on the role of full-time caregiver, thanks to the professional and financial support of Caregiver Homes™.
Caregiver Homes is a multi-state, agency provider of Adult Foster Care. Caregiver Homes serves more than 2,000 complex elders and adults with significant disabilities on a 24/7 basis in their own homes, delivering high quality care and lower LTSS and medical costs.
FOR MORE INFORMATION:
Call Matt Lockwood Mullaney, VP Business Development at 617-456-3758 or Rachel M. Richards, VP Government Relations at 617-456-3703. www.caregiverhomes.com
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
2 0 1 3 - 2 0 1 4
T A H P
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Aetna
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Humana
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Amerigroup Texas
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KS Plan Administrators, LLC
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AmeriHealth Mercy
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Memorial Hermann Health Solutions, Inc.
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BlueCross BlueShield of Texas
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Molina Healthcare of Texas
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Christus Health
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Parkland Community Health Plan
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CIGNA
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Scott & White Health Plan
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Community First Health Plans
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Sendero Health Plans
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Community Health Choice
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Seton Health Plan
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Cook Children’s Health Plan
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Superior HealthPlan
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Driscoll Children’s Health Plan
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Texas Children’s Health Plan
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El Paso First Health Plans
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UnitedHealthcare
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FirstCare
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WellCare of Texas
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HealthSpring
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WellPoint, Inc.
2 0 1 3 - 2 0 1 4
A F F I L I A T E / A S S O C I A T E
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AbbVie
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MedeAnalytics
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Access2Care
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MedImmune
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Actavis
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MedSolutions
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AECC Total Vision Health Plan
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Merck
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Beacon Health Strategies
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Natera, Inc.
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Biogen Idec
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Navitus Health Solutions
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Block Vision of Texas, Inc.
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Novo Nordisk
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Caregiver Homes a division of Seniorlink
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Onyx Pharmaceuticals
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Daiichi Sankyo
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PerformRx
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Express Scripts
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ProgenyHealth
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Genentech
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Sanofi
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Gilead Sciences
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Sedgwick LLP
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HealthEdge
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Sunovion Pharmaceuticals
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HealthLOGIX
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Total Transit
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Krames StayWell
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Treo Solutions
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LeFleur Transportation Texas
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Valeritas
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LogistiCare
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Value Options
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Management & Network Services
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Varis, LLC
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Medco Medical Supply
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Vertex Pharmaceuticals
PAGE 27
M E M B E R S
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
TAHP Managed Care Conference & Trade Show
NOVEMBER 3-5, 2014 IN DALLAS
SAVE THE DATE NOW FOR NEXT YEAR’S EVENT!
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2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
RESERVE YOUR BOOTH TODAY FOR 2014!
MANAGED CARE CONFERENCE & TRADE SHOW Hyatt Regency Dallas at Reunion • November 3-5, 2014
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2013 C
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Access2Care is a national leader in medical transportation management among Health plans seeking to minimize costs, improve customer satisfaction, and emphasize quality. Our custom programs reach the most challenged and leastengaged members. For us, it’s not just about providing quality transportation, it’s about delivering affordable and dependable access to healthcare.
The new Actavis, Inc. (NYSE:ACT) is a combination of the previously separate Watson Pharmaceuticals, Inc. and Swiss-based Actavis Group. Actavis, Inc. is a specialty pharmaceutical company that develops, manufactures and distributes generic, brand and biosimilar products. The Company has global/U.S. headquarters in Parsippany, NJ and international headquarters in Zug, Switzerland.
At Genentech, we use human genetic information to discover, develop, manufacture and commercialize medicines to treat patients with serious or life-threatening medical conditions. Today, we are among the world’s leading biotech companies, with multiple products on the market and a promising development pipeline.
Gilead Sciences is a biopharmaceutical company that discovers, develops and commercializes innovative therapeutics in areas of unmet medical need. The company’s mission is to advance the care of patients suffering from lifethreatening diseases worldwide. Headquartered in Foster City, California, Gilead has operations in North America, Europe and Asia Pacific.
Krames StayWell is the premier single-source consumer health engagement and health management communication and behavior change solutions help our clients engage and empower members, build closer relationships to aid in retention, improve quality and reduce costs.
Logisticare is your complete solution for non-emergency transportation and access to Preventative HealthCare: • Cost effective • Reduced fraud and abuse • Case management approach to service • Best-in-class quality assurance programs • Improved recipient access to Preventative HealthCare • High recipient satisfaction • Specializing in Medicaid and Medicare transportation
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2013 C
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Medco is leading the medical supply accountability revolution by partnering with managed care programs to educate patients, reduce readmissions, and intelligently utilize resources. For more than forty years, Medco Medical Supply has been committed to making their patients smile by providing high-quality medical supplies and exceptional customer service.
Navitus Health Solutions, LLC is a full service, URAC-accredited pharmacy benefit management company. As a zero-spread, full pass through pharmacy benefit manager (PBM), Navitus aligns performance with plan sponsors’ benefit goals to deliver comprehensive clinical programs and cost-saving strategies that lower drug trend and promote good member health. Navitus provides its flexible services to government entities, self-funded employers, coalitions, labor organizations, third-party administrators, and health plans, including managed Medicaid and Medicare Part D. For more information about Navitus Health Solutions’ call 877-571-7500.
Novo Nordisk is a global healthcare company with nearly a century of innovation and achievement in diabetes care. Our portfolio of diabetes treatments and delivery systems is the most comprehensive available. We engage in programs and partnerships built on helping to improve the lives of patients with diabetes.
Sanofi, a global and diversified healthcare leader, discovers, develops and distributes therapeutic solutions focused on patients’ needs. Sanofi has core strengths in the field of healthcare with seven growth platforms: diabetes solutions, human vaccines, innovative drugs, rare diseases, consumer healthcare, emerging markets and animal health.
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2013 C
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A NEW BIOPHARMACEUTICAL COMPANY AbbVie represents a new biopharmaceutical company— combining the expertise and stability of a long-standing pharmaceutical company with the focus and innovative spirit of biotech. Our portfolio of biologics and other compounds addresses some of the world’s most complex, unmet medical needs making us disease-state leaders through our products.
Founded in 1996, Beacon Health Strategies LLC (Beacon) is an NCQA-accredited managed behavioral healthcare organization (MBHO) that specializes in the treatment of mental illness and substance use on a fully integrated basis for individuals with complex medical, behavioral, and social needs. Today, Beacon manages behavioral health benefits for over 9.1 million members, including Medicaid, Medicare, Health Insurance Exchange, and commercially insured beneficiaries.
Seniorlink’s Caregiver Homes is a multi-state, agency provider of Adult Foster Care. Caregiver Homes serves more than 2,000 complex elders and adults with significant disabilities on a 24/7 basis in their own homes, delivering high quality care and lower LTSS and medical costs.
Daiichi Sankyo, Inc. headquartered in Parsippany, New Jersey, is the U.S. subsidiary of Daiichi Sankyo, Co., Ltd. The Company is dedicated to the creation and supply of innovative pharmaceutical products to address diversified, unmet medical needs. We currently market therapies in hypertension, dyslipidemia, diabetes, acute coronary syndrome and metastatic melanoma. www.dsi.com. Daiichi Sankyo, Inc. headquartered in Parsippany, New Jersey, is the U.S. subsidiary of Daiichi Sankyo, Co., Ltd. The Company is dedicated to the creation and supply of innovative pharmaceutical products to address diversified, unmet medical needs. We currently market therapies in hypertension, dyslipidemia, diabetes, acute coronary syndrome and metastatic melanoma. www.dsi.com.
®
Through cutting-edge science and medicine, Biogen Idec discovers, develops and delivers to patients worldwide innovative therapies for the treatment of neurodegenerative diseases, hemophilia and autoimmune disorders. Founded in 1978, we are the world’s oldest independent biotechnology company and a Fortune 500 company with more than $5 billion in annual revenues. Patients worldwide benefit from our leading multiple sclerosis therapies.
HealthEdge provides the only integrated financial, administrative and clinical platform for healthcare payors, delivered via the HealthEdge Cloud or onsite deployment. The HealthRules product suite, built on modern, patented technology, enables payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. An award-winning company, HealthEdge delivers disruptive technology that makes the new healthcare economy work. For more information, visit www.healthedge.com.
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2013 C
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HealthLOGIX is an expert in the personalization, production and fulfillment of Pre- and Post-Enrollment packages & ID cards for health plans nationwide. All production is done in-house keeping prices affordable and package receipt accurate and on time! Contact: Kelly Flynn at kflynn@ healthlogixonline.com
MedeAnalytics delivers performance management solutions across the healthcare system—including hospitals, physician practices and payers—to ensure accountability and improve financial, operational and clinical outcomes.
MedImmune is the worldwide biologics research and development arm of AstraZeneca, a global, innovationdriven biopharmaceutical business that focuses on the discovery, development and commercialization of small molecule and biologic prescription medicines. MedImmune is pioneering innovative research and exploring novel pathways across key therapeutic areas, including respiratory, inflammation and autoimmunity; cardiovascular and metabolic disease; oncology; neuroscience; and infection and vaccines.
Today’s Merck is a global healthcare leader working to help the world be well. Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships. www.merck.com
MedSolutions specializes in quality-driven, intelligent management of medical services for commercial, Medicare, and Medicaid members. We use clinical expertise, nationally recognized guidelines and a diagnostic approach to improve patient outcomes through innovative solutions in Advanced Imaging, Cardiac Imaging, Ultrasound, Radiation Therapy, Sleep Management, Cardiac Rhythm Devices, Spine Surgery and Post-Acute Care. Visit www. medsolutions.com to learn more.
In late 2012 Natera announced The PanoramaTM Test, the most accurate and comprehensive non-invasive prenatal test available. Natera has a history of proven excellence in reproductive genetic testing having previously launched preimplantation genetic diagnosis (PGD) for IVF, carrier screening and the only prenatal non-invasive paternity test. Visit www.panoramatest.com for additional information.
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2013 C
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Based in San Francisco, California, Onyx Pharmaceuticals, Inc. is a global biopharmaceutical company engaged in the development and commercialization of innovative therapies for improving the lives of people with cancer. The company is focused on developing novel medicines that target key molecular pathways. For more information about Onyx, visit the company’s website at www.onyx.com.
Since 1999, PerformRx, LLC has provided innovative pharmacy benefit management through customizable solutions and specialized standalone services. Our success stems from a clinical focus infused with cutting-edge, proprietary technology. Through a high-touch approach, we collaborate with clients to improve patient therapy while optimizing financial performance.
ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization, improves access, educates family members and reduces costs. Progeny’s foundation is built on evidence-based best practices, timely communication, and ongoing collaboration with clients and providers. This proactive approach has resulted in our expansion into all 50 states and significant and reproducible cost savings for our clients.
Sunovion Pharmaceuticals Inc. is dedicated to discovering, developing and commercializing scientifically advanced therapeutic products that are focused on helping patients suffering from central nervous system and respiratory disorders, as well as other illnesses. A wholly-owned subsidiary of Dainippon Sumitomo Pharma Co. Ltd. (DSP), Sunovion was formed following the merger of DSP’s two U.S. based operations, Sepracor Inc. and Dainippon Sumitomo Pharma America, Inc. Treo Solutions is a trusted, proven partner with the vision of a value based healthcare delivery system that leverages enhanced data assets, collaborative relationships, and dynamic feedback on performance to transform care. Our broad range of highly scalable tools, optimized database of over 45 million covered lives and expertise in collaborative care logistics empowers clients to make value-informed decisions to create new risk-sharing and total cost of care models, thus transforming how patient care is delivered and paid for. Our focused experience and agility allows our clients to anticipate—and rapidly react to—a constantly changing market.
Valeritas develops and commercializes innovative treatment solutions with an initial focus on Type 2 diabetes. ® Headlining Valeritas’ portfolio is the V-Go , a disposable insulin delivery device that is simple, convenient, and easy to use and provides a continuous preset basal rate of insulin for 24 hours plus on-demand bolus dosing at mealtimes.
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2013 C
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VARIS, a national recovery audit company, specializes in overpayment identification services for inpatient and outpatient claims specific to DRG and APC. We typically identify up to 3% of your total paid claims dollars using VARIS’ proven approach. For more information, call 916294-0860 or visit www.varis1.com.
Vertex, founded in 1989, is a global biotechnology company that aims to discover, develop and commercialize innovative new medicines so people with serious diseases can lead better lives. Vertex scientists are working on new medicines to significantly advance the treatment of life-shortening diseases.
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Best known for our market-leading coding and ICD10 expertise, 3M Health Information Systems delivers innovative software and services that raise the bar for documentation improvement, computer-assisted coding, and case mix and quality reporting. We are committed to helping lower costs, improve the accuracy of clinical documentation and enhance patient outcomes.
CENTENE Corporation is committed to transforming the health of the community, one person at a time with solutions that treat the whole health of a member—better health outcomes at lower costs. Behavioral health and specialty rehabilitation therapies (Cenpatico), care management software (CaseNet), correctional systems healthcare (Centurion), life and health management (Nurtur), managed vision (OptiCare), pharmacy benefits management (US Script), specialty pharmacy (AcariaHealth), and telehealth services (Nurse Response).
Alere provides services that are designed for the entire lifespan from pre-cradle (high-risk pregnancy risk assessment, obstetrical homecare and NICU management), the continuum of health from wellness to prevention (health, wellness and productivity programs), chronic care (care management and specialized case management) to end-oflife care (complex case management Visit www.alere.com for more information.
Carenet provides Care Management and Engagement solutions that measurably improve the quality and lower the cost of healthcare. By combining unrivaled clinical and consumer marketing expertise with actionable data, Carenet educates, empowers and motivates more than 20 million consumers worldwide to take a more active role in their healthcare.
Coram is a leading provider of specialty home infusion and pharmacy services with more than 30 years of experience. With over 85 branches nationwide, Coram offers both national presence and local coverage. Coram’s staff is known for providing an exceptional level of care to thousands of patients every day.
Since 1993, LeFleur Transportation has been successfully providing and managing passenger transportation programs that deliver the best service available. Today, LeFleur Transportation manages more than 2 million annual trips in AR, MS, OH, OK, & TX. LeFleur utilizes over 18 years’ experience in providing non-emergency transportation for multiple Medicaid environments, managed care organizations, social service programs, public transit agencies, and healthcare facilities, to give its clients the most cost effective, efficient, and safe option for their transportation needs.
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2013 C
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At Palladian Health, our services are focused on musculoskeletal healthcare. The way it’s accessed—and the way it’s delivered. We’re dedicated to improving the coordination of patient care, enhancing the clinical effectiveness and efficiency of caregivers, and ultimately, improving the quality of people’s lives.
Shield HealthCare is a leading provider of medical supplies, serving the caregiving community since 1957. Product lines include Incontinence, Enteral Nutrition, Ostomy, Urological, Wound and Diabetes supplies. Shield HealthCare maintains an outstanding reputation in customer service, quality products, reimbursement expertise and distribution. For online ordering and information, visit www.shieldhealthcare.com
Sandata’s Santrax Payor Management (SPM) integrates Electronic Visit Verification, Agency Management, Claims Validation, and Jurisdictional View tools giving payers near real-time insight into the delivery of home care services. SPM improves care coordination of HCBS services, enables the monitoring and quality oversight of home care providers, and ensures accurate payment of services delivered.
Outreach TransitionCare provides professional, coordinated care which dramatically reduces hospital readmissions and ER visits. Outreach Helath Services, a home health care company which has been in business throughout Texas for 35 years, now offers Outreach TransitionCare. Providing experienced, compassionate caregivers to serve as the payor’s eyes and ears in patients’ homes.
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Globally, Boehringer Ingelheim is among the top 20 leading pharmaceutical companies operating within 50 countries with over 41,500 employees. Since inception in 1885, we have been family-owned and operated. We are committed to researching, developing, manufacturing and marketing of novel products of high therapeutic value for human and veterinary medicine.
Providing strategic counsel on a variety of sophisticated legal matters for over 58 years, the attorneys of Mitchell Williams bring together decades of diverse professional experience and extensive relationships to offer clients in Arkansas and across the United States the most comprehensive services and solutions possible. As progressive leaders in the legal community, we work as advocates and partners to help companies meet the complex business needs required to succeed in today’s challenging economic climate.
Based in South San Francisco, California, Onyx Pharmaceuticals, Inc. is a global biopharmaceutical company engaged in the development and commercialization of innovative therapies for improving the lives of people with cancer. The company is focused on developing novel medicines that target key molecular pathways. For more information about Onyx, visit the company’s website at www.onyx.com.
National Jewish Health is known worldwide for treatment of patients with respiratory, cardiac, immune and related disorders, and for groundbreaking medical research. As a part of our mission, we are committed to using evidencebased guidelines for addressing the most relevant causes of preventable death in the U.S. through our tobacco cessation and weight management programs.
McGinnis Lochridge is a Texas-based firm providing quality legal services for more than 85 years. We work with individuals, small and medium businesses, large enterprises and multinational Fortune 500 corporations. From our offices in Austin and Houston, we represent clients throughout Texas, the United States and the world.
PremierTox Laboratory is an elite provider of physiciancentric clinical drug testing services, focused research as well as patient and provider education to support comprehensive treatment objectives. Our San Antonio-based laboratory and unique pricing strategies make us ideal partners for Texas health plans to improve patient outcomes and reduce long-term expenditures.
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For 30 years, Total Transit has been a mobility management company that provides fully outsourced, turn-key transportation management services for managed care organizations such as yours. We base our company’s reputation on service and giving you and your members the attention they deserve and go the “extra mile” to provide each member with the best experience possible.
Valence Health provides healthcare organizations solutions for value-based care, helping them better manage their patient populations and accept financial responsibility for the quality of care they provide. Headquartered in Chicago, with three other office locations, Valence Health serves more than 30,000 physicians and 100 hospitals, helping manage the health of over 15 million patients nationwide.
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OUR FOCUS: YOUR MEMBERS That’s why we make sure they have the lowest out-of-pocket costs.
©2013 VSP Vision Care. All rights reserved.
VSP® Vision Care gives your members what they want most—the lowest out-of-pocket costs. With competing vision plans, members could pay hundreds more for identical glasses. See for yourself at vsp.com. Kandi Alyousef-Garza | Sr. Account Executive 469.461.8507 | Kandi.Alyousef-Garza@vsp.com
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Novartis
Emdeon is a proven provider of claims, payment, clinical exchange and fraud and abuse management solutions that increase efficiencies through intelligent transaction services. Emdeon helps healthcare payers streamline processes and reduce administrative costs while lowering the overall cost of healthcare.
Novartis Pharmaceuticals is dedicated to discovering, developing, manufacturing and marketing prescription drugs that help meet our customers’ medical needs and improve their quality of life. Please visit the Novartis exhibit where our sales representatives will be available to discuss our products.
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Verinata Health
Business Ink
Verinata Health, Inc., an Illumina subsidiary, is a leader in the field of non-invasive testing for the early identification of fetal ® chromosomal abnormalities. Our verifi prenatal test, run in our CAP accredited and CLIA certified national independent laboratory, detects the broadest array of the most common fetal chromosomal abnormalities.
Business Ink specializes in data-driven communication services within highly regulated industries. We have manufacturing facilities in Austin and Fort Worth strategically located near postal hubs, allowing us to deliver highly customized print, mail and fulfillment solutions to customers in 50 states. We are a certified Women Business Enterprise and HUB vendor.
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Pfizer
Envision Pharmaceutical Services
At Pfizer, we apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines for people and animals. Our diversified global health care portfolio includes human and animal biologic and small molecule medicines and vaccines, as well as nutritional products and many of the world’s best-known consumer products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time.
Envision Pharmaceutical Services, Inc is a full service pharmacy benefits management company. Our business model is based on transparency and full disclosure, guaranteeing 100% pass through pricing of all pharmaceutical rebates and any other fees/discounts at the point-of –sale. Additionally, we offer solutions for your retirees in terms of Medicare Part D and Employer Group Waiver Plans.
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Forest Pharmaceuticals At Forest Laboratories, improving lives is at the heart of what we do. Our strong partnerships have helped yield innovative drug therapies and the most robust pipeline of medicines in our company’s 57-year history. _______________________________________________
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Medical Transportation Management Medical Transportation Management, Inc. (MTM) provides transportation management, home and community based services, call center services, ambulance claims management, functional assessments and travel training to state and county governments, Medicaid and Medicare managed care organizations (MCO), thirdparty administrators, and health care providers. MTM’s mission is to improve the health and well-being of individuals by removing healthcare barriers and promoting independence while helping clients reduce costs, and increase customer satisfaction. _______________________________________________
Sequenom Laboratories Sequenom Laboratories, a wholly-owned subsidiary of Sequenom, Inc., is a CAP-accredited and CLIA-certified molecular diagnostics laboratory dedicated to improving patient outcomes by offering revolutionary laboratory-developed tests for a variety of prenatal and eye conditions. Sequenom Laboratories pioneered NIPT with the launch of the MaterniT21 PLUS test. Sequenom Laboratories’ quality of science allows you to deliver results. Confidently.
Block Vision Block Vision manages all levels of vision and eye care benefits, from wellness vision plans to comprehensive eye care programs that include management of medical and surgical eye care services. We are one of the industry’s most experienced vision benefits managers, delivering outstanding value and responsive service to our clients.
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BuSineSS inK:
compliant, coSt-efficient SolutionS for print, mail & fulfillment The bedrock that Business Ink (BI) builds customer partnerships on is extreme adaptability of compliant, secure programs. Our multi-plant structure, industry leading technology and proprietary processes allow us to provide highly customized print, mail and fulfillment solutions to customers in 39 states (shown at left.)
HealtHcare SpecialiStS Since 1986, BI has specialized in communications services within the highly regulated healthcare industry. This means that we understand the sensitive nature of NPI, PHI, State & Federal regulations (including HIPAA), and the strict timelines that can be associated with member communications programs. These are just some of Providing print, mail and fulfillment solutions to customers in 39 states
the services we are currently providing for Enrollment Brokers, State Agencies and Managed Care Organizations in Texas and across the country:
Enrollment kits
Texas HealthSteps mailings
ID cards
Health Education & Marketing Collateral
Audit trails for member communications via BI’s proprietary 2D coding feature
Member Handbooks, benefits information and prior-auth/claims correspondence
508 Compliance for web materials
Disease Management Communication
Recurring communication programs for Provider Webinars/ Member Orientations
Fulfillment systems to provide standardized materials to remote campuses
certified Knowledge & expertiSe • Data Security & Health Insurance Portability and Accountability Act (HIPAA) compliance are ensured through file transmission, data modeling, production and delivery to USPS (HHSC-certified compliance trainer on staff) • Certified USPS Full-Service Entity - BI can help reduced returned mail & postage costs via USPS National Change of Address (NCOA) & USPS manifest and combined mailing approvals; BI tracking systems provide 100% verification that every piece mails • Quality Certifications - ISO 9001:2008 standards & SSAE 16 Type II audit guidelines • Women’s Business Enterprise National Council (WBENC) & State of Texas Historically Underutilized Business (HUB) certifications allow you to meet HHSC contractual obligations for vender diversity • Forest Stewardship Council/Sustainable Forestry Initiatives ensure a Green approach to all Seton programs
Business Ink • 15404 Long Vista Drive • Austin, TX 78728 • Ph: 512.949.2200 • www.businessink.com
Using a simple blood draw from the mother, Panorama provides >99% combined accuracy for T21, T18, T13, X and Y and Triploidy, even with fetal fraction as low as 4%. Available at 9 weeks gestation.
Go to www.panoramatest.com for more information
Overpayment Identification Services by experienced, innovative leaders
Recover up to 3% of paid claims dollars
www.varis1.com
2013
TAHP Managed Care
CONFERENCE & TRADE SHOW The Texas Association of Health Plans
S I L V E R
S P O N S O R S
B R O N Z E
S P O N S O R S
Thank You to all the 2013 TAHP Conference Sponsors & Exhibitors
E X H I B I T O R S Block Vision
Envision Pharmaceutical Services
Pfizer Vaccines
Business Ink
Forest Pharmaceuticals
Sequenom Center Molecular Medicine
Emdeon
Medical Transportation Management, Inc.
Verinata Health
Novartis
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