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Best practices to manage your top cost drivers for 2018 T H E 3RD A N N U A L

Utilization Management Summit Innovations for Health Plans June 14-15, 2018 Sheraton Grand Hotel Phoenix, AZ » » Answer the Increasingly Difficult Questions Involved in Managing End-Of-Life Care

» » Achieve Big Cost Reductions Through Incremental Improvements in Outcomes for Your Plan’s Super-Utilizers

» » Explore the Latest Strategies for Sharing Real-Time Data Between the Health Plan and Various Care Settings

To Register: Call 888. 452.3580 or visit us at healthcare-conferences.com/utilizationmgmt v10 dw 5 .16. 2018


As expensive new treatments, tests and medicines come on the market, healthcare costs continue to soar, while member expectations rise, and pressures mount from the increasing focus on value-based care. In this challenging environment, optimizing Utilization Management at your plan is key to achieving your goals of improving both clinical and financial outcomes. Gain a new perspective on reducing healthcare costs while improving quality at the industry’s premier event for Utilization and Care Management professionals. In its third year, this innovative conference takes an intensive look at the new problems you will face this year, while providing insights and best practices that will enable you to fine-tune your ongoing UM initiatives. Join leading experts for an original, broad-based picture of how to balance cost containment with improved outcomes. Important takeaways: • • • •

Hear how large savings can result from incremental improvements in outcomes for your plan’s super-utilizers Discover the latest strategies and technologies for effective prior authorization Find out from an industry veteran how to increase your detection of fraud, abuse, and overutilization Gain new insight into the difficult questions involved in effectively managing end-of-life care

Sincerely, Tim Hart, Conference Director HEALTHCARE EDUCATION ASSOCIATES P.S. An impactful Utilization Management program requires a coordinated effort. We’ve made it easier for multiple members of your team to attend by offering significant group discounts and early-bird rates. See back page for details.

O ur Renowne d Sp eak ing Fac ult y

Who Should At tend?

Chandrakala Gowda, MD, MBA, Vice President, Executive MD— Government Markets HIGHMARK INC.

From health plans, professionals with roles in: • Utilization Management/Review

Marvin Gordon, MD, Regional Medical Director HEALTH NET OF CALIFORNIA

• Medical Management/Services

Ana Handshuh, Vice President, Corporate Programs ULTIMATE HEALTH PLANS

• Healthcare Services

Twila Johnson, Pharm. D. PHARMACY CONSULTANT former Director of Pharmacy Services SECURITY HEALTH PLAN

• Chief Medical Officers/Medical Directors

John Poikonen, Pharm. D., Adjunct Professor, Biomedical Informatics MCPHS UNIVERSITY Alanna Lavelle, Senior Principal, Life Sciences MITRE Dr. Kendall Payne, Specialist in Sports and Spine Injuries, CONSULTANT FOR BLUE CROSS BLUE SHIELD OF KANSAS Danielle J. Howard, Manager- Utilization Review ANCHOR HOSPITAL Eliza Ng, MD, MPH, Senior Medical Director MONTEFIORE CARE MANAGEMENT

• Care/Case Management

• Clinical Operations/Services

• Quality Improvement/Clinical Quality • Compliance

Top Rea s on s to At tend • Find out how to build a “care community” around your members to reduce costs • Hear how to more effectively manage end-of-life care • Understand how to contain costs through optimal management of costly specialty drugs • Learn how to improve detection of fraud, abuse and overutilization • Hear from an innovative plan that improves results by educating providers on the full extent of its benefits


DAY ONE: Thur sday, June 14 , 2018 8:00 – 8:45

E xhibit s Se t-Up, Break fa s t

Regis t ra t ion,

&

8:45 – 9:00

Chair ’s Opening Remark s

9:00 – 10:00

SPOTLIGHT: 5% of Members = 50% of Expenditures — Reducing Costs by Improving Outcomes for Top Users

11:15-12:15

• I dentify novel collaborative strategies and tactics in utilization management with provider partners in value based relationships • Leverage programs including Bundle Payments for Comprehensive Care and Oncology Care Model to advance your health plans UM goals • Achieving medical expenditure efficiency by aligning practice and hospital quality agendas

Cont inental

This statistical relationship remains generally true over time and across different populations. Consequently, significant cost reductions can be achieved by making relatively small changes to more effectively serve the highest users of healthcare. This session examines:

Eliza Ng, MD, MPH, Senior Medical Director MONTEFIORE CARE MANAGEMENT 12:15 – 1:15

Luncheon for all a t tendee s & speaker s

1:15 – 2:15

Answering the Dif f icult Ques tions Involved in Ef fec tively Managing End of Life C are

• How to identify those members who will be the highest users this year and in the future • Analyzing commonalities among these cases to target cost-effective solutions: addressing behavioral health and social determinants of health issues, fostering lifestyle changes to alleviate chronic conditions • Managing transitions to ensure that care occurs in the most efficient setting • Examining alternative care arrangements that reduce costs while enhancing care quality: community-based programs, telehealth

More and more providers are recognizing the benefits of hospice care, and many health care organizations are helping patients formalize their wishes for end-oflife care through an advance directive. However, this area remains fraught with potentially high costs and difficult decisions. This session will examine: • Understanding the different implications of: care for advanced illness, palliative care, and hospice • Evaluating when to transition to a different type of care and in what location • Creating effective communication strategies to enable asking delicate questions

Chandrakala Gowda, MD, MBA, Vice President, Executive MD—Gtovernment Markets HIGHMARK INC. 10:00 – 11:00

E xploring the L ates t Strategies and Technologies for Ef fec tive Prior Authoriz ation

Marvin Gordon, MD, Regional Medical Director HEALTH NET OF CALIFORNIA 2:15 – 3:15

One healthcare publication estimates that physicians spend over 868 million hours annually on prior authorization activities. This session examines how advances in methodology and technology can save time and money for health plans and physicians, as well as ensuring prompt delivery of care to members. • Identifying areas for improvement at your organization • Specifying exactly what information is needed for each type of prior authorization, in order to expedite decision-making • Identifying prior authorization processes that can benefit from electronic handling • Examining available technologies and outsourcing options to improve effectiveness Ana Handshuh, Vice President, Corporate Programs ULTIMATE HEALTH PLANS 11:0 0 – 11:15

Morning Ne t working Break

Utiliz ation Management in Value – Ba sed Model s

Optimizing Utiliz ation Management through Ef fec tive Coordination Across Depar tment s • Strategies for establishing UM concerns as an integral part of the care coordination, quality improvement, and compliance teams • Ensuring communication pathways that keep the concerned departments informed of decisions and developments • Collecting appropriate clinical information to enhance both case and utilization management • Taking quality improvement and compliance initiatives into account in UM decision-making Ana Handshuh, Vice President, Corporate Programs ULTIMATE HEALTH PLANS

3:15 – 3: 30

Af ternoon Break


3:30 – 4:30

Strategies for Sharing Real-Time Data Bet ween the Health Plan and Various C are Set tings

11:00 – 11:45 Containing Pharmac y Cos t s through Management of Cos tly Specialt y Drugs

• Examining technologies that facilitate data interoperability • Transforming the payer-provider relationship through improved data access and cost transparency • Giving clinicians the information they need to close care gaps during an office visit • Driving population health through increased scores and c ompliance

Statistics show that about 30% of drugs sold in the US are specialty pharmaceuticals, with that figure expected to reach 50% within three years, as 700 new specialty drugs are reportedly under development. In this context, it is essential to understand the steps you can take to control these costs. This session examines: • Resolution of the definition of a “specialty drug” during contracting to assure clarity and transparency in drug pricing and rebates • Ensuring coding accuracy to obtain a clear picture of what is being used and how • Step therapy, where less expensive, alternative therapies are tried first • Optimizing collaboration with specialty pharmacies

John Poikonen, Pharm. D., Adjunct Professor, Biomedical Informatics MCPHS UNIVERSITY 4: 30 – 5: 30

Cock tail Recept ion

Twila Johnson, Pharm. D. PHARMACY CONSULTANT former Director of Pharmacy Services SECURITY HEALTH PLAN

DAY T WO : Friday, June 15 , 2018 8:0 0 – 8:45

Cont inental Break fa s t

8:45 – 9:00

Chair ’s Recap of Day 1

9:00 – 9:45

Engaging Providers for Optimal Utiliz ation Management : The E xample of Spine C are • Creating relationships: working with providers to create pathways and control costs • Educating providers on appropriate documentation and care through pathways adherence • The importance of engaged first contact providers • Preventing over-utilization through Outlier Management

11:45-12:30

Danielle J. Howard, Manager- Utilization Review ANCHOR HOSPITAL 12: 30 – 1: 30

Luncheon for all a t tendee s & speaker s

1:30 – 2:15

Panel Discussion: Building an Integrated “C are Communit y ” Around the Member to Optimize Outcomes and Control Cos t s • Coordinating efforts among PCP, pharmacist, social worker and family to support member health • Optimizing skilled nursing discharge planning programs • Helping the member understand their own health • Leveraging community-based programs • Facilitating collaboration to successfully transition the member to lower levels of care

Detec ting Fraud, Abuse and Overutiliz ation • Monitoring strategies to discover potential irregularities • Avoiding unnecessary expenditure by ensuring members are receiving the most suitable amount and type of supplies • Creating algorithms to identify aberrant overutilization and remedy with edits, medical policies and pre-payment reviews

John Poikonen, Pharm. D., Adjunct Professor, Biomedical Informatics MCPHS UNIVERSITY

Alanna Lavelle, Senior Principal, Life Sciences MITRE 10:45 – 11:0 0

Managing Your Way to Improved Star Ratings: Success ful UM Strategies & Tool s • Augment your CM activities with supportive programs for: Patient-centered medical home • H ospital transitions • Skilled nursing discharge planning programs • Keys to an integrated UM/CM approach to identify trends in overturns and denial decisions

Dr. Kendall Payne, Specialist in Sports and Spine Injuries, CONSULTANT FOR BLUE CROSS BLUE SHIELD OF KANSAS 9:45 – 10:45

Optimal

Eliza Ng, MD, MPH, Senior Medical Director MONTEFIORE CARE MANAGEMENT Dr. Kendall Payne, Specialist in Sports and Spine Injuries, CONSULTANT FOR BLUE CROSS BLUE SHIELD OF KANSAS

Morning break

2:15

Summit conclude s


Venue D e t ail s

Team D is coun t s Sheraton Grand Phoenix 340 North 3rd Street Phoenix, AZ 85004 602.262.2500

• Three people will receive 10% off • Four people will receive 15% off • Five people or more will receive 20% off In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please contact Kathie Eberhard at (704) 341-2439 or keberhard@healthcare-conferences.com REFUNDS AND CANCELLATIONS

We have a limited number of hotel rooms reserved for the conference. The negotiated room rate of $209 per night will expire on May 23, 2018, although we expect the block to sell out prior to this date. To ensure you receive a room at the negotiated rate book well before the expiration date. Upon sell-out of the room block, availability will be at the hotel’s discretion. Please call 602.262.2500 to book your room, and mention the “Utilization Management Summit” to receive the negotiated rate.

For information regarding refund, complaint and/or program cancellation policies, please visit our website: https://www.healthcare-conferences.com/thefineprint.aspx

Sp on s or ship and E x hibit O pp or tunit ie s Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a custom-designed networking event. To learn more about sponsorship opportunities, please contact Michelle Elam at (704) 341-2393 or MElam@healthcare-conferences.com

T he Con ference O r gani zer s

Healthcare Education Associates is a division of Financial Research Associates, LLC. HEA is a resource for the healthcare and pharmaceutical communities to improve their businesses by providing access to timely and focused business information and networking opportunities in topical areas. Offering highly targeted conferences, Healthcare Education Associates positions itself as a preferred resource for executives and managers seeking cutting-edge information on the next wave of business opportunities. Backed with over 26 years of combined conference industry experience, the producers of HEA conferences assist healthcare professionals, actuaries, attorneys, consultants, researchers and government representatives in their professional endeavors. For more information on upcoming events, visit us online: www.healthcare-conferences.com

RISE (Resource Initiative & Society for Education) Vision: To build a community and an educational system that promotes successful careers for professionals who aim to advance the quality, cost and availability of health care. RISE provides: • A forum to build professional identity and a network of colleagues • A platform to capture and share knowledge and insights • A venue to develop and share benchmarks and document best practices

• Career track development support • A channel for building alliances, partnerships and affiliations that fulfill the vision

RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development. To learn more about RISE and to join, visit us online: www.risehealth.org


CPE Cre dit s Financial Research Associates is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org. Program Level: Overview Anticipated CPE Credits: 10.5 Recommended Field(s) Of Study: Specialized Knowledge Prerequisites: None Advance Preparation: None Instructional Delivery Method: Group Live Learning Objectives: Upon completing the course, participants will: •  U nderstand how large savings can result from incremental improvements in outcomes for their plan’s super-utilizers •  D iscover the latest strategies and technologies for effective prior authorization •  L earn from an industry veteran how to increase detection of fraud, abuse, and overutilization For more information, visit our website: www.frallc.com/thefineprint.aspx

ACC M E and A NCC CEUs :

Satisfactory Completion Learners must complete an evaluation form to receive a certificate of completion. Your chosen sessions must be attended in their entirety. Partial credit of individual sessions is not available. If you are seeking continuing education credit for a specialty not listed below, it is your responsibility to contact your licensing/certification board to determine course eligibility for your licensing/ certification requirement. Physicians and Nurses In support of improving patient care, this activity has been planned and implemented by Amedco LLC and Wilmington FRA – Healthcare Education. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation Statement – Amedco LLC designates this live activity for a maximum of 9.50 AMA PRA Category 1 CreditsTM for physicians and 9.50 contact hours for nurses. Learners should claim only the credit commensurate with the extent of their participation in the activity.


THE 3RD ANNUAL UTILIZATION MANAGEMENT SUMMIT

WILMINGTON FRA 3420 TORINGDON WAY, SUITE 240 CHARLOTTE, NC 28277

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healthcare-conferences.com/ utilizationmgmt

Wilmington FRA 3420 Toringdon Way, Suite 240 Charlotte, NC 28277

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Best practices to manage your top cost drivers for 2018 T H E 3RD A N N U A L

Innovations in Utilization Management for Health Plans The Industry’s Premier Forum for UM and CM Professionals June 14-15, 2018 Sheraton Grand Hotel Phoenix, AZ

The 3rd Annual Utilization Management Summit  

The Industry’s Premier Forum for UM and CM Professionals

The 3rd Annual Utilization Management Summit  

The Industry’s Premier Forum for UM and CM Professionals