2019 Agenda

Bridging the Gap in the Care Continuum to Deliver Value-Based Care

April 23, 2019

Registration and Networking Breakfast


Welcome Remarks

William De Marco, President, 
Chairman of the Board, Pendulum HealthCare Development Corporation,
GoldStar Alliance for Health
RaeAnn Grossman, Chief Growth Officer, DataLink Software 


KEYNOTE: The Future of Payer/Provider Alignment and the Building of a Delivery System to Care for Patients Responsible for 80% of the Spend

  • Examine Primary Care led integrated care taking Global capitation 
  • Understand the Six Pillars of Care achieving the Quadruple Aim with focus on the high-risk patient
  • Discuss novel ways to bring back the joy to medicine in patient -physician engagement
  • Learn how to engineer the health care process and designing IT to power the change

Stuart Levine, Physician Chief Advisor, Google Brain; CEO and President, Medical Innovations Inc.; Chief Medical and Innovation Officer, Agilon Health

9:55 AM

Achieve Success in Value Based Care: Essential Contracting & Delivery Capabilities, Tools & Services

  • Understand how value-based transformation impacts and creates opportunities for critical payer-provider collaboration 
  • Examine the important roles of independent physicians (IPAs/CINs) and like-minded preferred provider networks of specialists and acute/post-acute providers/health systems
  • Grasp the critical need for a robust population health MSO infrastructure—clinical, technology and business/risk management platform—and how that impacts contracting, payment, care coordination, network collaboration, quality as well as cost.

Ralph Tang, President, MD/VA IPA
WellCare Health Plans

10:50 AM

Networking Break

11:10 AM

PANEL: Payer/Provider Partnerships: Examine What It Really Takes to Make Value-Based Care Arrangements Work

  • Benchmark best practices in setting up shared-risk contracts 
  • Win-win communication – examine effective techniques needed for both parties to work together  
  • Hear how physicians can address competing payer requests 


Jeff Micklos, Executive Director
Health Care Transformation Taskforce 

Ralph Tang, President, MD/VA IPA
WellCare Health Plans 
Ethan Lipkind, Chief Development Officer
Clover Health
Denise Patriaco, Director
Hackensack Alliance ACO
Lili Brillstein, Director
Episodes of Care, Horizon Blue Cross Blue Shield (NJ) 

12:00 PM

Networking Lunch & Unscripted Roundtable Discussions

Attendees have the option to join a roundtable on a pertinent industry topic. Discussion will be open, idea-exchange so, come with conversation starters! 
#1 Value-Based Contract Standardization – Is There Room for Improvement?
#2 Discuss Commercial Payer Initiatives and Strategies
#3 Explore APMs and Effect on MACRA
#4  Best Practices for Payer/Provider Partnerships in Urban Market

1:30 PM

Concurrent Sessions

1:30 PM

Track A: Contracting Intensive – for Providers

The Complete Financial Checklist for Risk-Bearing/Value-Based Provider Arrangements
Understand revenue, expenses and the keys to mitigating risk  
Get tactical advice on financial reserves and measuring metrics
Delve into the operational steps, implementation and challenges of moving to a Risk-Based Provider Arrangement
Stephen Linesch, Principal
Paradigm Group 

1:30 PM

Track B: Contracting Intensive- for Payers

Successfully Negotiating Value-Based Care Contracts
  • Review contract types & alternative payment models – weigh out risks and benefits
  • Examine uses of data analytics for optimizing contract negotiations 
  • Learn how to find the “sweet spot” in value-based contracts
  • Hear about additional value-based elements to include in contracts 
  • Once it’s all said and done – Measure success post-negotiation


Aaron JurgaitisSenior Consulting Actuary

Wakely Consulting Group 

Sion Hughes, Consultant, Market and Provider Strategy

Wakely Consulting Group 

2:30 PM

Track B: Update from Health Care Transformation Taskforce

Jeff Micklos, Executive Director
Health Care Transformation Taskforce

3:00 PM
Networking Break


Concurrent Sessions

3:30 PM

Track A: Previous session continued

3:30 PM

Track B: The Move from Fee-For Service to Value-Based Care: Dissect the Future of Primary Care Reimbursement

  • Examine the impact of primary care aggregation 
  • Hear case examples from Blue Cross and Blue Shield and gain insights into future initiatives
  • Dive into the forces that are shaping new reimbursement models, i.e. CMS Innovation (CPC+, MACRA, MSSP), large employer groups, brokers, and providers 
David Wirka, Director of Network Innovation
Blue Cross and Blue Shield of Nebraska


Concurrent Sessions

4:15 PM

Track A: Deep Dive: Examine the Evolving Risk Requirements around Medicare Shared Savings (MSSP) and Where it Fits in the Journey to Value-Based Care

  • Discuss the new risk requirements announced by CMS and how they affect your programs 
  • Analyze MSSP programmatic overlap with other Value-Based models and whether it can co-exist with other value-based plans 
  • Delve into whether independent physician groups are more successful in this model – where, why, and how? 
  • Examine MA – hear what’s working with full risk agreements with MA plans and hear success strategies to drive MA growth  
Mike Barbati, Manager Medical Economics & Innovations, Enterprise Population Health
 Advocate Aurora Health

4:15 PM

Track B: PANEL: Network Optimization - Keys to Constructing Commercially Viable Networks

  • Learn the keys to constructing a commercially and financially viable network 
  • Discuss how to balance narrow vs. wide networks 
  • Attain faster network adequacy through improved contract process management 
Speaker from Wakely Consulting Group
Hans Wiik, President and CEO, Hans Wiik Health Group LLC; former President & CEO
Integrated Physician Network Centura Health
Jon Swisher, Director of Solution Development
Ethan Lipkind, Chief Development Officer
Clover Health

5:00 PM

Closing Remarks

William De Marco, President; Chairman of the Board, GoldStar Alliance for Health Pendulum HealthCare Development Corporation

RaeAnn Grossman, Chief Growth Officer, DataLink Software 

5:10 PM

Networking Cocktail Reception

April 24th, 2019


Registration and Networking Breakfast

8:45 AM

Opening Remarks

William De Marco, President, Chairman of the Board, GoldStar Alliance for Health, Pendulum HealthCare Development Corporation


RaeAnn Grossman, Chief Growth Officer, DataLink Software 


Direct-to-Employer Contracting Arrangements – The Impact and Implications for the Healthcare Marketplace

  • Hear lessons learned from a health system directly partnering with a large employer – including specifics around contracting 
  • Discuss benefits of direct-to-employer programs including patient outcomes, cost savings for employers and patient satisfaction 
  • Explore whether plans should look to narrow networks in the future to sustain costs and enhance patient outcomes  
Bob Jordan, Director, Market Advancement & Growth


The Rise of “Payviders” – A Look into the Risks and Benefits of Joint Ventures Between Payers and Providers

  • Hear how payers and clinical delivery systems are partnering to share clinical expertise and deliver value together 
  • Discuss the risks / benefits of value-based contracts vs. joint ventures 
  • Hear the outcomes of tapping into data within the Payvider Model – e.g. lowering readmissions
Kenneth Persaud MD, CEO
Visualize Health LLC
Networking Break

10:50 AM

Concurrent Sessions


Track A: Case Study: Incorporate Payment for SDOH Programs in Payor Contracts

  • Explore trends in social determinants of health and understand how they drive health outcomes 
  • Learn best practices in creating and addressing value-based care solutions for vulnerable populations 
  • Hear successful efforts around the country that could be replicated 
Elizabeth A. Jacobs, MD MPP, Chief of Primary Care and Value Based Health and Professor
University of Texas at Austin


Track B: Mind the Care Gap: Motivate Providers to Boost Performance

  • Examine provider engagement techniques including case examples of behavior change techniques 
  • Learn how to effectively communicate data to physicians 
  • Assess, report and communicate quality measures to physicians --via scorecards and analytics tools
Karla Richardson, Director of Value Based Care
University of Toledo Physicians, LLC


Concurrent Sessions


Track A: Peeling Back the Layers of the ACO Onion – Review the Value, Risks and Opportunities of the ACO Model

  • Examine if ACOs are the future of healthcare
  • Analyze whether there is success in shared savings within the ACO model 
  • Weigh the risks and benefits of the ACO model  
William De Marco, President, Pendulum HealthCare Development Corporation; Chairman of the Board, GoldStar Alliance for Health


Track B: Examine Current and Future Bundled Payment Models

  • Understand the evolution of alternative payment models, including the current state of bundled payments 
  • Implement success examples from the use of bundled payments to control costs and grow clinical volume
  • Examine metrics and success measures within bundled payment initiatives
Liz Myers, Senior Consulting Actuary
Wakely Consulting Group
Aaron Jurgaitis, Senior Consulting Actuary
Wakely Consulting Group
Networking Lunch


Concurrent Sessions

1:15 PM

Track A: Payer Perspective - The Secret Sauce to High Performance and Good Quality

  • Explore innovative ways that a health plan can help support a practice
  • Discuss how physicians can increase efficiency and reduce administrative burden of practice while meeting reimbursement criteria


Ebony Gilbert, Director of Network Relations

Amerigroup Health Plan



Track B: Go Narrow or Go Home – Considerations for High Performance Provider Networks

  • Examine how to identify, engage and incentivize high quality, cost effective providers 
  • Evaluate what criteria a high performer needs to have
Kendall Payne, Director of Independent Review Division, 
Spine Care Partners, LLC


The Intersection of Care and Technology - Making Data Insights Actionable

  • Explore telehealth tools that enhance communication and data sharing to drive better patient outcomes
  • Hear about advancements and trends with EMR
  • Examine electronic health record interoperability – is there room for improvement? 
Stacy Garrett-Ray, MD, MPH, MBA, Vice President, University of Maryland Medical System; Medical Director, Population Health Service President, Quality Care Network; former Deputy Director
U.S. Department of Veterans Affairs
Karen Wilding, Senior Director of Quality & Value Based Care
University of Maryland Medical System


Closing Remarks

William De Marco, President, Chairman of the Board, GoldStar Alliance for Health,Pendulum HealthCare Development Corporation

RaeAnn Grossman, Chief Growth Officer, DataLink Software