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FIRST NATIONAL CONGRESS ON HEALTH CARE COST CONTAINMENT
AGENDA: PRECONFERENCE SESSION
Wednesday, October 26, 2011
(Participation Optional; Requires Separate Registration)
PRECONFERENCE: HEALTH REFORM AND THE NEW HEALTHCARE ENVIRONMENT:
CHALLENGES AND OPPORTUNITIES FOR HEALTHCARE BOARDS OF DIRECTORS AND EXECUTIVES
Sponsored by
8:00 am Welcome and Introductions

The Introduction will provide a brief overview of the Quality in Action Toolkit and highlight other available Public Information Series resources.
Elisabeth Belmont, Esq.
Corporate Counsel, MaineHealth, Chair, AHLA Pre-Conference Program Planning Committee, Past President, American Health Lawyers Association, Portland, ME (Chair)
8:05 am Accountable Care and Governance Challenges under the Affordable Care Act

Healthcare provider organizations and the ACOs that they form or in which they participate in face a variety of challenges and opportunities in the Accountable Care Era. Provider entity boards and ACO boards will need to review their committee structures related to quality in order to ensure that the board or board committee's charter requires attention to effectiveness, efficiency and patient-centeredness in addition to patient safety. ACO boards and ACO sponsoring organization boards also will need to ensure that appropriate and effective management and clinical personal and protocols are in place to meet CMS, NCQA and other requirements and to achieve the ACO's quality and financial goals. The speakers will address the fiduciary duties of board members in implementing accountable care including: payment changes which will further reduce reimbursement to providers with poor scores on quality measures or who evidence inefficiencies such as above-average readmissions; the shift to various forms of pay-for-performance, bundled payments and global or population-based payments, or other value-based reimbursement methodologies which will require infrastructure investments by providers that may or may not be reimbursed, further threatening financial solvency; the increasing focus on quality measurement and reporting which may trigger fraud and abuse enforcement against providers making claims to public and private payers for care that is ultimately deemed substandard; greater quality data reporting and transparency which will require board oversight to assure that reporting is accurate; and compliance plans which will need to be enhanced to address these expanded concerns.
Douglas A. Hastings, Esq.
Partner and Chair, Board of Directors, Epstein, Becker & Green, Past President, American Health Lawyers Association, Washington, DC
Presentation Material (Acrobat)
Robert Homchick, Esq.
Partner and Chair, Health Law Practice, Davis, Wright Tremaine LLP, Seattle, WA
Presentation Material (Acrobat)
9:05 am In Search of a Systems-Based Approach to Healthcare Delivery

The Affordable Care Act promotes a paradigmatic shift toward a clinically integrated, systems-based approach to healthcare delivery designed to promote patient safety and quality while reducing overall healthcare cost. The hallmark of this approach is that it focuses on the system of care delivery more than on individual providers' competence, and it employs evidence-based practices based on aggregated error data analysis. Significant quality improvement requires aligned and integrated leadership that can drive a systemic, evidence-based approach to quality improvement. This session will discuss the legal and operational issues inherent in designing an effective systems-based approach to healthcare delivery including: (i) managing the care across the healthcare delivery system; (ii) corralling variability through the use of clinical protocols; (iii) reconfiguring the supporting infrastructure and practices to maximize resource use; and (iv) constant learning from daily care practices. Additionally, this session will explore how barriers presented by the traditional model of hospital governance involving a bifurcated structure in which the oversight of physician competence and quality resides in a "self-governing, organized medical staff" that exists outside the hospital management structure and reports directly to the hospital's governing body can be overcome to create the type of alignment that has led to the quality successes of highly integrated healthcare systems.
Mark Browne, MD, MMM, FACPE, CPE
Principal, Pershing Yoakley & Associates, Knoxville, TN
Robin Locke Nagele, Esq.
Partner, Post & Schell, PC, Philadelphia, PA
Presentation Material (Acrobat)
10:05 am Break
10:15 am New Developments in the Responsible Corporate Officer Doctrine

Federal healthcare fraud enforcement recently has focused not only on corporate actors, but also on holding individuals accountable for corporate noncompliance, either through direct proof of their knowledge of noncompliant practices or through strict liability under the Responsible Corporate Officer Doctrine (RCOD). The new expansion of the Department of Health and Human Services (HHS) Office of Inspector General's (OIG's) civil permissive exclusion authority regarding key individuals brings RCOD exposure to the doorstep of the hospital/health system board room and executive suite. The speakers will provide an update on recent enforcement initiatives, review the factors specified in the recent Exclusion Guidance that the OIG will consider in deciding whether to impose its permissive exclusion authority, and address the need of hospitals and health systems to adopt a specific action plan to mitigating RCOD risk in general and permissive exclusion risk in particular.
Lewis Morris, Esq.
Chief Counsel, Office of the Inspector General, US Department of Health and Human Services, Washington, DC
Michael W. Peregrine, Esq.
Partner, McDermott, Will & Emery, LLP, Chicago, IL
Presentation Material (Acrobat)
Presentation Material (Acrobat)
Presentation Material (Acrobat)
Presentation Material (Acrobat)
11:15 am Panel Discussion: Operational and Legal Challenges in Implementing Quality Initiatives

This Panel Discussion will discuss the operational and legal challenges in implementing new quality initiatives in a health reform environment from the perspectives of hospital and health system board members and counsel who advises board members.
Rex P. Killian, Esq.
Trustee, Providence Hospital, Washington, DC, President, Killian & Associates, LLC, Hall, Render, Killian, Heath & Lyman, PC, Indianapolis, IN
William J. Oetgen, MD, MBA, FACC, FACP
Board Member, MedStar Health, Inc., Co-editor: Nash DB, Oetgen WJ, Pracillio VP, eds. Governance for Health Care Providers: The Call to Leadership. New York, N.Y: Productivity Press, 2008, Washington, DC
Michael W. Peregrine, Esq.
Partner, McDermott, Will & Emery, LLP, Chicago, IL
Michael Wirth
President, The Governance Institute, San Diego, CA (Moderator)
12:15 pm Preconference Adjournment

AGENDA: DAY ONE
Wednesday, October 26, 2011

FIRST NATIONAL CONGRESS ON HEALTH CARE COST CONTAINMENT: DAY I
12:45 pm

Welcome and Introductions

Kavita Patel, MD, MSHS
Fellow, Economic Studies and Managing Director, Clinical Transformation and Delivery Reform, Engelberg Center for Health Care Reform, The Brookings Institution; Former Director of Policy, Office of Intergovernmental Affairs and Public Engagement, White House, Washington, DC (Co chair)
1:00 pm

Overview of the Role of Clinical Innovations, Quality Improvement and Cost Containment in Healthcare

Samuel R. Nussbaum, MD
Executive Vice President, Clinical Health Policy and Chief Medical Officer, WellPoint, Indianapolis, IN
Presentation Material (Acrobat)
1:30 pm

Living Well at the End of Life: A National Conversation

Mark B. Ganz
President and Chief Executive Officer, Regence BlueCross BlueShield; Chair, Health Stewardship Project, Aspen Institute, Portland, OR
Presentation Material (Acrobat)
2:00 pm Transition Break

MINI-SUMMITS I - CHOOSE ONE
MINI SUMMIT I: SUCCESSFUL CLINICAL INNOVATION AND COST CONTAINMENT CASE STUDIES I
2:15 pm Best Practices and Pitfalls in Health Plan-Provider Risk Sharing: Cost Containment Implications

H. Scott Sarran, MD, MM
Chief Medical Officer, Blue Cross Blue Shield IL, Chicago, IL
3:00 pm Improving Physicians' Clinical Decisions to Enhance Quality and Contain Costs

Jerry Avorn, MD
Professor of Medicine, Harvard Medical School; Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA
Presentation Material (Acrobat)
3:45 pm Transition Break

MINI SUMMIT II: LAW, ETHICS, COST CONTAINMENT AND QUALITY
2:15 pm Facing the Challenge of Health Care Rationing

Burke Balch, Esq.
Director, Powell Center for Medical Ethics; Former Director, Department of State Legislation, National Right to Life Committee; Former Attorney-Advisor, US Commission on Civil Rights; Former Chief Staff Counsel, National Legal Center or the Medically Dependent and Disabled; Former Staff Counsel, Americans United for Life Legal Defense Fund, Washington, DC
3:00 pm Controlling Health Care Costs through Public, Transparent Processes: The Conflict between the Morally Right and the Socially Feasible

David Orentlicher, JD, MD
Samuel R. Rosen Professor of Law, Co-director, William S. and Christine S. Hall Center for Law and Health, Indiana University School of Law, Indianapolis, IN
Presentation Material (Acrobat)
3:45 pm Transition Break

MINI SUMMIT III: COST OF TRANSFORMING A SYSTEM
2:15 pm The Role of HIT in Delivery System Transformation

Janet M. Marchibroda
Chair, Health Information Technology Initiative, The Health Project at the Bipartisan Policy Center, Washington, DC
Presentation Material (Acrobat)
3:00 pm ACO, Bundled Payments and ACO Return on Investment (ROI)

Edward G. Murphy, MD
Towerbrook Capital Partner, President and Chief Executive Officer, Carilion Clinic; Professor of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
3:45 pm Transition Break

MINI SUMMITS II - CHOOSE ONE
MINI SUMMIT IV: SUCCESSFUL CLINICAL INNOVATION AND COST CONTAINMENT CASE STUDIES II
4:00 pm Specialty-Specific Patient Experience Feedback

John L. Gerdes, PhD
Associate in Psychiatry, Department of Service Quality, Geisinger Health System, Danville, PA

Randall Hutchison, MBA
Director, Customer Service and Performance Enhancement, Geisinger Health System, Danville, PA

Robert C. Spahr, MD
Senior Vice President of Quality, Geisinger Health System, Danville, PA
Presentation Material (Acrobat)
4:45 pm The Group Health Medical Home: Cost Savings, Higher Patient Satisfaction and Less Burnout for Providers

Paul Fishman, PhD
Associate Investigator, Group Health Research Institute, Seattle, WA
5:15 pm Financial Implications in Promoting Excellence in End-of-Life and Palliative Care

J. Brian Cassel
Senior Analyst, VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
Presentation Material (Acrobat)
5:45 pm Adjournment and Networking Reception

MINI SUMMIT V: ROLE OF MENTAL HEALTH IN COST, QUALITY AND VALUE
4:00 pm Commercial Payer Support for Behavioral Health Integration: The Grand Junction Colorado Experience

Steve ErkenBrack, JD
President and Chief Executive Officer, Rocky Mountain Health Plans, Grand Junction, CO

Kavita Patel, MD, MSHS
Fellow, Economic Studies and Managing Director, Clinical Transformation and Delivery Reform, Engelberg Center for Health Care Reform, The Brookings Institution; Former Director of Policy, Office of Intergovernmental Affairs and Public Engagement, White House, Washington, DC
5:00 pm Community-Based Strategies that Reduce Cost, Improve Quality and Embrace the Resilience of a Community

Kenneth B. Wells, MD, MPH
Community Partners in Care Steering, Senior Scientist, RAND; Professor-in-Residence of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California Los Angeles, Santa Monica, CA
5:30 pm Adjournment and Networking Reception

MINI SUMMIT VI: COST CONTAINMENT AND CONSUMER-DIRECTED HEALTH CARE
4:00 pm The Role of Consumer-Directed Health Care in Cost Containment

Grace-Marie Turner
President, Galen Institute; Founder and Facilitator, Health Policy Consensus Group, Alexandria, VA
Presentation Material (Acrobat)
4:45 pm Consumer-Directed Health Care: Early Evidence about Effects on Quality and Cost

Melinda Beeuwkes Buntin, PhD
Congressional Budget Office; Former Director, Office of Economic Analysis and Modeling, Office of the National Coordinator for Health Information Technology, Department of Health and Human Services; Former Director, Public-Sector Initiatives, RAND Health, RAND Corporation, Washington, DC
5:30 pm Adjournment and Networking Reception





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