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Payer and Risk Owner Track Organizers
Jonathan Blum, EVP, CareFist and Former Principal Deputy Administrator, CMS
Joshua Rosenthal, PhD, RowdMap Inc. and NCHVS Data Group
Paul Wallace, MD, AcademyHealth Senior Scholar in Residence
OWNING	RISK	IS	TOUGH,	BUT	IT’S	WHERE	THE	ACTION’S	AT
Once	upon	a	time	plans	had	large	 group	commercial	 populations	with	years	of	consistency	and	
providers	simply	delivered	 services	for	a	fee.	 	But	government	 programs	like	Medicare	
Advantage,	 Marketplace	 /	Exchange	 and	Medicaid,	 have	populations	changing	every	 year,	 or	
even	every	 month	and	providers	managing	 a	population's	health	over	time.
Changing	populations	and	dynamic	payment	 models	may	 make	it	tough	to	predict	and	achieve	
member	 outcomes	in	a	financially	sustainable	way	 precisely	when	providers	are	 getting	in	the	
game	 to	take	 on	risk.		
Public	health	data	are	providing	solid	case	studies	of	achieving	 member	 health	and	happiness	
with	sustainable	financial	models	for	all	players	in	this	new	game.
If	you	are	 managing	 risk,	considering	taking	on	risk,	or	investing	in	or	providing	products	or	
services	to	anyone	bearing	 risk,	camp	out	in	these	sessions	to	learn	how	to	use	public	data	and	
internal	 resources	to:
§ Effectively	 leverage	analytic	approaches	to	manage	risk
§ Accurately	assess	risks	and	project	costs	
§ Effectively	 align	providers	and	incentivize	care	delivery
7 SESSIONS	 DEDICATED	 TO	THE	VALUE	 PUBLIC	DATA	BRINGS	 PAYERS	 AND	RISK	 OWNERS	 BY:
1.	Optimizing	Population	Health	and	Containing	Costs
2.	Designing	and	Curating	a	Pay-for-Value	Ready	Network
3.	Facilitating	Payer	and	Provider	Partnerships	for	New	Care	Delivery
4.	Coordinating	Care	and	Sharing	Risk	between	Health	Plans,	States	and	CMS
5.	Projecting	and	Managing	Costs,	Risk	and	Disease	Burden
6.	Aligning	Strategy	and	Delivery	with	Member	Outcomes	and	Experience
7.	Transforming	Delivery	Systems,	Measurement	and	Payment	Models
Chair & Vice Chair
Kavita Patel, MD, Brookings Institute and
Former Director of Policy, The White House
Niall Brennan, Chief Data Officer, CMS
“The	value	
propositions	for	
public	data	either	
disintermediate	or	
innovate	owning	risk	
– either	way	they	
can’t	be	ignored.”
1. FINDING	 UNTAPPED	 VALUE	THROUGH	 SHARING	AND	USE	OF	MULTI-SECTOR	 DATA
Value	Proposition:	 Optimizing	 Population	Health	and	Containing	Costs
Moderator:	Peter	Eckart,	Illinois	Public	Health	Institute;	Alison	Rein,	AcademyHealth
Panelists:	Craig	Brammer,	 HealthBridge;	 Nikki	Olson,	Center	for	Outcomes	 Research	and	Education;	 Bren	Manaugh,	The	Center	for	
Health	Care	Services;	Chief	J.	Scott	Thomson,	 Camden	 County	 Police	Department
2.	CREATING	 A	VIRTUOUS	CYCLE:	 DESIGNING	 NETWORKS	 TO	MITIGATE	 NO-VALUE	 CARE	FROM	FEE	FOR	SERVICE	AND	CREATE	VALUE-
BASED	WINS	FOR	BOTH	 PAYERS	AND	PROVIDERS	USING	CMS	BENCHMARK	 DATA
Value	Proposition:	 Designing	and	Curating	a	Pay-for-Value	 Ready	Network
Moderator:	Joshua	Rosenthal,	 RowdMap
Panelists:	Jonathan	Blum,	 CareFirst	Blue	Cross	BlueShield;	 Sachin Jain,	CareMore;	Steve	Ondra,	Health	Care	Service	Corporation
3.	BANKING	 ON	DISRUPTION:	 NEW	DELIVERY	MODELS	AS	COMPETITIVE	 ADVANTAGE	 IN	A	PAY	FOR	VALUE	WORLD
Value	Proposition:	 Facilitating	Payer	and	Provider	Partnerships	 for	New	Care	Delivery
Moderator:	Maureen	Sullivan,	BCBS
Panelists:	Lynn	Banaszak Brusco,	 Disruptive	Health	Technology	 Institute, Carnegie	Mellon	University;	Jonathan	Mathieu,	Center	for	
Improving	 Value	in	Health	Care;	Eric	Armbrecht,	 Midewest Health	Initiative;	Elizabeth	Mitchell,	Network	for	Regional	 Healthcare	
Improvement;	 Farzad Mostashari,	Aledade,	Inc.
4.	HOW	 STATES	AND	OTHERS	ARE	USING	 MEDICARE	DATA	TO	MANAGE	POPULATIONS
Value	Proposition:	 Coordinating	 Care	and	Sharing	Risk	between	Health	Plans,	States	and	CMS
Moderator:	Sharon	Donovan,	 Centers	for	Medicare	 &	Medicaid	 Services	
Panelists: Mylia Christensen,	 Oregon	 Health	Care	Quality	Corporation;	 Doris	Lotz,	New	Hampshire	 Department	of	Health	and	Human	
Services;	Patricia	Murphy,	Illinois	Department	 of	Healthcare	and	Family	Services
5.	SOCIAL	 DETERMINANTS	 AND	WHAT	TO	DO	WITH	THEM:	IMPROVING	 COST	PROJECTIONS	 AND	NAILING	 RESOURCE	ALLOCATION
Value	Proposition:	 Projecting	and	Managing	Costs,	Risk	and	Disease	Burden
Moderator:	Dianne	Munevar,	Avalere Health	(Moderator)
Panelists:	Jim	Sorace,	US	Department	 of	Health	and	Human	Services;	Sandeep	Wadhwa,	Noridian Healthcare	Solutions;	Eric	Williams,	
Omada Health;	Gui Woolston,	 NunaHealth
6.	FROM	POLICY	 TO	WAREHOUSE	 TO	BEDSIDE:	 USING	PUBLIC	 AND	PRIVATE DATA	TO	IMPROVE	TRIPLE	AIM	GOALS
Value	Proposition:	 Aligning	Strategy	and	Delivery	with	Member	Outcomes	 and	Experience
Moderator:	Paul	Wallace,	AcademyHealth
Panelists:	Paul	Bleicher,	Optum	 Labs;	Helen	Burstin,	 The	National	Quality	Forum;	 Kate	Goodrich,	 Centers	for	Medicare	&	Medicaid	
Services
7.	HOW	 STATES	ARE	USING	NEW	DATA	SOURCES	FOR	SYSTEMS	TRANSFORMATION
Value	Proposition:	 Transforming	 Delivery	Systems,	Measurement	 and	Payment	Models
Moderator:	Rachel	 Block,	Milbank	Memorial	Fund	
Panelists:	David	Mancuso,	 Washington	State	Department	of	Social	and	Health	Services;	Áron Boros,	Massachusetts	 Center	for	Health	
Information	 and	Analysis;	Richard	Shonk,	HealthBridge

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Health Datapalooza - Payer and Provider Risk Owner Track

  • 1. Payer and Risk Owner Track Organizers Jonathan Blum, EVP, CareFist and Former Principal Deputy Administrator, CMS Joshua Rosenthal, PhD, RowdMap Inc. and NCHVS Data Group Paul Wallace, MD, AcademyHealth Senior Scholar in Residence OWNING RISK IS TOUGH, BUT IT’S WHERE THE ACTION’S AT Once upon a time plans had large group commercial populations with years of consistency and providers simply delivered services for a fee. But government programs like Medicare Advantage, Marketplace / Exchange and Medicaid, have populations changing every year, or even every month and providers managing a population's health over time. Changing populations and dynamic payment models may make it tough to predict and achieve member outcomes in a financially sustainable way precisely when providers are getting in the game to take on risk. Public health data are providing solid case studies of achieving member health and happiness with sustainable financial models for all players in this new game. If you are managing risk, considering taking on risk, or investing in or providing products or services to anyone bearing risk, camp out in these sessions to learn how to use public data and internal resources to: § Effectively leverage analytic approaches to manage risk § Accurately assess risks and project costs § Effectively align providers and incentivize care delivery 7 SESSIONS DEDICATED TO THE VALUE PUBLIC DATA BRINGS PAYERS AND RISK OWNERS BY: 1. Optimizing Population Health and Containing Costs 2. Designing and Curating a Pay-for-Value Ready Network 3. Facilitating Payer and Provider Partnerships for New Care Delivery 4. Coordinating Care and Sharing Risk between Health Plans, States and CMS 5. Projecting and Managing Costs, Risk and Disease Burden 6. Aligning Strategy and Delivery with Member Outcomes and Experience 7. Transforming Delivery Systems, Measurement and Payment Models Chair & Vice Chair Kavita Patel, MD, Brookings Institute and Former Director of Policy, The White House Niall Brennan, Chief Data Officer, CMS “The value propositions for public data either disintermediate or innovate owning risk – either way they can’t be ignored.”
  • 2. 1. FINDING UNTAPPED VALUE THROUGH SHARING AND USE OF MULTI-SECTOR DATA Value Proposition: Optimizing Population Health and Containing Costs Moderator: Peter Eckart, Illinois Public Health Institute; Alison Rein, AcademyHealth Panelists: Craig Brammer, HealthBridge; Nikki Olson, Center for Outcomes Research and Education; Bren Manaugh, The Center for Health Care Services; Chief J. Scott Thomson, Camden County Police Department 2. CREATING A VIRTUOUS CYCLE: DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE FROM FEE FOR SERVICE AND CREATE VALUE- BASED WINS FOR BOTH PAYERS AND PROVIDERS USING CMS BENCHMARK DATA Value Proposition: Designing and Curating a Pay-for-Value Ready Network Moderator: Joshua Rosenthal, RowdMap Panelists: Jonathan Blum, CareFirst Blue Cross BlueShield; Sachin Jain, CareMore; Steve Ondra, Health Care Service Corporation 3. BANKING ON DISRUPTION: NEW DELIVERY MODELS AS COMPETITIVE ADVANTAGE IN A PAY FOR VALUE WORLD Value Proposition: Facilitating Payer and Provider Partnerships for New Care Delivery Moderator: Maureen Sullivan, BCBS Panelists: Lynn Banaszak Brusco, Disruptive Health Technology Institute, Carnegie Mellon University; Jonathan Mathieu, Center for Improving Value in Health Care; Eric Armbrecht, Midewest Health Initiative; Elizabeth Mitchell, Network for Regional Healthcare Improvement; Farzad Mostashari, Aledade, Inc. 4. HOW STATES AND OTHERS ARE USING MEDICARE DATA TO MANAGE POPULATIONS Value Proposition: Coordinating Care and Sharing Risk between Health Plans, States and CMS Moderator: Sharon Donovan, Centers for Medicare & Medicaid Services Panelists: Mylia Christensen, Oregon Health Care Quality Corporation; Doris Lotz, New Hampshire Department of Health and Human Services; Patricia Murphy, Illinois Department of Healthcare and Family Services 5. SOCIAL DETERMINANTS AND WHAT TO DO WITH THEM: IMPROVING COST PROJECTIONS AND NAILING RESOURCE ALLOCATION Value Proposition: Projecting and Managing Costs, Risk and Disease Burden Moderator: Dianne Munevar, Avalere Health (Moderator) Panelists: Jim Sorace, US Department of Health and Human Services; Sandeep Wadhwa, Noridian Healthcare Solutions; Eric Williams, Omada Health; Gui Woolston, NunaHealth 6. FROM POLICY TO WAREHOUSE TO BEDSIDE: USING PUBLIC AND PRIVATE DATA TO IMPROVE TRIPLE AIM GOALS Value Proposition: Aligning Strategy and Delivery with Member Outcomes and Experience Moderator: Paul Wallace, AcademyHealth Panelists: Paul Bleicher, Optum Labs; Helen Burstin, The National Quality Forum; Kate Goodrich, Centers for Medicare & Medicaid Services 7. HOW STATES ARE USING NEW DATA SOURCES FOR SYSTEMS TRANSFORMATION Value Proposition: Transforming Delivery Systems, Measurement and Payment Models Moderator: Rachel Block, Milbank Memorial Fund Panelists: David Mancuso, Washington State Department of Social and Health Services; Áron Boros, Massachusetts Center for Health Information and Analysis; Richard Shonk, HealthBridge