Institute for International Research

Wednesday, June 21st, 2006

8:30

Co-Chairperson's Re-Cap of Day One

G. Kirk Olsen, Chief Executive Officer
CEOMOLINA HEALTH CARE OF UTAH

Vernon K. Smith, PhD, Principal
HEALTH MANAGEMENT ASSOCIATES

Keynote Panel: Medicaid Plan CEO and State Executive Panel – Overcoming the Various Barriers to Implementation of Managed Care at the State and Federal Level

• Examining the flow of Federal Dollars and how the money flow influences the lines of business that thrive or fail in each state
• Making Managed Care work in your State
• Determining where Managed Care saves the most money and why

Thomas L. Johnson, Executive Director
MEDICAID HEALTH PLANS OF AMERICA (Moderator)

Daniel J. Hilferty, President & CEO
AMERIHEALTH MERCY

Anthony Rodgers, Director
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

Phillip Nowak, Chief, Division of Health Care Financing and Policy
NEVADA DEPARTMENT OF HEALTH AND HUMAN
SERVICES

Bob Thompson, President & CEO, MONROE PLAN FOR MEDICAL CARE, INC.

Keynote: Better Healthcare Through Information Technology – Developing a Master Patient Index and Health Information Infrastructure to Improve Quality
and Efficiency

The state of Rhode Island has received a five-year grant for $5 million from the Agency for Healthcare Research and Quality to develop a statewide infrastructure for healthcare information technology. The grant is part of an AHRQ initiative, totaling $139 million in grant and contract funding, dedicated to promoting health-IT usage. Rhode Island is one of five states that received funding to develop networks designed to construct secure, statewide healthcare networks, allowing providers to exchange data. Other states awarded grants are Colorado, Tennessee, Indiana, and Utah. In this session, Congressman Patrick Kennedy discusses the program and provides his vision for how improved healthcare information technology will impact the industry.

• Changing the financial incentives in health care, so that providers are rewarded, not penalized, for improving patient outcomes
• Bring the transformative power of information technology to every corner of our health care system
• Better develop the science of delivering health care

Patrick J. Kennedy, Representative, State of RI
US HOUSE OF REPRESENTATIVES (Invited)

Wednesday, June 21st, 2006

Track A: Operational and Financial Management

Track B: Care Management and Quality Improvement

Preventing Government Inquiries into Fraud and Abuse and What to Do When they Come Knocking

CMS, Attorney General, and States have increased focus on fraud and abuse prevention. With investigations on the rise
and increasingly creative provider billing strategies, plans must act now to put several mechanisms in place to curb fraud and abuse. In this session leading healthcare fraud and abuse expert, Cliff Barnes and Health Plan executives help
participants to:

• Become more proactive in fraud and abuse prevention
• Learn strategies providers use to get around detection
• Implement effective mechanisms for identifying provider upcoding to ensure that your plan is not seen as part of the problem
• Ensure the income reporting systems are fine tuned to pick up unreported income

Clifford Barnes, Shareholder
EPSTEIN BECKER & GREEN

Elizabeth Murphy, Associate                     EPSTEIN BECKER & GREEN

Best Practices on Reducing ER Utilization/Effective Strategies to Reduce Emergency Room Utilization

The State of Rhode Island recently launched a program to incentivize and reward plans and physicians for their efforts in reducing ER utilization for Medicaid populations. In this session experts involved in the program discuss:

• Developing a comprehensive ER utilization reduction program
• Rewards, incentives, and criteria used for the program
• Measuring outcomes and documenting improvements

Alison Croke, Senior Health Program Development Specialist
RHODE ISLAND DEPARTMENT OF HUMAN SERVICES (Moderator)

Gilson DaSilva, Product Manager, Medicaid & FEHBP
BLUE CROSS BLUE SHIELD OF RHODE ISLAND

Nancy Hermiz, Director of Provider Partnerships
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
(invited)

Turning Encounter Data into Knowledge - Ensuring HIPAA Compliance When Using Encounter Data for Rate Setting and Pay for Performance Programs

The implementation of HIPAA has provided a much-needed standardized method for collecting encounter data on Medicaid beneficiaries enrolled in managed care. Because of the standards, it is now possible to combine encounter data from managed care with similar claims data from fee-forservice, thus enhancing the ability to monitor utilization, costs, and quality of care in managed care and to compare managed care with fee-for- service. In this workshop experts discuss:

• Technical issues/considerations as we move to HIPAA compliance
• How data and comparability may have changed, richer coding yields
• Utilizing this data for analytics, rate setting, and pay for performance programs

John Kaelin, VP, Risk Adjusted Rates
AMERICHOICE

Implementing an Evidence Based Approach to Benefit Coverage to Ensure you are Paying for the Most Cost Effective Services

In Medicaid, where there are finite resources, money should be spent on the most effective treatments. Historically Medicaid relies on the accepted standard of care for medical services but has been more evidence driven with respect to pharmacy coverage. In 2006, some States and Plans are reshaping how
benefits are administered by limiting coverage of new services until there is evidence that supports efficacy. In this session, a leading expert discusses:

• Establishing a cost effective benefit analysis
• Determining which services have adequate evidence for effectiveness
• Pros and cons of this approach

Michael H. Bailit, MBA, President & Founder
BAILIT HEALTH PURCHASING, LLC

Jeffery Thompson, MD, Chief Medical Officer Director, Division of Medical Management, The Medical Assistance Administration
WASHINGTON DEPARTMENT OF SOCIAL & HEALTH SERVICES