Institute for International Research

September 24, 2007

AM Workshop
Provider Contracting 101: Laying the Foundation for Building a Solid Payer/Provider Network

Networks come in various configurations and constantly struggle to find appropriate methodologies for contracting with their diverse providers. Additionally, legislative requirements on transparency and quality create additional complexities in contracting and managing your provider network. This workshop takes you through the logic of the provider contracting process from start to finish, challenging you to analyze if your contracting decisions add value to your organization and your providers. Our workshop leaders discuss the different contracting methodologies available and how to align them based on corporate structure.

At the close of this workshop, participants will be able to:

• Understand various re-pricing structures and how to use them to attract providers
  o The pro's and con's of developing your own network fee schedules
  o Using Medicare/Medicaid as your "base" fee schedule
  o Comparative methodologies for pricing.
  o Creating the pricing adaptability to address multiple product lines (Medicare, Medicaid, commercial group health, workers compensation, liability product pines).
• Implement effective contracting mechanisms based on best practices across corporate settings
• Evaluate and improve contract administration and negotiation

This workshop is designed for network developers and contract specialists with health plans and preferred provider organizations.

About the Workshop Leaders:
Rob Robidou, Director of Network Development, COOK CHILDREN'S HEALTH PLAN
Currently the Director of Network Development for contracting and provider relations for Cook Children's Health Plan, Mr. Robidou has over 17 years of Managed Care Experience encompassing the successful development of 3 start-up HMO programs and restructuring of 2 additional plans. His experience includes contracting both nationally and regionally for commercial payors, provider sponsored programs, employer direct contracting, National Transplant Networks, case specific relationships and joint venture relationships.

 Deborah M. Woodard, President, DMW CONSULTING

PM Workshop
Metrics: Define, Assess & Implement Benchmarks to Measure Performance throughout Your Provider Network

Health plans are evaluating provider performance to improve quality, cost efficiency, create tiered networks and restructure provider reimbursement. Measuring the relative performance of individual providers along these kinds of metrics can be one of the health plan's most time consuming challenges. How do health plans reconcile differences across diverse patient populations (relative risk, geography, demographics, etc) and how does this affect the provider's performance score?

1.30-1.35: Opening of workshop and introduction of speakers by Darren Rodgers

1.35-2.15: Presentation by Sandy Lutz from PriceWaterhouseCoopers Health Research Institute on the state of provider performance management by health plans

2.15-3.00: Presentation by Darren Rodgers from BCBSTX regarding our pay for performance and performance based recognition experience

3.00-3.30: Scheduled Networking Break

3.30-4.15: Presentation by Bob Kelley from Thomson Healthcare on how Thompson works with health plans (and the issues they face) to develop performance measurement plans

4.15-5.00: Presentation by Dr. Richard Bankowitz from Premier on their hospital performance improvement initiatives

In this workshop, learn how to:

• Define benchmarks & assess their value
  
• Implement standards that appropriately measure provider quality across dissimilar populations
  
• Use available technology to effectively measure & rank providers
  
• Improve reporting techniques to improve quality This workshop is designed for directors of network management with health plans and preferred provider organizations.

About the Workshop Leaders:

J. Darren Rodgers, Divisional Senior Vice President, Health Care Management & Public Affairs, BLUE CROSS AND BLUE SHIELD OF TEXAS
Mr. Rodgers is responsible for the areas that seek to provide a balance between access to health care services and affordability of Blue Cross and Blue Shield of Texas. Additionally, Mr. Rodgers is responsible for BCBSTX's external relations through Government, Community and Media relations areas. Mr. Rodgers is the President of the Caring for Children Foundation of Texas, Inc., a nonprofit corporation for medically underserved populations in Texas. He also serves on the board of directors of the Texas Health Institute

Bob Kelley, Vice President, Healthcare Analytics, Product Development, THOMSON HEALTHCARE

Dr. Richard Bankowitz, PREMIER INC

Alix Love, Public Policy Manager, NCQA