The Future of Revenue Cycle Management

Agenda and Information

Up to 9 CPE Credits Available
Sponsored by the South Texas Chapter of HFMA, Sponsor# 009106. See session descriptions below for Level, Prerequisites, Course Descriptions, and Learning Objectives. All sessions are presented as Group Live.

Conference Location:
The Club at Sonterra
901 Sonterra Blvd. | San Antonio, TX 78258
►Map and Directions

Thursday, September 30, 2010

7:00 - 8:00 am Registration & Continental Breakfast

8:00 - 8:10 am Opening Remarks

8:10 - 9:00 am

What Do KPIs Have To Do With Being Successful in Managed Care Contracting?

Course: 930-01 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: KPIs tell a story by measuring results, comparing to standards, keeping record and driving change to ensure managed care contracts are optimized. The questions are: What are the best KPIs for managed care contracting? How do you structure a process with both quantitative and qualitative dimensions to improve contracting results? What is a managed care KPI scorecard?

Learning Objectives: Participants will:
•Will define KPIs in the context of managed care contracting
•Explore all parts of a KPI system including value of national Vs geographic data
•Compare different KPI systems
•Use a system/process for developing and using managed care contracting KPIs
•Determine how change impacts KPIs including mindset needed during payor negotiations to optimize results
•Review an innovative solution ▬ the managed care scorecard ▬ that consists of both quantitative comparisons and qualitative insights of a hospital’s commercial data (on a national and by-payor basis)

Russ Weaver - Director of Managed Care, Southwest Region, Adventist Health System | As Regional Director, Russ Weaver is responsible for managed care contracting and payer relations for 4 hospitals in Texas and has been in his current position since 2005. Over the past 20 years Mr. Weaver has enjoyed a number of challenging opportunities in healthcare to include nursing home administration, managing various hospital departments, physician recruiting, physician practice management, employee health plan management, and managed care contracting.

Dan McAfee - Sr. Managing Director, Payor Contracting and Reimbursement Strategy, The Godbey Group - Irving, Texas | Dan has an extensive, diverse background in the managed healthcare industry. His operational experience includes: hospitals, medical groups and health plans. Dan’s 16+ years in managed care focuses on: Aetna Health Plans, Texas Health Resources and Medical Select Management IPA.

9:00 - 9:50 am

Healthcare Reform: Readiness and Repositioning Strategies for Hospitals and Health Systems

Course: 930-02 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: Accelerated by the recent legislation, significant reform of the healthcare delivery and payment systems is now occurring. The new environment will require a fundamental redefinition of the provider-success model; success will be achieved through delivery of positive patient outcomes at acceptable "value," rather than service volume. This session will identify for hospital and health system executives the core competencies required for hospitals' success under the new business model and provide practical paths toward achieving such competencies.

Learning Objectives: After this session, attendees will be able to identify for hospital and health system executives the core competencies required for hospitals' success under the new business model and provide practical paths toward achieving such competencies. Participants will learn: The key mechanisms that will be used to achieve the cost-savings goals of healthcare reform and their likely impact on hospitals; Methods to determine the hospital's current strategic financial position and capital capacity-the starting point for needed repositioning efforts; Multipronged approach to physician integration with aligned incentives, as critical to successful care management; An approach to care and disease coordination and the characteristics of a high-quality IT system and a well-organized service distribution system; Strategic options available to hospitals depending upon organization type and financial and competitive position.

Robert Turner - Vice President, Kaufman, Hall & Associates - Dallas, TX | Based in Dallas, Mr. Turner consults with healthcare clients on a national basis, focusing on issues related to capital structure and the analysis and implementation of debt transactions. He specializes in credit capacity analysis, plan of finance development, and debt restructurings. Mr. Turner is a regular speaker on capital market issues and financial planning topics for organizations including Healthcare Financial Management Association. Prior to joining Kaufman Hall, Mr. Turner was a Vice President with Goldman, Sachs & Co. in the Not-for-Profit Healthcare Group, where he specialized in tax-exempt healthcare finance.

9:50 - 10:00 am Refreshment Break

10:00 - 11:40 am

Changes in Medicaid: Healthcare Reform and its Impact on Texas

Course: 930-03 | CPE Credits: 2.0 | Level: Overview | Prerequisites: A basic knowledge of healthcare delivery system infrastructure, Texas healthcare finance and public health.

Course Description: The presentation will examine the impact of federal healthcare reform legislation on Texas with particular emphasis on costs to the state and impacts on the healthcare delivery infrastructure.

Learning Objectives: After this session, attendees will be able to Understand healthcare reform basics. They will also understand the impact of healthcare reform on Texas Medicaid, on the Texas healthcare delivery system, and on the Texas healthcare delivery system infrastructure.

Billy Millwee - Associate Commissioner for Medicaid/CHIP | Mr. Millwee was previously responsible for management of the claims administration contract with the Texas Medicaid and Healthcare Partnership (TMHP) and management of the Medicaid Eligibility and Health Information System. He also has served as director of Texas Medicaid Policy and Operations, Managed Care and the Texas Health Steps and Medical Transportation programs. Mr. Millwee also has experience with other Texas public health programs, including trauma system planning and immunizations.

11:40 am - 12:30 pm Lunch

12:30 - 2:10 pm

Commercial Payer Panel

Course: 930-04 | CPE Credits: 2.0 | Level: Basic| Prerequisites: None

Course Description: A panel of experts from major healthcare payer organizations will discuss the impact of health reform legislation on insurance companies, providers and employers. Some of the issues addressed will include the effects on physician panels, quality reporting bonus payments, strategies for remaining fiscally viable, effects of participants gaming the new system, incentives for large employers to drop their employee health benefit programs, changes in payment/reimbursement policies and methods, payment for patient-centered medical homes, and effects of the cuts in Medicare Advantage programs. Time will be included for interactive questions & answers with the conference participants and panel members.

Learning Objectives: After this session, attendees will be able to:Identify key issues in the recent healthcare reforms; Assess the potential impact on their organization of major changes and subtle adjustments; Gain strategic insights for successful navigation through this sea-change that affects all constituents, including payers, providers, employers and beneficiaries.

C. Carleton King - Head of National Networks, Aetna� |Carl was just appointed as Aetna’s Head of National Networks and Contracting Services. His team is responsible for contracting strategy and implementation nationwide. Prior to his new assignment, Carl was a Regional President with Aetna responsible for network, utilization management and quality management in eleven states including Texas. This encompassed 5.2 million members and the management of billions of dollars of medical expenses. He was President of Aetna’s HMOs in seven states including Texas. Prior to joining Aetna he was Executive Director for Prudential’s North Texas operation. Mr, King was also CEO of Health Alliance Medical Plans, an innovative provider-sponsored plan based in Urbana, Illinois for five years. Carl started out in the hospital business running hospitals for Hospital Corporation of America and Hospital Affiliates International. He also has multi-specialty group management experience.Carl is listed in the Who’s Who in Managed Care publication. He has served on numerous boards and committees in the health care industry, and is a frequent speaker at industry events.

Johnna Lenamon - Regional Director, Professional Provider Network, Southeast Region, Blue Cross Blue Shield of Texas | Johnna Lenamon joined Blue Cross and Blue Shield of Texas (BCBSTX) in 1992. As Regional Director she is responsible for maintaining the HMO & PPO Provider Networks, negotiating contracts with professional providers along with evaluating and reporting on the effectiveness of the various professional networks and their providers in the Southeast Texas Region.

Alan M. Preston, MHA, Sc.D. - Founder of Synergist Research, Honorary Insurance Commissioner for the State of Louisiana, and former CEO of four Managed Care Payers l Dr. Preston has over 20 years in the multi-site healthcare services field. Prior to founding Synergyst Research in 2003, Dr. Preston was CEO of 4 different Managed Care Payors, and CEO of large Multi-Specialty Physician Group with primary care clinics, outpatient surgery center, physical therapy, occupational medicine, radiology, and urgent care. In addition, Dr. Preston was CEO of Radiation Oncology Physician Group with over 8 locations. Dr. Preston's particular areas of expertise include healthcare research, strategic business development, negotiating strategies and marketing. Dr. Preston is Honorary Insurance Commissioner for the State of Louisiana.

Dana Forgione,�PH.D., CPA, CMA, CFE - Moderator -�Professor of Accounting,�University of Texas at San Antonio | Dana A. Forgione, PH.D., CPA, CMA, CFE is the Janey S. Briscoe Endowed Chair in the Business of Health at the University of Texas at San Antonio, where he leads the MBA in the Business of Health program—a Participant in the American College of Healthcare Executives (ACHE) Higher Education Network. He is also an Adjunct Professor in the School of Medicine and in the School of Public Health, both at the University of Texas. Dr. Forgione previously served as advisor to the MBA in Healthcare Management program at the University of Baltimore, and held a joint appointment in the School of Pharmacy at the University of Maryland, where he taught in the Doctor of Pharmacy program. He is an active member of the American College of Healthcare Executives (ACHE), the Healthcare Financial Management Association (HFMA), and the Medical Group Management Association. He was the founder and Director of the International Society for Research in Healthcare Financial Management, one of the world’s first, primarily Internet-based professional associations. He also served as the Senior Editor of Research in Healthcare Financial Management, and as a Columnist for the Journal of Health Care Finance.

2:10 - 3:00 pm

Texas' Plan for Enrollment

Course: 930-05 | CPE Credits: 1.0 | Level: Basic| Prerequisites: None

Course Description: Federal Health Insurance Reform requirements establish new opportunities for businesses and individuals to obtain health insurance through a complex, multi- year phase in of insurance and health care regulatory requirements. This presentation will address new insurance regulatory requirements, the impact on the Texas market, and how consumers will obtain insurance within the new regulatory structure implemented during the next four years. The session will include information on the Department’s implementation plans and how the Department will work with employers, consumers, brokers and insurers to facilitate and encourage insurance enrollment. The session will include information on previous studies of the uninsured and Texas’ experience with the small employer market.

Learning Objectives: After this session, attendees will be able to understand how federal reform will affect consumers and the health insurance industry, how the Texas Department of Insurance is working to ensure the long-term viability and success of the commercial insurance market, and how health care industry professionals can prepare for future changes under federal health reform.

Dianne Longley - Director, Research and Analysis Live, Health and Licensing, Texas Department of Insurance | Currently employed as Director of Research and Analysis for the Life, Health and Licensing Program, Dianne’s primary responsibilities include: research oversight, data collection, analysis and reporting on health insurance and related health care technology issues; coordinating special projects related to health insurance legislation and legislative interim studies; and representing the agency on various state and national committees. She is responsible for directing development and implementation of various insurer transparency and reimbursement rate data collection projects, including web-based data collection and reporting activities, analysis of reported information, and creation of consumer web-site for reimbursement information and health plan comparison report. She has recently designated to coordinate implementation of federal health insurance reform for the Department. Dianne completed detailed summary documents of legislation, timelines, implementation plans, fiscal estimates and agency planning structure to oversee implementation of first year requirements. Ms. Longley works with all levels of Texas government to provide information and develop a coordinated, statewide approach that will ensure an effective and efficient implementation strategy that serves the needs of the state and consumers.

3:00 - 3:15 Refreshment Break

3:15 - 4:05 pm

Revenue Cycle Management in the ED

Course: 930-06 | CPE Credits: 1.0 | Level: Basic| Prerequisites: None

Course Description: Presentation will address best practices for managing and improving the revenue cycle of the emergency department, including the use of EMRs and other technology to improve data capture and improve efficiencies.

Learning Objectives: Identify departments and their roles that impact ED revenue cycle; Identify nursing and physician documentation’s impact on ED revenue; List strategies in leveraging data and technology in ED revenue management; Identify best practices for billing and coding that facilitate successful ED revenue capture

Elaine Barry, RN, MSN - Vice President of Clinical Client Relations, EDIMS | Elaine is responsible for directing clinical policy and compliance initiatives as well as efforts to maximize the adoption of EDIMS software in the ED environment. Elaine has a clinical operations background, with experience in ED process optimization, and extensive domain knowledge that will continue to strongly influence the evolution of our EDIMS product.

Anne Marie Wertz, CPC, MICP - Business Manager, Clara Maass Medical Center l Anne Marie Wertz has been the Business Manager of the Emergency Department at Clara Maass Medical Center in Belleville, New Jersey for the past nine years managing an 8M+ budget. She is also a licensed paramedic, and has been coordinating and directing Mobile ICU operations for the St. Clare’s Health System in Denville/Dover NJ. Anne Marie is a graduate of Rutgers University with a BS in Human Ecology and a graduate of Excelsior College with an AS in Nursing.

4:05 - 4:55 pm

Healthcare Reform: Changes in Medicare and Medicare Advantage

Course: 930-07 | CPE Credits: 1.0 | Level: Basic| Prerequisites: A basic knowledge of Medicare

Course Description:An overview of Medicare related insurance products, the choices seniors face today and how those choices affect hospitals.

Learning Objectives: After the session, attendees will be able to understand the evolution of Medicare and Medicare related insurance products, be familiar with the various options available today from a senior’s perspective, be aware of how plans are changing for 2011 and how these changes affect hospitals, better understand MA plan reimbursement & the impact on hospitals’ accounts receivable, consider new opportunities for hospitals in the Medicare arena, and develop strategies to deal with the changing Medicare market.

Donny Anderson - National Director of Network Development, Select-Plus Network | Donny Anderson brings a wide range of experience and perspectives to the Select-Plus Management team. He served as Medicare Select Sales Director for Columbia HCA South Texas Division and also worked as a liaison between hospitals and insurance companies to help open up Medicare Select markets across Texas. Having been an insurance agent for over 30 years, Donny has focused on the needs of seniors and has personally sat across the table from hundreds of Medicare recipients, helping them find the solutions to their individual needs. He has also been a Field Marketing Officer for numerous insurance carriers, overseeing large numbers of insurance agents. Physicians have come to refer patients to Donny and his team on a regular basis, and hospitals count on Donny for information regarding the latest Medicare related products.

4:55 - 6:30 pm Networking Reception