- November 10, 2015
- Posted by: Health Care Payment Learning & Action Network
- Categories: LAN Webinar Q&As, Webinars
November 10, 2015
Co-presenters answer participants’ questions on population-based payments that were not answered during the webinar.
David Muhlestein - Leavitt Partners
At LVHN, our Achieving Clinical Excellence (ACE) provider incentive program includes both commercial and multipurpose senior services program (MSSP) ACO populations, but we do not currently include any Medicare Advantage lives. However, the current ACE program will be expanded to include Medicare Advantage lives when these value-based Medicare Advantage contracts become effective.
At LVHN, our ACE provider incentive program has included an incentive for end-of-life planning for several years. We have temporarily had to suspend this with the switch to a new electronic medical record (EMR) system, but we are looking to revive and expand it in the near future.
There are no specific measures related to behavioral health in the ACE provider incentive program at LVHN today. However, it is an area of growing interest.
At LVHN, our ACE incentive program is based on the patient population that actually utilizes our services, coupled with those in the MSSP ACO who are attributed to LVHN, regardless of the extent to which they seek services outside our network. Since ACE is built around influencing behaviors of our physicians and we have no way of assigning patients from various geographic regions to particular physicians or practices, ACE does not take such an approach.
Allison Yudt and Kerry Snyder - Populytics, Inc.
We have looked a lot at which medical groups are forming ACOs and we have done some evaluations of the physicians who are participating in them. Feel free to contact us for more information.
We have not seen much of a movement toward this. It’s possible that ACOs that work closely with a public health agency, such as some Medicaid ACOs, may adopt some of the measures, but I don’t expect it to happen broadly.
Purchasers
Enabling Organizations | 
Policy Makers
Community Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
