Thanks to all who attended the LAN Spring Forum!
For those who missed the broadcast or who would like to view again,
Here is the webcast and accompanying presentations
By LAN Co-Chair Dr. Mark McClellan
By Seema Verma, Administrator, Centers for Medicare and Medicaid Services
Viewpoint: Patient Perspective
Former long-term patient, inspirational speaker, and business consultant Nancy Michaels will share her personal experience and perspective on the impact of care organized around quality and the importance of working toward patient-centered payment models.
Adopter Panel Dialogue
Hear APM implementation stories from provider organizations and a regional payer, followed by an interactive discussion among presenters, stakeholder commenters, and the virtual audience – moderated by LAN Co-chair Dr. Mark Smith. Join the dialogue by submitting your own questions and comments to the panel.
APM Framework Refresh
Sam Nussbaum, past chair of the APM Framework and Progress Tracking Work Group, will share how the APM Framework is being refreshed in light of evolving concepts of what constitutes an APM.
LAN Guiding Committee Co-chairs round-up highlights from the event.
Administrator, Centers for Medicare and Medicaid Services
President Trump nominated Seema Verma to be the Administrator for the Centers for Medicare and Medicaid Services (CMS) on November 29, 2016, and she was confirmed by the United States Senate on March 13, 2017. As Administrator of CMS, she oversees one of the largest federal agencies that administers vital healthcare programs to over 100 million Americans. Before becoming CMS Administrator, she was the President, CEO and founder of SVC, Inc., a national health policy consulting company. For over 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with Governor’s offices, State Medicaid agencies, State Health Departments, State Departments of Insurance, as well as the federal government, private companies and foundations.
Ms. Verma has extensive experience redesigning Medicaid programs in several states. Ms. Verma is the architect the Healthy Indiana Plan (HIP), the Nation’s first consumer-directed Medicaid program under Governor Mitch Daniels of Indiana and Governor Pence’s HIP 2.0 waiver proposal. Ms. Verma has supported Indiana through development of the historic program since its inception in 2007, from development of the enabling legislation, negotiating the financing plan with the State’s hospital association, developing the federal waiver, supporting federal negotiations and leading the implementation of the program, including the operational design.
Ms. Verma and her SVC team developed many of the recent Medicaid reform programs including waivers for Iowa, Ohio and Kentucky. She helped design Tennessee’s coverage expansion proposal and also provided technical assistance to Michigan as that State implemented its 1115 Medicaid waiver. Ms. Verma and SVC also supported Iowa’s Medicaid transition to managed care, as well as supporting efforts Medicaid strategy efforts in Maine.
Ms. Verma served as the State of Indiana’s health reform lead following the passage of the Affordable Care Act in 2010 and has worked with multiple public health agencies and state insurance agencies as they prepared for implementation of the Affordable Care Act, including interpreting and implementing regulatory changes and understanding the impact of the health exchanges on state insurance markets. Ms. Verma has served as Vice President of Planning for the Health & Hospital Corporation of Marion County, Indiana, and as a Director with the Association of State and Territorial Health Officials (ASTHO) in Washington D.C.
Ms. Verma received her Master’s degree in Public Health with concentration in health policy and management from Johns Hopkins University and her Bachelor’s degree in Life Sciences from the University of Maryland.
Manager, Policy and Strategy Initiatives, Michigan Department of Health and Human Services
Phillip Bergquist Manages Policy and Strategic Initiatives for the Michigan Department of Health and Human Services (MDHHS). Phillip’s work at MDHHS centers on aligning the programs, services and benefits MDHHS provides including leadership in the Department’s efforts to integrate health and human services programs as well as MDHHS’ care delivery and payment reform efforts in the State Innovation Model. Prior to working for MDHHS, Phillip worked in health policy and management as the Director of Health Center Operations for the Michigan Primary Care Association where he focused on improving the operational efficiency, financial stability, and enabling services infrastructures of community-based healthcare providers in Michigan. Phillip received his Bachelors degree from Rochester College and completed his Executive Fellowship through the University of Kansas. Phillip has been recognized nationally as a 2011 Centers for Medicare and Medicaid Services (CMS) Excellence in Children’s Health Outreach and Enrollment Honoree and 2012 Nominee for the Geiger Gibson Emerging Leader Award.
Director, Practice Operations, Oncology Hematology Care
Brian Bourbeau is the Director of Practice Operations at Oncology Hematology Care in Cincinnati. OHC is a community oncology practice, with offices in Ohio, Kentucky and Indiana. In his current role, Brian oversees quality programs, managed care and revenue cycle operations. At this time, OHC participates in alternative payment models with government and commercial payors, including a Medicare Shared Savings Program ACO and the Oncology Care Model.
Prior to joining OHC, Brian was a hospital administrator, serving the not-for-profit health systems of The Ohio State University Hospitals; The Health Alliance; and Lee Memorial Health System. The focus of Brian’s career has been in the areas of clinical quality improvement, financial viability and improving cash and operating cycles.
Brian holds a degree of Master of Business Administration from Franklin University in Columbus, as well as certifications in Lean, Six Sigma, and Business Intelligence.
Health Care Strategy and Policy, The Boeing Company
|Emily DuHamel Brower
Vice President of Population Health, Atrius Health
Emily DuHamel Brower is Vice President of Population Health for Atrius Health, an innovative non-profit healthcare organization with 30 medical practices and a home health and hospice agency providing care to 675,000 patients in eastern Massachusetts. Emily first joined Atrius Health in 2010, as Senior Director, Clinical Improvement Ventures for Harvard Vanguard and became Executive Director of Atrius Health’s Accountable Care Programs in 2012.
In her position at Atrius Health, Emily has developed opportunities to support transformational work that measurably improves healthcare within value-based payment models. Key accomplishments include securing Atrius Health’s participation in, and leading our implementation of, the Pioneer ACO model, an initiative of CMS’ Center for Medicare
and Medicaid Innovation, and launching the organizations participation in two
Medicare demonstrations for the dual-eligibles, developing new care models for patients with both Medicare and Medicaid. In her position, Brower leads cross-Atrius Health, cross-discipline teams involved in redesigning care for Atrius Health’s highest risk patients, moving from a payer-based to population-based approach.
Previously, Brower spent fifteen years as the Chief Operating Officer/Director of Finance and Operations at Urban Medical Group in Jamaica Plain, a non-profit healthcare organization specialized in medical management of medically complex, chronically ill populations across a community-based long term care continuum. Among her accomplishments at Urban Medical, Brower served as Principal Investigator for a multi-year research project analyzing cost and quality outcomes to support payment reform, and developed innovative, capitated contracts for medically complex populations.
Brower received her Bachelor of Arts from Smith College, and MBA from the New York University Stern School of Business.
Deputy Administrator for Innovation & Quality, CMS Chief Medical Officer
Patrick Conway, MD, MSc, is the Deputy Administrator for Innovation and Quality & CMS Chief Medical Officer. He leads the Center for Clinical Standards and Quality (CCSQ) and the Center for Medicare and Medicaid Innovation (CMMI) at CMS. CCSQ is responsible for all quality measures for CMS, value-based purchasing programs, quality improvement programs in all 50 states, clinical standards and survey and certification of Medicare and Medicaid health care providers across the nation, and all Medicare coverage decisions for treatments and services. The center’s budget exceeds $2 billion annually and is a major force for quality and transformation across Medicare, Medicaid, CHIP, and the U.S. health care system. The CMS Innovation Center is responsible for testing numerous new payment and service delivery models across the nation. Models include accountable care organizations, bundled payments, primary care medical homes, state innovation models, and many more. Successful models can be scaled nationally. The CMS Innovation Center budget is $10 billion over 10 years.
Previously, he was Director of Hospital Medicine and an Associate Professor at Cincinnati Children’s Hospital. He was also AVP Outcomes Performance, responsible for leading measurement, including the electronic health record measures, and facilitating improvement of health outcomes across the health care system. Other relevant experience includes previous work as the Chief Medical Officer at the Department of Health and Human Services (HHS) in the Office of the Assistant Secretary for Planning and Evaluation. In 2007-08, he was a White House Fellow assigned to the Office of Secretary in HHS and the Director of the Agency for Healthcare Research and Quality. He also served as Executive Director of the Federal Coordinating Council on Comparative Effectiveness Research coordinating the investment of the $1.1 billion for CER in the Recovery Act. He was a Robert Wood Johnson Clinical Scholar and completed a Master’s of Science focused on health services research and clinical epidemiology at the University of Pennsylvania and Children’s Hospital of Philadelphia. Previously, he was a management consultant at McKinsey & Company, serving senior management of mainly health care clients on strategy projects.
He has published articles in journals such as JAMA, New England Journal of Medicine, Health Affairs, and Pediatrics and given national presentations on topics including health care policy, quality of care, comparative effectiveness, hospitalist systems, and quality improvement. He is a practicing pediatric hospitalist and was selected as a Master of Hospital Medicine from the Society of Hospital Medicine. He has received the HHS Secretary’s Award for Distinguished Service. This is the Secretary’s highest distinction for excellence. He completed pediatrics residency at Harvard Medical School’s Children’s Hospital Boston, graduated with High Honors from Baylor College of Medicine, and graduated summa cum laude from Texas A&M University.
|Karen S. Johnson
Health & Benefit Strategy Consultant, Blue Cross and Blue Shield of Kansas City
Karen Johnson has worked in a variety of roles throughout the health insurance and health care industries since 1984 – all of which have shaped her vision and fueled her passion to make health care work better for more people. Most of Karen’s work has focused on health care plans and programs purchased by employers for the benefit of their employees and families. Helping employers make the most of a sometimes dysfunctional and irrational purchasing system has been her mission. Achieving success in this endeavor often involves drawing outside the lines to create new approaches to benefit design or to forge unexpected alliances, all with a singular goal in mind – better health care at lower cost for more people.
Karen continues to work with employers and health plans as an independent consultant. She has been working as an internal consultant to Blue KC since 2011 involved in Product Development, Marketing and Integrated Health Services where she is currently assigned. Most of Karen’s work within Blue KC has been focused on the market implications of emerging value-based care models, such as the Blue KC Medical Home program. She is in the final stage of completing her PhD in Health Policy and Management at the University of Kansas School Of Medicine. Karen also holds a MHSA degree from Arizona State University and a BA in Sociology from Hanover College.
Director, Robert J. Margolis Center for Health Policy
Robert Margolis Professor of Business, Medicine, and Health at Duke University
Mark B. McClellan, MD, PhD, serves as Co-chair of the Health Care Payment Learning & Action Network’s Guiding Committee. He is the Director of the Robert J Margolis Center for Health Policy and a Robert Margolis Professor of Business, Medicine, and Health Policy at Duke University. Previously, he was a senior fellow and Director of the Health Care Innovation and Value Initiative at the Engelberg Center for Health Care Reform at The Brookings Institution. His work focuses on strategies and policy reforms to improve health care, including accountable care, better evidence from real-world practice, and more effective drug and device innovation. Dr. McClellan also served as Commissioner of the United States Food and Drug Administration (FDA) from 2002 through 2004, where he developed and implemented major reforms in health policy, and subsequently as an administrator of the Centers for Medicare and Medicaid Services (CMS) from 2004 through 2006. During 2001 and 2002, Dr. McClellan served on the President’s Council of Economic Advisers where he advised on domestic economic issues. He also served as a senior policy director for health care and related economic issues for the White House. From 1998-1999, McClellan served as Deputy Assistant Secretary of the Treasury for Economic Policy where he supervised economic analysis and policy development on a wide range of domestic policy issues. In 1997, the Journal of Economics and Management Strategy published his paper, Hospital Reimbursement Incentives: An Empirical Analysis, which served as a review and analysis of provider payment incentives resulting from the Medicare prospective payment system. After graduating from the University of Texas, he earned his MD degree from the Harvard-MIT Division of Health Sciences and Technology and his PhD in economics from MIT. He also earned a Master of Public Administration degree from the Harvard University Kennedy School of Government. Dr. McClellan completed his residency training in internal medicine at Brigham and Women’s Hospital, and he is board-certified in internal medicine.
Inspirational Speaker, Healthcare Speaker, Business Consultant
In 2005 Nancy had it all. She was a published author of several books and had a roster of Fortune 500 companies as clients. Nancy’s business was the first recipient of the Tom Peters Wow! Project Personified Award.
Nancy Michaels’ life was on the fast track. She was literally the picture of success; a sought-after business speaker and mentor; the president and CEO of her own company and the mother of three small children.
In what seemed like an instant, Nancy found herself in a health crisis that would twice nearly end her life. In that year, Nancy underwent an emergency liver transplant and cranial procedure which brought with them significant medical complications that left her in a two-month coma in the intensive care unit at a major Boston medical facility.
Miraculously, her extensive rehab left her with no residuals; but, Nancy’s life – and the message she wanted to bring to her audiences – were irrevocably changed.
Now Nancy provides her inspirational speeches including “Lessons Learned from Dying” to audiences inside – and outside the U.S. Nancy also offers strategies, tactics and tools to increase patient satisfaction, engagement and safety to medical and healthcare audiences derived from her own experience as a long-term patient.
President, National Partnership for Women & Families
Debra L. Ness, M.S. is President of the National Partnership for Women & Families. Before assuming her current role as president in 2004, she served as executive vice president of the National Partnership for 13 years. Ness has played a leading role in positioning the organization as a powerful and effective advocate for today’s women and families.
Ness is a member of the Board of Directors and chairs the Consumer Advisory Council of the National Committee for Quality Assurance (NCQA). She was recently elected to serve as the first public member on the American College of Cardiology (ACC) Board of Trustees and sits on the management board of the National Cardiovascular Data Registry (NCDR). She is also one of the first public members of the American Board of Internal Medicine Board of Directors. Ness co-chairs the Consumer-Purchaser Alliance, a group of leading consumer, employer, and labor organizations working to promote high value care through the use of quality measurement, smarter payment, and effective Health Information Technology (HIT). She serves on the Executive Committee of the Health Care Transformation Task Force (HCTTF), and recently completed service on the Board of Directors of the National Quality Forum (NQF).
In addition, Ness serves on the Executive Committee of the Leadership Conference on Civil and Human Rights and co-chairs its Health Care Task Force. She also serves on the Board of Directors of the Economic Policy Institute (EPI).
Ness graduated summa cum laude from Drew University with a bachelor’s degree in psychology and sociology. After completing graduate work in social welfare and public health policy, she received her Masters of Science from Columbia University School of Social Work.
|Sam R. Nussbaum
Chair, LAN Alternative Payment Model Framework Refresh Advisory Group
Senior Fellow, Schaeffer Center for Health Policy and Economics, University of Southern California
Samuel R. Nussbaum, MD, serves as Chair of the Health Care Payment Learning & Action Network’s Alternative Payment Model Framework Refresh Advisory Group and previously served as Chair of the Alternative Payment Model Progress and Tracking Work Group. He is a Senior Fellow at the USC Schaeffer Center for Health Policy and Economics and serves as an advisor to Epstein, Becker, Green, and to venture funds and life science companies.
He is former Executive Vice President and Chief Medical Officer of Anthem. During a 15 year tenure, he oversaw medical and pharmacy policy, health improvement, care management, provider contracting, innovative payment models, and outcomes research and drug safety through HealthCore, an Anthem subsidiary. Nussbaum guided Anthem’s vision regarding quality of care and a strategy to collaborate with physicians and hospitals to strengthen patient care. Prior to Anthem, Dr. Nussbaum was executive vice president for BJC HealthCare, overseeing integrated clinical services. Dr. Nussbaum had a 20 year career at Harvard Medical School and led a basic and clinical research program at Massachusetts General Hospital where he directed the endocrine group practice.
|Mark D. Smith
Visiting Professor, University of California at Berkeley
Clinical Professor of Medicine, University of California at San Francisco
Mark D. Smith, MD, MBA, serves as Co-chair of the Health Care Payment Learning & Action Network’s Guiding Committee. He is a Visiting Professor at the University of California at Berkeley, and a Clinical Professor of Medicine at the University of California at San Francisco. He was the Founding President and former Chief Executive Officer of the California HealthCare Foundation (CHCF). While at CHCF, Dr. Smith led the launch of California HealthLine and iHealthBeat, daily electronic publications; the CHCF Center for Healthcare Reporting at USC, which partners with local publications and broadcast outlets throughout California in producing original reporting; the CHCF Innovation Fund; and the CHCF Leadership Fellows Program. Previously, Dr. Smith was Executive Vice President at the Henry J. Kaiser Family Foundation where he oversaw programs in HIV, reproductive health, and the health care marketplace. Prior to that, he was a faculty member at the Johns Hopkins Schools of Medicine and of Public Health. Dr. Smith was elected a member of the Institute of Medicine (IOM) in 2001 and chaired the IOM’s Committee on the Learning Healthcare System, which produced the 2012 report, Best Care at Lower Cost. He previously served as Associate Director of AIDS services and Assistant Professor of Medicine and of Health Policy and Management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine. A nationally recognized health policy expert, Dr. Smith has published over 50 articles in peer-reviewed journals and 25 book chapters and monographs, and he is a frequent keynote speaker. In 2014, he was a Menschel Senior Policy Fellow at the Harvard School of Public Health. Dr. Smith holds a BA from Harvard College, an MBA from the Wharton School with a concentration in health care administration, and an MD degree from the University of North Carolina, Chapel Hill.