Measurement Track: Health Equity
Capability: Development of health optimization and wellness initiatives
Definition:
Programs designed to optimize workplace wellbeing and health while also reducing costs. Examples include smoking cessation, weight loss programs and preventative health screening
Measurement Track: Health Equity
Capability: Provider/payer integration on local, regional, and national community resources
Definition:
Active bidirectional sharing of best practices and collaboration on challenging patient situations
Measurement Track: Health Equity
Capability: Population specific identification of gaps in equitable access to services
Definition:
Focusing on specific high-risk populations and conditions that have highest disparities in equitable care with greatest interventional impact
Measurement Track: Health Equity
Capability: Develop community engagement and partnerships
Definition:
Also includes alignment of community needs assessments between hospitals, Federally Qualified Health Centers, Certified Community Behavioral Health Clinics, community action agencies, etc.
Measurement Track: Health Equity
Capability: Enable online appointment and resource scheduling
Definition:
Giving patients the option to self-schedule appointments from a computer or mobile device to improve convenience, experience, and satisfaction
Measurement Track: Health Equity
Capability: Enable access to telemedicine/remote monitoring
Definition:
The ability to monitor and actively manage certain clinical connection points of a patient’s health from their own home (e.g., blood pressure, weight, glucose levels)
Measurement Track: Health Equity
Capability: Development of a health equity plan
Definition:
Includes engagement with the community to develop a list of priority activities, timelines, and responsibilities that addresses gaps voiced by community representatives
Measurement Track: Health Equity
Capability: Omni-channel communication including mobile and digital designed with cultural diversity
Definition:
Focuses on offering and delivering a personalized and culturally sensitive communication experience leveraging multiple communication tools including as phone, email, mobile apps, and online platforms
Measurement Track: Health Equity
Capability: Screening for social determinants of health barriers during member/patient interactions
Definition:
Incorporating routine screening questions during each interaction to assess for potential risks and provide interventions as needed
Measurement Track: Health Equity
Capability: Deliver care with cultural competency
Definition:
Effectively deliver health care services that meet the social, cultural, and linguistic needs of patients/members. Contributes to the elimination of racial and ethnic health disparities. Examples include employing community health workers, training on cultural competence and cross-cultural issues, and creating policies that reduce barriers to care and promote engagement
Measurement Track: Health Equity
Capability: Incorporate member/patient preference to enhance communication engagement
Definition:
Assessing for preferred communication channels during each member/patient interaction and incorporating those preferences into ongoing communications
Measurement Track: Health Equity
Capability: Investment in digital community resource directories
Definition:
Shared digital community resource directories provide accurate and consistent information across teams. Internally created or leverage regional and national platforms that allow for referral monitoring
Measurement Track: Health Equity
Capability: Access to nurse line
Definition:
A service for patients to ask basic health questions and address concerns about an illness or injury. Typically, available 24/7/365 as a resource to help decide where to get care
Measurement Track: Health Equity
Capability: Utilize member, patient, and family portal data appropriate to the population
Definition:
Includes capturing member feedback data which connects back to Data and Infrastructure Measurement Track
Measurement Track: Health Equity
Capability: Administer wellness and preventative screenings
Definition:
Used to screen for potential illnesses and maintenance of health. Screenings are inclusive of mammograms, colonoscopies, blood pressure, diabetes, cholesterol, weight loss, depression/anxiety, alcohol use, etc.
Measurement Track: Health Equity
Capability: Stratify and analyze current socioeconomic status data for potential health inequities
Definition:
Close alignment with Data and Infrastructure Measurement Track to ensure proper data collection available and analyze data to identify local populations with potential health inequities
Measurement Track: Health Equity
Capability: Development of loyalty programs/incentives
Definition:
Rewards systems that can be used to encourage healthy lifestyle, focus on prevention measures, and navigate towards lower cost/higher quality health care
Measurement Track: Health Equity
Capability: Develop assessment approach for care access barriers
Definition:
Includes joint collaboration on community needs with community advisory boards/governance structures
Measurement Track: Health Equity
Capability: Develop manual community resource directory for local community
Definition:
Consolidated collection of local resources available to internal organizational stakeholders
Measurement Track: Health Equity
Capability: Conduct health risk assessments
Definition:
Instrument used to collect health information including biometrics, health status, risks, and habits
Measurement Track: Health Equity
Capability: Conduct member/patient surveys
Definition:
A process or systematic way to capture, document and analyze member/patient health risk assessments to learn from/inform next phases (e.g., establishing goals, expanding data collection and resources, etc.)
Measurement Track: Health Equity
Capability: Incorporate propensity for patient/member engagement in the care model delivery
Definition:
Integrated with Data and Infrastructure Measurement Track. Identification of members/patients with higher probability of engagement/participation in care model, which causes patients to seek better quality of care and reduce costs
Measurement Track: Health Equity
Capability: Provide advanced consumer tools
Definition:
Decision-support tools available to member/patients to help understand essential data/background information, provide evidence-based education and identification of patient values and preferences in making healthcare decisions
Measurement Track: Health Equity
Capability: Enable mobile/virtual health access outside of acute and ambulatory settings
Definition:
Ability for patients to keep track of their own health and connect with care delivery teams and support resources by mobile communication channels and network technologies
Measurement Track: Data & Infrastructure
Capability: Analytics reporting includes insights generated from the addition of clinical, financial, and business considerations
Measurement Track: Data & Infrastructure
Capability: Value based contract insights identified across sub-populations utilized to improve quality, outcomes, utilization, and performance
Measurement Track: Data & Infrastructure
Capability: Create chronic disease registries with electronic health records (EHR) and claims-based data
Definition:
Participation in clinical registries is a critical component of quality outcomes reporting
Measurement Track: Data & Infrastructure
Capability: Analytics rules engine with multidimensional identification and stratification modeling
Definition:
Building on the initial Analytics Rules Engine to utilize multiple data sources (e.g., claims, clinical, social determinants) in the performance of advanced reporting and identification of high-risk patients/members for care management and interventions
Measurement Track: Data & Infrastructure
Capability: Implement hierarchical condition category/risk stratification
Definition:
Ability to utilize claims and clinical data to analyze conditions and apply risk and rating for basic identification of high-risk patients/members
Measurement Track: Data & Infrastructure
Capability: Leverage analytics rules engine
Definition:
Consumes raw data to apply and execute a defined logical rule set to create meaningful output that can be further analyzed to develop actionable next steps
Measurement Track: Quality
Capability: Medical policy transparency
Measurement Track: Quality
Capability: Transformed utilization management with provider/payer interoperability
Definition:
Includes implementation of FHIR API standards
Measurement Track: Quality
Capability: Utilizes insights from enhanced reporting to drive improvements across sub-populations and performance to contracted metrics
Definition:
Application of quality performance results to drive larger scale process improvements that influence larger populations and drive improvements with contracted metrics
Measurement Track: Quality
Capability: Ongoing monitoring of low-value care
Definition:
Incorporating low-value care monitoring and analysis into ongoing quality performance reviews
Measurement Track: Quality
Capability: Develop inclusive and equitable health policies
Definition:
Includes comparison against industry standards and best practices
Measurement Track: Quality
Capability: Leverage quality standards and benchmarks for top performance
Definition:
Using top performance benchmarks and quality standards to align quality improvement plan targets
Measurement Track: Quality
Capability: Utilizes insights from reporting to support provider specific and system improvements
Definition:
Application of quality performance results to drive provider specific process improvements
Measurement Track: Quality
Capability: Leverage AI-assisted clinical reviews and gold-carding in utilization management
Definition:
Increased clinical review efficiency and accuracy to reduce administrative burden
Measurement Track: Quality
Capability: Clinician leadership receives quality outcomes and participates in results’ interpretation and improvement efforts
Definition:
Ensuring clinical stakeholders participate in outcomes discussions to determine interventions and next steps
Measurement Track: Quality
Capability: Develop approach to address low-value care
Definition:
Approach may include focus on appropriateness of care that is anchored in improving outcomes (high-value care)
Measurement Track: Quality
Capability: Develop standardized medical policies across population
Definition:
Configuration of medical policies guidelines to be applicable for entire population instead of specific sub-populations; eases burden on providers to determine applicability of medical policies for specific patient types
Measurement Track: Quality
Capability: Enhancements to utilization management to reduce barriers to care
Definition:
Includes re-evaluation of prior authorization list to eliminate low value/non-standard sub-categories and electronic submissions
Measurement Track: Quality
Capability: Identify low-value care
Definition:
Services that provide little or no benefit to patients, have potential to cause harm, incur unnecessary costs to patients, or waste limited healthcare resources; data-driven process
Measurement Track: Quality
Capability: Develop medical policy review approach
Definition:
Collection and clinical review of medical records and related information for specific conditions/procedures against predefined guidelines and requirements
Measurement Track: Quality
Capability: Develop utilization management approach
Definition:
Framework to evaluate medical necessity, appropriateness and efficiency of health care services, procedures, and facilities
Measurement Track: Quality
Capability: Promote evidence-based decisions and support
Definition:
Understanding the value and purpose of effective decision making by leveraging data analysis and information. Putting support systems in place to ensure compliance and inter-rater reliability
Measurement Track: Quality
Capability: Measurement framework
Definition:
Awareness of the organizational approach/framework on quality measurement that will be used for consistent monitoring and comparison year over year
Measurement Track: Quality
Capability: Quality improvement assessments
Definition:
Processes that include testing acceptance/adherence to new/revised practices, determining how the new practices are affecting the delivery of patient–-centered care, assessment of how much patient care is improving
Measurement Track: Quality
Capability: Develop organizational quality management program
Definition:
Standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations. Structures may include technology, culture, and leadership
Measurement Track: Quality
Capability: Coordinate clinical quality and performance metrics across governmental and commercial health plans enabling synergistic improvements in health outcomes and total cost of care
Definition:
Application of best practices and efficiencies identified from individual payer arrangements across all contracts
Measurement Track: Quality
Capability: Enhanced utilization, financial, quality and outcomes reporting across sub-populations
Definition:
Aggregated from multiple populations/subpopulations to identify multi-dimensional opportunities
Measurement Track: Quality
Capability: Incorporation of patient-reported outcomes into performance reporting
Definition:
Measure developers should construct quality measures that apply the outcome data collected by the tools to measure the quality of care
Measurement Track: Quality
Capability: Provide transparent quality benchmarking methodology
Definition:
Methodology must be adjusted for population mix, risk (including social determinants of health) and market. Also includes participation in clinical registries
Measurement Track: Quality
Capability: Develop key performance indicator management and alignment
Definition:
Aligning on what key performance indicators the organization will focus on as well as tools to monitor results with actionable interventions
Measurement Track: Quality
Capability: Engage and collaborate with provider leadership in reconciling perceived conflicts between clinical quality and governmental and health plan performance quality metrics
Definition:
Ensuring that provider/clinical stakeholders are included in quality reporting analysis and resolving potential conflicts early in the performance review period
Measurement Track: Quality
Capability: Encourage provider-specific reporting incorporating quality, utilization, financial outcomes, and benchmark comparisons
Definition:
Ensuring that quality reporting includes multiple sources of measurement and comprehensive assessment within a defined provider network/group
Measurement Track: Quality
Capability: Aggregate quality reporting incorporating utilization, sites of service and patient outcomes
Definition:
Inclusion of multiple sources and types of quality data for well-rounded measurement
Measurement Track: Quality
Capability: Reporting of patient-reported outcomes (PROs)
Definition:
Effective collection and analysis of patient-reported outcomes including measurement of health disparities; timely collection and use of alternative collection methods (e.g., mobile devices)
Measurement Track: Quality
Capability: Reporting of quality outcomes (including specialty-oriented)
Definition:
Integration with the Data and Infrastructure Measurement Track for Enterprise Data Warehouse. Includes establishing the importance of data quality in driving business decisions
Measurement Track: Quality
Capability: Encourage adoption of pay-for-reporting
Definition:
Incentivizing providers for quality reporting to demonstrate successful achievement of specific measures and/or completion of specific diagnostics; Physician Quality Reporting System (PQRS)
Measurement Track: Quality
Capability: Collection of patient-reported outcomes (PROs)
Definition:
Report of the status of a patient’s health conditions that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else. Examples of patient self-reported data collection tools include: Patient-Reported Outcomes Measurement Information System (PROMIS), Medicare Health Outcomes Survey, FOTO Patient Outcomes
Measurement Track: Quality
Capability: Encourage adoption of pay-for-performance
Definition:
Developing an incentive structure to demonstrate successful achievement of defined process and clinical measures to earn shared savings and/or incentive payments
Measurement Track: Health Equity
Capability: Coordinate cross-organization approach to address gaps in equitable access to services
Definition:
Collaborative approach to coordinate reporting and best practice sharing to have greatest impact/change
Measurement Track: Health Equity
Capability: Develop population health approach utilized across the health care ecosystem
Definition:
Comprehensive analysis of equity gaps impacting all including low, moderate, and rising risk populations
Measurement Track: Health Equity
Capability: Interdisciplinary coordination and site of care
Definition:
Deliberate collaboration between multiple health specialties to provide holistic approach to care; focused attention on most appropriate level and site of care based on performance and cost containment strategies
Measurement Track: Health Equity
Capability: Care management identification and stratification based on predictive analytics
Definition:
Incorporates identification of rising risk populations that have significant potential to decline in health based on predictive factors
Measurement Track: Health Equity
Capability: Impact based prioritization of care management outreach
Definition:
Supports focusing on patients with modifiable risk factors that if controlled and minimized will have increase/improve health outcomes
Measurement Track: Health Equity
Capability: Longitudinal care management approach inclusive of chronic disease management
Definition:
Holistic and dynamic long term care management incorporating disease prevention and treatment. Patient values and preferences are incorporated into the care plan
Measurement Track: Quality
Transforming stage supports using standardized system-wide processes to predict rising risk within populations to improve patient experience and drive high–-quality care for all
Measurement Track: Quality
Aligning stage supports benchmarking quality performance results and executing improved outcomes towards person-centered care
Measurement Track: Quality
Investing stage supports establishing evidence-based quality goals with ongoing data collection for measuring improvement and progress towards goals
Measurement Track: Quality
Learning stage supports recognition of standard quality metrics and current state of quality performance
Measurement Track: Health Equity
Capability: Develop provider/payer coordinated plan of care
Definition:
Initial collaboration in development of patient plans of care and ongoing communication on updates to ensure alignment
Measurement Track: Health Equity
Capability: Identify care management activities and stratification based on clinical, claims, social drivers, urgency of needs
Definition:
Multiple sources of data for a comprehensive 360-degree analysis
Measurement Track: Health Equity
Capability: Incorporate behavioral health, medication management and adherence programs in holistic approach
Definition:
Team-based care with shared information systems to improve coordination and create individualized, person-centered care. May also include cross screening for common behavioral and physical health conditions
Measurement Track: Health Equity
Capability: Develop population-focused complex case management transition management
Definition:
Inclusion of chronic co-morbidity patients with modifiable risks to promote supportive, trusting relationships between providers and patients. Interventions include focused attention on adherence to medical treatments, navigating the health care ecosystem and provider care coordination
Measurement Track: Health Equity
Capability: Care management identification and stratification based on encounter data
Definition:
Identification of patients for care management services based on provider collected clinical conditions diagnosed as well as the services and items delivered to treat these conditions
Measurement Track: Health Equity
Capability: Care management identification and stratification based on claims-based analytics
Definition:
Leveraging analyzed healthcare claims and cost data to identify patients will rising costs and at-risk health conditions
Measurement Track: Health Equity
Capability: Care management inclusive of ambulatory/outpatient level of care, specialty health conditions, and readmissions
Definition:
Care management activities include additional focus on the long-term needs of members/patients including preventative care, condition-specific education, and interventions on readmission prevention
Measurement Track: Health Equity
Capability: Learning to leverage care management utilization metrics outcomes to track discrepancies and inequities for targeted populations
Definition:
Utilization metrics include average length of stay, readmissions, days/1000, barriers to discharge by population
Measurement Track: Health Equity
Capability: Care management approach focusing on inpatient length of stay, level of care, care navigation and transition management (Learning)
Definition:
Foundational member/patient support and education to reduce hospital visits, navigate and transition care to most appropriate level of care, and short-term interventions
Measurement Track: Health Equity
Aligning stage supports alignment of multiple resources and collaborations to continue monitoring ongoing health equity initiatives and disparities
Measurement Track: Health Equity
Transforming stage supports improved equity across the organization, and demonstrates improved outcomes and access to care across all populations
Measurement Track: Health Equity
Investing stage supports expansion of baseline health disparities identification and investment in improvement strategies and initiatives to successfully measure outcomes
Measurement Track: Health Equity
Learning stage supports assessment and evaluation of baseline health disparities impacting the population
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop regional collaboration approach to drive APM movement
Definition:
Integration of state, public health, social service and community level data
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Cohesive digital referral and management platform
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop integrated approach and referral management to address underserved populations on shared partnership and resources
Definition:
Bidirectional timely referrals and coordination between community resources/partnerships focused on resolving health inequities and disparities
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Build qualitative indicators for multi-stakeholder network success
Definition:
Identify success indicators and set short-and long-term goals
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Development of aligned measurement sets
Definition:
Inclusive of specialty and primary care. Takes into consideration local needs as well as national programs
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Create appropriate partnerships and initiatives to address the needs of high-risk population
Definition:
Creating purposeful partnerships focused on closing gaps identified from community health needs assessment
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Implement interoperable data exchange/electronic clinical quality measures
Definition:
Advancing interoperable digital measurement
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Organize/join network of local and diverse stakeholders to identify and design community health goals
Definition:
Assemble local stakeholders to start aligning on common goals and share individual organizational best practices
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Conduct community health needs assessment focused on high-risk populations
Definition:
Targeted assessment focused on high-risk populations in the community to identify potential gaps and required interventions
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Identify organizational incentive-based performance
Definition:
Incentivization of organizational stakeholders to collaborate and be held responsible for their role in moving towards an accountable care model
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Analysis of community organizations and partnerships for underserved populations
Definition:
Analysis to determine strengths and gaps in current community partnerships
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Ability to assess current ecosystem (alignment framework inclusion in strategic planning)
Definition:
Requires alignment on near-term and long-term objectives
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop multi-disciplinary education and coaching on value of accountable care
Definition:
Ensuring that all stakeholders understand the importance of accountable care and understand their role in achieving outcome targets
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop strategy for market supply and analysis
Definition:
Determine market supply gaps within network of employed and independent primary and specialty provider groups
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Align incentives across organizational leadership and provider network
Definition:
Cascading of incentives down to all providers within the organization ensures knowledge of inclusion in quality measurement and performance monitoring. Promotes team-based framework of inter-disciplinary collaboration
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Coordinated patient-centric partnerships that serve as foundation for multiple commercial and governmental payer products
Definition:
Leveraging best practices identified from coordinated care delivery and incorporating into a standardized approach with payer products
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Ability to conduct provider stratification
Definition:
Identification and stratification of providers serving higher risk patient populations to find opportunities to target interventions at specific provider locations to maximize impact
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop patient-centric coordinated partnerships
Definition:
Collaboration across primary and specialty care on coordinated patient-centered care delivery
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Provider performance incentive alignment
Definition:
Inclusion of employed and independent provider practices into performance incentive model
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Enhanced provider coordination across levels, intensity, and continuum of care
Definition:
Coordinated patient-centered care delivery incorporating all levels of care including home and community-based providers
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Create ACO for defined payment population
Definition:
Initiate a shared risk and incentive model for a specific patient population to facilitate movement toward value-based care payment models
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop network development strategy to improve adequacy gaps
Definition:
Creating a strategy and actionable interventions to improve network adequacy using identified gaps from provider network adequacy analysis
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Implement provider performance reporting
Definition:
Transparent performance reporting across employed and independent provider practices
Measurement Track: Multi-stakeholder Alignment & Design
Capability: Develop strategy for provider network adequacy analysis
Definition:
Baseline analysis to determine care access gaps within network
Measurement Track: Multi-stakeholder Alignment & Design
Transforming stage supports transparent multi-stakeholder alignment and forward-thinking infrastructure that advances accountable care models and arrangements
Measurement Track: Multi-stakeholder Alignment & Design
Aligning stage supports multi-stakeholder participation in advancing accountable care models and arrangements with measurable progress
Measurement Track: Multi-stakeholder Alignment & Design
Learning stage supports identifying opportunities available to educate multi-stakeholders on the existing accountable care landscape
Measurement Track: Multi-stakeholder Alignment & Design
Investing stage supports investing in multi-stakeholder performance and consensus-generating groups that allows for facilitation, relationship building and ownership of health goals
Measurement Track: Data & Infrastructure
Transforming stage supports advanced data collection and sharing infrastructure and activities to measure progress on payment reform, quality, affordability, and equity
Measurement Track: Data & Infrastructure
Aligning stage supports participation in broader data-sharing activities and patient/consumer engagement in their own care
Measurement Track: Data & Infrastructure
Investing stage supports investment in improved data collection, analytics, and measurement outcomes
Measurement Track: Data & Infrastructure
Learning stage supports baseline data collection and infrastructure for initial patient/consumer engagement
Measurement Track: Data & Infrastructure
Capability: Leverage employer and administrative services only (ASO) reporting
Definition: Utilization of quality, outcomes, financial, and utilization reporting for usage with employers and ASO to provide insights on performance and potential impactable interventions
Measurement Track: Data & Infrastructure
Capability: Develop data strategy structure and governance
Definition:
This includes a process and structure to ensure data validation and a data governance body
Measurement Track: Data & Infrastructure
Capability: Enhanced usage of enterprise software
Definition: Utilization of enterprise software such as data warehouses to capture, store, and analyze multiple types of data at once (e.g., clinical, claims, quality, and financial data)
Measurement Track: Data & Infrastructure
Capability: EHR incorporates digital integration with community and social services
Definition: Ability for EHR to capture and communicate with community or social services tools and systems for sharing of data and referrals
Measurement Track: Data & Infrastructure
Capability: Develop technology infrastructure to support advanced consumer tools
Definition: Ability to capture and incorporate data from remote patient monitoring devices, telehealth services, and consumer wearables, (including phones, etc.)
Measurement Track: Data & Infrastructure
Capability: Leverage clinical natural language processing (cNLP) to optimize medical record data capture
Definition: Utilization of cNLP to assist with data capture and categorization
Measurement Track: Data & Infrastructure
Capability: Leverage interoperable data exchange
Definition: May include the usage of a regional Health Information Exchange (HIE) or other tools that facilitate the exchange of multiple types and formats of data between organizations
Measurement Track: Data & Infrastructure
Capability: Sending, receiving, and reconciling data from multiple/aggregated sources
Definition: Ability to send and receive clinical, claims, and other various data (including SDOH). May also include Health Information Exchange (HIE), usage of APIs to share data between disparate systems, and other interoperable data exchange types
Measurement Track: Data & Infrastructure
Capability: Access to electronic health records (EHR) across and between organizations
Definition: Ability for multiple types of users across the organization to access clinical data to develop corresponding analytics for care management, and reporting
Measurement Track: Data & Infrastructure
Capability: Enhanced member/patient portals
Definition:Usage of the portal to further capture and communicate enhances/additional services and activities such as online scheduling or provider bidirectional messaging
Measurement Track: Data & Infrastructure
Capability: Leverage claims system that accommodates alternative payment models (APMs)
Definition: Implementation and utilization of a claims system which can process payments beyond fee-for-service, without manual workarounds
Measurement Track: Data & Infrastructure
Capability: Implement member/patient portals (lab, immunization, etc.)
Definition: Incorporates obtaining member feedback data
Measurement Track: Data & Infrastructure
Capability: Develop integrated electronic health records (EHRs)
Definition: Inclusion of primary care, specialty, behavioral health, acute, etc. for comprehensive member/patient view
Measurement Track: Data & Infrastructure
Capability: Implement member/patient portal (demographic)
Definition: Implementation and usage of a patient portal to capture and communicate demographic data between the payer, provider, and member/patient
Measurement Track: Data & Infrastructure
Capability: Implement electronic health records (EHR)
Definition: Implementation and usage of an EHR to capture medical records and other clinical data for usage in reporting
Measurement Track: Data & Infrastructure
Capability: Population risk stratification and registries
Definition:
Utilizing multiple data sources (e.g., clinical, claims, SDOH, consumer behavior patterns) combined with registries and predictive analytics to identify/stratify individuals and populations with the highest addressable risk
Measurement Track: Payment Reform
Capability: Enhanced reporting of delegated and collaborative community services on member outcomes and plan/provider performance
Definition:
Promotes accountability and transparency of health equity interventions
Measurement Track: Payment Reform
Capability: Continuous improvement outputs based on insights and target performance
Definition:
Improvement initiatives are generated from understanding the actual performance to defined metrics and associated targets
Measurement Track: Payment Reform
Capability: Financial Incentive alignment across organizational leadership and providers focused on value-based care
Definition:
Compensation and/or incentive opportunities align organizational goals to the level of individual provider/practitioner across clinical delivery and leadership teams to optimize improvement capture
Measurement Track: Payment Reform
Capability: Integrated financial and clinical team actively engaged to incorporate clinical perspectives with data outputs to identify insights and target performance improvement opportunities
Definition:
Clinical and financial data are reviewed together to capture understanding of cost, utilization, quality, and outcome relative to metric targets
Measurement Track: Payment Reform
Capability: Leveraging multiple reports (integrated clinical, claims, quality, and financial data)
Definition:
Reporting includes information captured from electronic health records, claims-based records, quality analysis, and financial sources
Measurement Track: Payment Reform
Capability: Manage financial reconciliation
Definition:
Process of making financial payments consistent with payment methodology, typically at the end of a defined period, e.g., annually
Measurement Track: Payment Reform
Capability: Development of contract management platform
Definition:
System to organize, track and monitor contracting terms, performance metrics and payment methodology across contracts with payors and providers
Measurement Track: Payment Reform
Capability: Network performance and reporting management
Definition:
Demonstration of a defined provider network’s performance to a set of pre-defined metrics with targets
Measurement Track: Payment Reform
Capability: Collaboration across organizational leadership (e.g., financial, contracting, and operations) to align metrics and performance management
Definition:
Review of actual and/or potential metrics and performance to defined targets included within payor contracts with providers
Measurement Track: Payment Reform
Capability: Leverage reports to identify opportunities to capture shared savings
Definition:
Document detailing focus areas for meeting defined target metrics to achieve shared savings’ potential
Measurement Track: Payment Reform
Capability: Develop financial risk management platform
Definition:
System to organize, track and monitor organizational financial capture of bonuses to target opportunity for defined performance metrics
Measurement Track: Payment Reform
Capability: Reporting of monitor targets and performance
Definition:
Includes stratified and risk adjusted performance measures
Measurement Track: Data & Infrastructure
Capability: Leverage employer and administrative services only (ASO) reporting
Definition:
Utilization of multiple data sources (e.g., clinical, claims, SDOH) to report and analyze contracts individually, compared to others and benchmarks
Measurement Track: Payment Reform
Capability: Enhanced physician education and coaching (including provider network collaboration)
Definition:
Intersects with Multi-Stakeholder Alignment and Design Measurement Track; important component of contract performance is first understanding the value proposition of accountable care
Measurement Track: Payment Reform
Capability: Develop provider dashboards and portals
Definition:
Reporting tools displaying defined provider specific metrics and key performance indicators often accessed through a secure website
Measurement Track: Payment Reform
Capability: Provide administrative and financial support
Definition:
Support resources available to capture and track alternative payment methodologies across commercial and governmental businesses
Measurement Track: Payment Reform
Capability: Management of population-based payment models
Definition:
All or much of a person’s overall care or care for related conditions is encompassed within a single payment. Encourages providers to deliver well-coordinated, high-quality, person-centered care within either a defined scope of practice, a comprehensive collection of care, or a highly integrated finance and delivery system
Measurement Track: Payment Reform
Capability: Use/application of risk adjustment
Definition:
Adjustment of payment incentives and quality performance through risk methodologies; Incorporates social and clinical risk inclusive of goal measurement while monitoring for adverse outcomes
Measurement Track: Payment Reform
Capability: Management of performance risk sharing
Definition:
Sharing of bonuses or upside/downside payments across a group of providers, health systems and/or care delivery services
Measurement Track: Payment Reform
Capability: Create risk adjustment methodologies (risk methodology, benchmarking, etc.)
Definition:
Incorporates social and clinical risk adjustment, including risk methodologies and benchmarking, with clear goals and ability to track desired outcomes
Measurement Track: Payment Reform
Capability: Enhance product and price transparency (episode-level pricing)
Definition:
Sharing of pricing for episode level products and services per governmental standards and in a manner that enables informed decision making between patient and provider
Measurement Track: Payment Reform
Capability: Develop shared savings/losses payment model
Definition:
Episode-based payments for procedures and comprehensive payments with upside and downside risk
Measurement Track: Payment Reform
Capability: Implement bundled payments
Definition:
Set payment for managing the care for a defined diagnosis or procedure across a preset time period
Measurement Track: Payment Reform
Capability: Enhance provider contracting (generating transparent model, payment model design)
Definition:
Enable data sharing between payers and providers. May include onetime infrastructure payments for care delivery transformation
Measurement Track: Payment Reform
Capability: Implement shared savings payment model
Definition:
Ability to have a defined threshold around cost of services provided. If performance is below the target, there is a capture of a defined amount of the savings
Measurement Track: Data & Infrastructure
Capability: Insights identified in employer and ASO reports utilized for improved quality, outcomes, and utilization
Measurement Track: Data & Infrastructure
Capability: Develop quality, outcomes, financial, and utilization reporting
Definition:
Includes regular data sharing, of multiple types of data (e.g., clinical, claims, SDOH) between organizations throughout the performance year to ensure accurate and timely analysis for impactable interventions
Measurement Track: Payment Reform
Capability: Implement pay-for-reporting
Definition: Gaining experience in APMs through bonuses for reporting data or penalties for not reporting data
Measurement Track: Payment Reform
Capability: Implement pay-for-performance payment model
Definition:
Bonuses for meeting a defined threshold of quality performance
Measurement Track: Data & Infrastructure
Capability: Implement performance reporting by individual value-based contract
Definition:
Ability to utilize data captured to see performance measures and metrics of a specific provider contract
Measurement Track: Data & Infrastructure
Capability: Leverage quality, financial, and utilization reporting
Definition:
Ability to utilize singular source of data captured for quality, financial, and utilization reporting individually and across contracts
Measurement Track: Payment Reform
Transforming stage supports understanding of the impact population-based payment methodologies have on organizational financial performance and health
Measurement Track: Payment Reform
Aligning stage supports movement to more affordable and accountable outcomes and reimbursement
Measurement Track: Payment Reform
Investing stage supports payment model framework for value-based outcome reimbursement
Measurement Track: Payment Reform
Learning stage supports baseline performance and commitment to develop an understanding of value-based payment systems and movement towards accountable care
Measurement Track: Payment Reform
Capability: Analysis to identify APM opportunities
Definition:
Conducting cost analysis and cost exercises. Business readiness assessments, and stakeholder engagement to explore APM opportunities including multiple APMs (e.g., total cost of care and specialty models) as well as APMs to promote health equity
Measurement Track: Data & Infrastructure
Capability: Implement singular source of data capture
Definition:
For example: capturing one of the following types of data (claims, demographic, or clinical episodic data for usage in reporting)
Dr. Judy Zerzan-Thul is the Chief Medical Officer at Washington State Health Care Authority, Co-Chair of the LAN Executive Forum, and a general internal medicine physician. She leads the state of Washington’s Medicaid Transformation Project, where she collaborates with stakeholders to advance health equity and the innovative use of data. As Chief Medical Officer of the Washington State Health Care Authority, she administers the state’s Medicaid program. She also works to advance the LAN’s strategic objectives to drive equitable health outcomes and lower the total cost of care.
Dr. Zerzan-Thul specializes in value-based payment models and healthcare financing. Prior to her role as the Chief Medical Officer for Washington State, Dr. Zerzan-Thul was the Chief Medical Officer at the Colorado Department of Health Care Policy and Financing. She led the implementation of the Affordable Care Act (ACA) in Colorado. She has extensive experience designing and implementing health plans and benefits for Medicaid programs. Dr. Zerzan-Thul’s background also includes leadership positions in the Medicaid Medical Director’s Network. She has also served as a committee member and advisor for national organizations, including the Agency for Healthcare Research and Quality, the National Quality Forum, the National Committee for Quality Assurance, the National Academy for State Health Policy, the Patient-Centered Outcomes Research Institute, and the Centers for Medicare & Medicaid Services.
Dr. Zerzan-Thul holds a Doctor of Medicine from Oregon Health and Science University and received a Master of Public Health in Health Policy and Administration from the University of North Carolina. She completed the Robert Wood Johnson Clinical Scholars Program at the University of Washington/VA Puget Sound Health Care System in 2007. From 2008 to 2010, she was a non-residential Health and Aging Policy Fellow for the office of Senator John D. Rockefeller IV of West Virginia, where she supported public policy for the Affordable Care Act.
Mark McClellan, M.D., Ph.D., is Director and Robert J. Margolis, M.D., Professor of Business, Medicine, and Health Policy at the Margolis Center for Health Policy at Duke University. He is a physician-economist who focuses on quality and value in healthcare, including payment reform, real-world evidence, and more effective drug and device innovation.
He is former administrator of the Centers for Medicare & Medicaid Services and former commissioner of the U.S. Food and Drug Administration, where he developed and implemented major reforms in health policy.
He is an independent director on the boards of Johnson & Johnson, Cigna, and Alignment Healthcare and is co-chair of the Health Care Payment Learning and Action Network Executive Forum.
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.
Ms. Brower joined Trinity Health from Atrius Health in Massachusetts, where she last served as vice president of Population Health. There, she built and executed the essential capabilities required to achieve strong financial and clinical outcomes within integrated care models under value-based reimbursement, particularly for publicly insured populations.
Prior to her career at Atrius Health, Ms. Brower spent 15 years in leadership roles at Urban Medical Group, a Massachusetts nonprofit healthcare organization specializing in the care of medically complex, chronically ill populations across a community-based, long-term care continuum. During that time, Ms. Brower launched a Program of All-inclusive Care for the Elderly (PACE) program and other innovative, capitated contracts for medically complex populations and served as Principal Investigator for a multi-year research project analyzing cost and quality outcomes to support payment reform.
Ms. Brower received her B.A. from Smith College and her M.B.A. from the New York University Stern School of Business.
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.
Sun River Health cares for over 240,000 general medicine, dental, behavioral health, mental health, agricultural, public housing, homeless, developmentally disabled, HIV and substance abuse patients and families generating nearly 780,000 patient encounters in over 43 clinical sites in both rural and urban settings in 10 counties of the Hudson Valley, 2 counties on Long Island and all of NYC. Sun River Health provides a full range of primary care, behavioral and mental healthcare services including but not limited to pediatrics, internal medicine, family medicine, OB/GYN, dentistry, urgent care, MAT and specific specialty care such as cardiology, endocrinology, and ophthalmology. Over 95,000 patients are managed under a variety of risk-based contacts as well as 11,000 MSSP ACO patients.
Mr. Sinkoff has worked in all sectors of the healthcare industry starting his career with Ernst & Young as an auditor and then as a senior management consultant to hospitals, physician practices, long term care facilities, and home health agencies. In the late ‘90s, he became the director of managed care financing for Berkshire Health Systems. Subsequently, he became the Chief Financial Officer for Fidelis Care New York (now Centene). Mr. Sinkoff was the Chief Executive Officer of Whitney M. Young Jr. Health Center in Albany, New York, before joining Sun River Health and Solutions 4 Community Health in late 2009.
As the DEO, Mr. Sinkoff oversees all aspects of Sun River Health’s service delivery system; clinical, financial and operational. He has been invited to share his thoughts on many topics including value-based systems of care, health equity, IT, interoperability, LEAN and Emotionally Intelligent management. Mr. Sinkoff is a coach to a number of clients seeking to grow and achieve their professional aspirations.
Mr. Sinkoff was an appointed member of the NYSDOH Transparency, Evaluation and HIT Workgroup. He is a member of the board and an executive committee member of the Health Care Transformation Task Force, formerly a part of the Levitt Group. He is a member serving the Robert Wood Johnson Foundation to Improve Health Equity led by the University of Chicago, the Institute for Medicaid Innovation, and the Center for Health Care Strategies. He is a member of the legislative, public policy and sub-committee on health center financing of the National Association of Community Health Centers. He is a member of the board of Amida Care, an HIV and Special needs plan. Mr. Sinkoff is the former chair of the board of the Community Healthcare Association of New York.
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.
Dr. Wilson joined the Center, following his tenure in federal service as a Senior Public Health Advisor with the Centers for Medicare and Medicaid Services (CMS) Office of Minority Health, where he led strategic initiatives to implement the Biden/Harris Administration’s priorities on health equity for underserved communities, and developed a health equity business case portfolio. He most recently received the CMS Impact Award from CMS Administrator Chiquita Brooks-LaSure for advancing health equity and accessibility in COVID-19 for persons living with disabilities. Prior to joining CMS OMH, Dr. Wilson led a $250 million portfolio in the CMS Innovation Center’s Accountable Health Communities Model and the Health Care Innovation Awards. At CMMI, he spearheaded the Health Equity Working Group, which laid the foundation for CMMI’s health equity focus in its 10-year strategy refresh. He later directed culture of patient safety quality improvement projects for the NIH Clinical Center Office of the Director, by reducing medication errors in the inpatient oncology pharmacy department. He also headed recruitment and retention approaches for increasing minority screening, enrollment, and retention in preventative and therapeutic vaccine clinical trials and participation in the Community Advisory Board at NIH. For his exceptional commitment and dedication in identifying a solution for a global infectious disease threat by advancing a malaria vaccine through a clinical trial, Dr. Wilson received awards from NIH’s Director, Dr. Francis Collins and NIAID’s Director, Dr. Anthony Fauci.
Dr. Wilson brings a wealth of knowledge, skills, and abilities in advocacy, health policy, and research from national policy organizations as the National Association of People with AIDS. Dr. Wilson completed his Master’s in Health Systems Management at George Mason University and his Doctor of Public Health at Morgan State University. He also holds Public Health faculty appointments at Purdue University and the UNC Gillings School of Global Public Health, where he teaches courses in health economics and policy, cultural competence and communications for health professionals, community health assessments, and healthcare marketing. His research interests include using patient centered and indigenous models of care, health economics outcomes research, policy analysis, and community-based participatory and action research to eliminate health disparities and advance health equity in underserved and disinvested 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.
Dr. Walsh is an Aerospace Medicine Specialist, who provided primary care to aircrew and special operational personnel and their families during much of his 21-year active-duty career in the U.S. Air Force. Upon retirement in 2006 he served as an Urgent Care Physician at the previous Memorial Health System in Colorado Springs between 2006 and 2008 and practiced at the Centura Center for Occupational Medicine in Colorado Springs, CO and Pueblo, CO between 2006 and 2009.
His prior positions include serving as the Chief Medical Officer, South State Operating Group of Centura Health, Corporate Chief Medical Executive for Centura Health in Denver, Colorado, and the VP of Medical Affairs at St. Francis Medical Center in Colorado Springs, Colorado.
Dr. Walsh received his B.A. at the University of Southern California, his M.D. from the Medical College of Ohio in Toledo, Ohio, and a M.P.H. from Harvard School of Public Health. He completed his residency in Aerospace Medicine at the USAF School of Aerospace Medicine at Brooks AFB, Texas.
Dr. William Shrank is Humana’s Chief Medical Officer (CMO). He leads the Integrated Health Solutions team that consists of several key clinical areas of the business. Dr. Shrank oversees Humana’s senior-focused, purpose driven, primary care organization, and guides the implementation of Humana’s integrated care delivery strategy, with an emphasis on advancing the company’s clinical capabilities. He launched Humana’s health equity department, Humana’s population health strategy (the Bold Goal), and the Humana Healthcare Research team. Across all divisions, Dr. Shrank promotes the idea of Humana as a learning organization and has dedicated his team to rapid learning – where meaningful insights are generated accurately and quickly, and enhance Humana’s ability to continually evolve to improve the health and health outcomes of those we serve.
Dr. Shrank is a member of the Management Team, which sets the firm’s strategic direction, and reports and to President and Chief Executive Officer, Bruce Broussard. Additionally, Dr. Shrank serves on the Board of National Committee for Quality Assurance and is co-chair of the Clinical Transformation Taskforce for the Health Care Payment Learning and Action Network.
Dr. Shrank joined Humana in April 2019 having previously been employed by the University of Pittsburgh Medical Center (UPMC) as CMO, Insurance Services Division from 2016 to 2019. At UPMC, Dr. Shrank was responsible for clinical operations, policy and quality for approximately 3.5 million members in government and commercial lines of business.
Prior, Dr. Shrank served as SVP, Chief Scientific Officer, and CMO of Provider Innovation at CVS Health from 2013 to 2016. From 2011 to 2013, Dr. Shrank served as Director, Research and Rapid[1]Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services.
Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital and as an Assistant Professor at Harvard Medical School.
Dr. Shrank completed his medical degree from Cornell University Medical College, his residency in internal medicine at Georgetown University and his fellowship in Health Policy Research at the University of California, Los Angeles. He also earned a Master of Science degree in Health Services from the University of California, Los Angeles and a Bachelor of Arts degree from Brown University.
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Mat Spaan, MPA, has worked with the state of Minnesota since 2008 in implementing and developing health policy and payment reform initiatives, with his most recent work managing care delivery and payment activities within the state’s Medicaid program. Since 2013, one of his primary roles is as lead on Minnesota’s Medicaid ACO demonstration, known as the Integrated Health Partnerships (IHP) program, and the development of value-based purchasing in Medicaid.
Mat’s previous state projects have included the development of the state’s All-Payer Claims Database and planning director overseeing the creation of a hospital and physician clinic cost and quality comparison tool. Prior to joining the state, he’s held several interesting positions in the private and nonprofit sectors, including as a manager with a national health advocacy organization, organizer for a neighborhood arts and economic development nonprofit in New Orleans, and as a boat captain on Lake Michigan. Mat earned his Master of Public Administration degree from the University of New Orleans.
Dr. Mark Friedberg is Senior Vice President of Performance Measurement and Improvement for our company, the largest private health plan in Massachusetts and one of the largest independent, not-for-profit Blue Cross Blue Shield plans in the country. We serve more than 3 million members and more than 20,000 employers and are consistently rated among the nation’s best health plans for overall member satisfaction and quality.
Mark is responsible for all activities related to measuring and improving the performance of our provider network, including quality and equity metrics used in our value-based contracts such as our Alternative Quality Contract. He also oversees data analytics related to our own performance, ensuring we meet or exceed state and federal standards as well as HEDIS, NCQA and CMS quality measures.
Before joining our company in 2019, Mark was a researcher at the RAND Corporation, a leading policy research organization, where he led multiple projects to measure, evaluate and improve health system performance.
He is a general internist who provides primary care at Brigham and Women’s Hospital, where he completed his residency and fellowship. Mark works at the Brigham a half day each week.
Mark has an M.D. from Harvard Medical School, a Master of Public Policy from the Harvard Kennedy School of Government, and a Bachelor of Arts from Swarthmore College. He is also a part-time assistant professor of medicine at Harvard Medical School. Mark enjoys music, food, and beach trips with his family.
Brian W. Powers, MD, MBA is Deputy Chief Medical Officer at Humana. In this role, he works across the organization to support rapid learning and evaluation of Humana’s integrated care delivery strategy; to lead research in payment and delivery innovation; and to drive physician engagement, alignment, advocacy, and education across the company. Prior to Humana, he led population health strategy and analytics for CareMore and Aspire Health, both care delivery subsidiaries of Anthem. In prior roles, he was responsible for initiatives to improve health care quality and value at Mass General Brigham, the National Academy of Medicine, and the Massachusetts Health Policy Commission. An accomplished researcher, Dr. Powers is an Assistant Professor of Medicine at the Tufts University School of Medicine, has published peer-reviewed studies in venues such as JAMA, Science, and the New England Journal of Medicine, and serves as Deputy Editor of Healthcare: The Journal of Delivery Science and Innovation. He holds an MD from Harvard Medical School, an MBA from Harvard Business School, and an AB from Bowdoin College. He completed his clinical training in internal medicine and primary care at Brigham and Women’s Hospital and is a practicing internist.
Elizabeth Fowler, Ph.D., J.D., is the deputy administrator and director of the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Fowler previously served as executive vice president of programs at The Commonwealth Fund and vice president for Global Health Policy at Johnson & Johnson. Liz was special assistant to President Obama on healthcare and economic policy at the National Economic Council. In 2008-2010, she was chief health counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). Liz has over 25 years of experience in health policy and health services research. She earned her bachelor’s degree from the University of Pennsylvania, a Ph.D. from the Johns Hopkins Bloomberg School of Public Health, where her research focused on risk adjustment, and a law degree (J.D.) from the University of Minnesota. She is admitted to the bar in Maryland, the District of Columbia, and the U.S. Supreme Court. Liz is a Fellow of the inaugural class of the Aspen Health Innovators Fellowship and a member of the Aspen Global Leadership Network.
Marc Harrison, M.D., President and CEO of Intermountain Healthcare, is a pediatric critical care physician with a proven track record as a top operation executive on a global scale. He is a national and international thought leader on transformation and innovation—ranking in Fortune’s Top 50 World’s Greatest Leaders in 2019. He also ranked third on Modern Healthcare’s 100 Most Influential People in Healthcare in 2020.
Dr. Harrison is leading Intermountain’s 41,000 employees—who are all called caregivers—to embrace bold new approaches to improve health, re-define value-based care, and serve people in new ways. For example, Intermountain launched Civica Rx, a not-for-profit generic drug manufacturer and distributor, to make generic medications more available and affordable in hospitals across the nation. Intermountain is also a founding member of the Utah Alliance for the Determinants of Health, which is a collaboration of community partners designed to proactively address forces that affect people’s health well before they come to a clinic or a hospital.
Dr. Harrison also served as CEO of Cleveland Clinic Abu Dhabi, Chief of International Business Development at Cleveland Clinic, and Chief Medical Operations Officer at Cleveland Clinic.
He received his undergraduate degree from Haverford College and his medical degree from Dartmouth Medical School, completed a pediatric residency and pediatric care fellowship at Intermountain’s Primary Children’s Hospital, and completed a Master of Medical Management at Carnegie Mellon University.
Dr. Harrison is an all-American triathlete and represented the U.S. at the 2014 World Championships. He is also a two-time cancer survivor with his sights currently on completing an Ironman.
Marshall H. Chin, M.D., M.P.H., the Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine at the University of Chicago, is a practicing general internist and health services researcher who has dedicated his career to reducing health disparities through interventions at individual, organizational, community, and policy levels.
Dr. Chin co-chairs the CMS HCP-LAN Health Equity Advisory Team. He also co-directs the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation program and collaborates with teams of state Medicaid agencies, Medicaid managed care organizations, and frontline healthcare organizations to implement payment reforms to support and incentivize care transformations that advance health equity. He also partners with eight urban and rural communities to integrate medical and social care to reduce diabetes disparities through the Merck Foundation Bridging the Gap program.
Dr. Chin is a graduate of Harvard College and the University of California at San Francisco School of Medicine, and he completed residency and fellowship training in general internal medicine at Brigham and Women’s Hospital, Harvard Medical School. He is a former President of the Society of General Internal Medicine, and he was elected to the National Academy of Medicine in 2017.
Christina Severin is a leading health care executive with more than 20 years of experience and numerous accomplishments in managed care, delivery systems, health insurance, Accountable Care Organizations, quality, public policy, and public health. She has led Community Care Cooperative (C3) since the organization’s launch in 2016, leveraging the proven best practices of ACOs throughout the country, building the organization on the collective strengths of its health centers, and growing the organization to better serve MassHealth members throughout the commonwealth. Christina’s prior leadership experience includes serving as President and Chief Executive Officer of Beth Israel Deaconess Care Organization and as President of Network Health, a nonprofit Massachusetts health plan.
Elizabeth Kasper is the Special Policy Advisor for Alternative Payment Models at North Carolina Medicaid. In this role, she works with external and internal stakeholders to support the design and implementation of value-based payment models and policies that advance NC Medicaid’s priorities. Liz’s 20-year career in health policy and health services research has also included work on health quality and public health measures, federally qualified health centers, Medicaid clinical policy, and pharmaceutical regulation and reimbursement. Liz holds a Master of Science in Public Health from the University of North Carolina at Chapel Hill and a BA from Oberlin College.
Alicia Berkemeyer is responsible for all programs related to provider networks, value-based programs, primary care, and commercial pharmacy for Arkansas Blue Cross and Blue Shield and its affiliates. She has led and managed the development of patient-centered medical homes, employer clinics, and pharmacy programs. Berkemeyer played an instrumental role in Arkansas being chosen as one of only seven regions in the United States to participate in the federal Comprehensive Primary Care initiative and assisted the state in receiving significant funding from the Center for Medicare & Medicaid Innovation in the form of a State Innovation Model grant.
Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. Prior to joining DHCS, she served as Chief Administrative Officer for Ambulatory Services at the Alameda Health System (AHS) where she was responsible for all outpatient clinical operations, quality of care, and strategy for primary care, specialty care, dental services, and integrated and specialty behavioral health, as well as executive sponsor for value-based programs including the Medi-Cal 1115 Waiver. She also previously served as Medical Director of K6 Adult Medicine Clinic, where she managed a large urban hospital-based clinic, overseeing all practitioners, improving quality of care, and patient safety programs. In addition, she served on the Clinical Advisory Committee with the California Association of Public Hospitals/Safety Net Institute. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Dr. Babaria received her bachelor’s degree from Harvard College, as well as her MD and Master’s in health science from Yale University. She completed her residency training in internal medicine and global health fellowship at the University of California, San Francisco.
Chiquita Brooks-LaSure is the Administrator for the Centers for Medicare and Medicaid Services (CMS), where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.
A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Brooks-LaSure has decades of experience in the federal government, on Capitol Hill, and in the private sector.
As deputy director for policy at the Center for Consumer Information and Insurance Oversight within the Centers for Medicare & Medicaid Services, and earlier at the Department of Health & Human Services as director of coverage policy, Brooks-LaSure led the agency’s implementation of ACA coverage and insurance reform policy provisions.
Earlier in her career, Brooks-LaSure assisted House leaders in passing several healthcare laws, including the Medicare Improvements for Patients and Providers Act of 2008 and the ACA, as part of the Democratic staff for the U.S. House of Representatives’ Ways and Means Committee.
Brooks-LaSure began her career as a program examiner and lead Medicaid analyst for the Office of Management and Budget, coordinating Medicaid policy development for the health financing branch. Her role included evaluating policy options and briefing White House and federal agency officials on policy recommendations regarding the uninsured, Medicaid, and the Children’s Health Insurance Program.
