This meeting is for HANYS' members only.

HANYS’ acclaimed SWAT program provides you with the tools and strategies you need in the evolving managed care marketplace. SWAT is designed to help you understand the changing managed care environment and how to position your organization to meet its challenges and opportunities.

This year’s SWAT program will focus on new care delivery models and innovative reimbursement mechanisms such as bundled and global payment. It will feature one of the first commercial Accountable Care Organizations (ACOs) in the nation and will cover new approaches to managing claim denials.

Experts from across the country who have developed successful models for succeeding in the changing managed care environment will discuss the core skills and approaches necessary to build similar successful programs in New York State.

Click here for a copy of the SWAT VI brochure

Agenda

Thursday, October 4

8 - 9:30 a.m. Breakfast and Registration

9 - 9:30 a.m. Introductory Remarks

Jeffrey Gold, Esq., Vice President, Managed Care and Special Counsel, Healthcare Association of New York State

9:30 - 10:45 a.m. Advocate Health Care: Building the Nation’s Largest Commercial ACO in Chicago, Illinois

Thomas Babbo, Esq., Partner, Hogan Marren, Ltd.

A Representative from Advocate Health Care

Thomas Babbo, Esq., an architect of the clinical integration program at Advocate Health Care, and a partner at Hogan Marren, will discuss Advocate’s journey to becoming one of the largest and most successful commercial ACOs in the nation.

11 a.m. - 12:15 p.m. Henry Ford Health System: A Framework for System Integration, Coordination, Collaboration, and Innovation in Detroit, Michigan

Nancy M. Schlichting, Chief Executive Officer, Henry Ford Health System (invited)

Henry Ford Health System is a vertically integrated health care system in southeastern Michigan whose leadership is committed to systemic integration, clinical excellence, and customer value through the core competencies of collaboration, care coordination, innovation, and learning. Henry Ford’s care innovation initiatives were recognized in 2011 when it was awarded a Malcolm Baldrige National Quality Award, America’s highest honor for innovation and performance excellence. Nancy Schlichting will discuss Henry Ford’s success and how its integration of care delivery facilitates quality monitoring, measurement, and improvement activities.

12:15 - 1:15 p.m. Lunch

1:15 - 2:30 p.m. Saint Francis Health System: Innovative Payer Management and Accountability in Greenville, South Carolina

Jack Henry, President and Chief Executive Officer, Saint Francis Health System (invited)

Saint Francis Health System has created an organizational culture designed to improve internal communications, hold payers accountable for timely claims processing and reprocessing, decrease turnaround times, and minimize unwarranted denials.
Jack Henry will discuss ways to:

• identify relevant metrics and potential improvement areas by developing individual payer scorecards and dashboards;
• create a structure to drive accountability; and
• develop a culture of improved communication between managed care representatives and patient accounting.

2:45 - 4:15 p.m. Interactive Panel Discussion: How to Develop Similar Programs and Success in New York State

FEATURING: Thomas Babbo, Esq.; A Representative from Advocate Health Care;
Nancy M. Schlichting (invited); and Jack Henry (invited)

MODERATOR: Jerry Salkowe, M.D., Vice President, Clinical Affairs,
Healthcare Association of New York State

The day’s program speakers will participate in an interactive discussion with SWAT participants to brainstorm how similar success and innovation can take place in New York State. Participants will be polled live to facilitate a dialogue about the current environment and what meaningful steps can be taken to transform New York’s delivery system.

5:00 p.m. Cocktail Reception
Hosted by HANYS Solutions at Jacob & Anthony American Grille

Friday, October 5

Breakfast will be available prior to the start of the program.

8:30 - 9:30 a.m. Denials Prevention: A Patient-Focused Model for Cost Reduction

Richard D. Wagner, CPA, Partner, Eide Bailly, LLP

Richard Wagner will explain strategies and tools to prevent claim denials and an approach to managing an organization’s response to audits, including how to:

• map problem areas in the claims submission process and develop solutions with the help of a multidisciplinary team;
• use case managers to prevent denials and assist in the appeal of rejected claims; and
• request oral reconsideration of pended claims and support attending physicians in orally responding to the payer’s medical team.

9:30 - 10:30 a.m. Managing Managed Care

Brandon Edwards, President, ReviveHealth

Brandon Edwards, President of ReviveHealth, publisher of the National Payor Survey, will describe recent shifts in the managed care marketplace. ReviveHealth annually interviews providers, insurers, and employers to accurately assess the current managed care environment. Mr. Edwards will review the conclusions that can be drawn from this year’s National Payor Survey and why more health plans are shifting to tougher contract negotiations and strict benefit design.

10:45 a.m. - noon Aligning Physicians to Insulate Your Facility from Financial Risk

John Zelem, M.D., F.A.C.S., Executive Medical Director, Client Relations and Education, Executive Health Resources

To date, medical staffs have often tried to steer clear of the “business” side of health care, leaving administration to the hospital. This separation has created frustration and challengesfor hospital administration in managing payer denials, length of stay, resource utilization, and clarity of documentation. Many have spent millions on educational programs and projects to create aligned understanding, but few have succeeded. Medical necessity compliance and patient status problems appear to be an additional manifestation of separation: physicians documenting medical necessity in a manner appropriate for fellow physicians, but leaving hospitals exposed to patient status scrutiny by payers. Both hospitals and physicians are at risk if they do not
work together.

Following this session, you should be able to:

• identify key points of intersection between clinical and administrative processes;
• describe regulatory requirements for both hospital and medical staffs;
• explain how the Centers for Medicare and Medicaid Services monitors compliance;
• outline processes to put in place to ensure concordance; and
• develop an action plan to support greater compliance.

Noon - 1 p.m. Lunch

1 - 2:15 p.m. Determining the Right Bundled Payment for Your Facility

Mark Lutes, Esq., Epstein Becker & Green, P.C.

Mark Lutes has a deep understanding of managed care markets and regulation, and has advised a variety of providers and payers on structuring innovative payment arrangements. Mr. Lutes will discuss the main challenges with the bundled payment model and strategies that industry pioneers are using to overcome them. He will also describe the types of bundled payment arrangements that have the highest degree of success in improving care and reducing costs for hospitals.

2:30 - 3:45 p.m. Data Analytics for Calculating Bundled Payments

Gloria Kupferman, Vice President, National Information Products, DataGen

Bundling payments for all inpatient, physician, and post-acute services provided during episodes of care is one of several new delivery and reimbursement models being tested under the federal health care reform law. Payment bundling allows hospitals and other provider organizations to contract to receive a fixed payment budget for selected patient conditions.

Gloria Kupferman will describe how hospitals can:

• identify high-volume and high-service variation patient conditions (e.g., Diagnosis Related Groups);
• pinpoint payment variability associated with inpatient, physician, and post-acute services;
• break down payments into categories for each episode of care, allowing for evaluation of service utilization;
• highlight strategic partnership opportunities; and
• benchmark payment and utilization mix to regional and national averages.

3:45 - 4 p.m. Concluding Remarks

Jeffrey Gold

Who should attend?

• Behavioral Health Directors
• Chief Financial Officers
• Directors of Managed Care
• Directors of Reimbursement
• Directors of Patient Accounts
• Legal Counsel

Continuing Education Credits

Program participants are eligible for 11 Category II non-American College of Healthcare Executives Continuing Education credits.

Program participants are eligible for 5 Certified Public Accountancy Continuing Education credits.

Registration

The deadline to register for this program is October 1. If you have questions about registration, contact Christopher Guyon, Webconference and Events Assistant, at (518) 431-7834 or at cguyon@hanys.org.

Room reservation and event registration are separate.

Hotel Reservations

Hampton Inn Suites,
Saratoga Springs Downtown
25 Lake Avenue, Saratoga Springs, NY
Telephone: (518) 584-2100

A block of rooms at the Hampton Inn Suites, Saratoga Springs Downtown has been reserved for SWAT attendees. Please reserve your room by September 10 to receive a discounted nightly rate of $159.

The group code is HAY.

To Reserve Online:
Visit http://bit.ly/MytrWL
or
To Reserve by Telephone:
Call the Hampton Inn Suites, Saratoga Springs Downtown at (518) 584-2100.

What to Wear

The atmosphere throughout the event is relaxed and we suggest that participants make themselves comfortable. Dress is business casual. Participants should bring a sweater to the meeting room as it tends to be cool.

Questions?

For registration questions, please contact Christopher Guyon, Webconference and Events Assistant, at (518) 431-7834 or at cguyon@hanys.org
For questions about the SWAT program, please contact HANYS’ managed care staff:
Jeffrey Gold, Vice President and Special Counsel: (518) 431-7730 or jgold@hanys.org
Cara Henley, Manager: (518) 431-7827 or chenley@hanys.org
Cheryl Kraus, Policy Specialist: (518) 431-7871 or ckraus@hanys.org
Anne-Marie Mull, Executive Assistant: (518) 431-7890 or ammull@hanys.org

Cancellations

Registrations cancelled after September 26 are subject to a $50 administrative charge. Registration fees for those canceling on the day of the program or failing to attend are forfeited. Substitutions are permitted and encouraged, but should be indicated either before or at the Conference.