Volume X   |    March 12, 2012  

Innovations in
Network Contracting –

Assuring Transparency, Implementing Viable P4P Strategies, and Creating Successful Partnerships

Published 3.12.2012  
Scientific Cowboys

Overview: Overview: On February 27, 2012 and February 28, 2012 at the Network Contracting Congress in Las Vegas Nevada leaders and innovators gathered to share their insights and offer tested solutions on how to streamline the network contracting process. Conference highlights included a quick peek at Molina’s contract management system, Independence Blue Cross’ significant insight and efforts in data analytics and ability to measure P4P success, a Provider Perspective from the Carle Foundation and a call to action by HEOPS for organizations’  to explore entrepreneurial partnerships.

Presentations:
2012 Network Contracting Congress in Las Vegas NV

Below is a summary of the conference topic introduction and links to the presentations.

• Cetti, Robert; Vice President, National Medical Cost Management-Cigna
  “Payment Methodologies for Ancillary Contracts – Incorporating Effective Reimbursement Strategies and Terminology”
• Crawford, Frederick; Corporate Director, Provider Contracting-Molina Healthcare
  “Implementing Innovative Technological Solutions to Improve Contracting Opportunities with Network Management”
• Everitt, Nancy C;  President & CEO-HEOPS, INC
  “The New New Thing”: Bridging Primary Care Shortages via Entrepreneurial Partnership Models”
• Garrett, Scott; Vice President, Managed Care-Alliant Health Plans
  “Utilizing Effective Contracting and Negotiating Strategies with Providers-Leveraging Key Contract Terms to Gain Advantage”
• Gordon, Marina; Director, Provider Services-CenCal Health Plan
  “Creating and Implementing Innovative Pay-for-Performance Programs in Provider Contracting to Improve Quality and Manage Costs”
• Lund, Carl; Vice President, Facility Contracting & Services-Emblem Health
  “Developing Provider Engagement Strategies that Maintain Long-Term, Mutually Successful Partnerships with Providers”
• Mytty, Al; Director, Payer Contracting-Carle Foundation
  “Provider Perspective: Network Contracting in An Era of Healthcare Reform-Opportunities Under the ACA”
• Pogar, Janet; Regional Vice President, Network Management-Anthem Blue Cross and Blue Shield
  “Innovative Network Contracting Strategies to Establish Effective Partnerships with Large Primary Care Practices and Multispecialty Groups”
• Robidou, Robert; Director, Network Development -Cook Children’s Health Plan
  “Creating Operational Efficiency through Cross-Departmental Collaboration in Areas that Impact Provider Network Management”
• Simpkins, Christopher; Director, Plan & Provider Performance-Independence Blue Cross
  “Utilizing Advanced Analytics and Health Plan Data to Ensure P4P Programs and ACOs Deliver Quality and Cost Reductions”
• Ruiz de Somocurcio, Michael; Director, Network Contracting-AmeriHealth
  “Data Driven Decision Making: Applying Sound Financial Modeling and Analysis to Provider Contracting”
• Webster, David; Director, Medicare Preferred Contracting, Network Contracting & Performance Management-Tufts Health Plan
  “Implementing Strategies with the Provider Network to Survive the Reduction in Medicare Advantage Funding”
• Weisblatt, Rick; SVP, Provider Network & Product Development-Harvard Pilgrim Health Care
  “Incentive-Based Contracting Models for Providers and Payers: Facilitating the Development of Accountable Care Organizations”

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About HEOPS:

HEOPS, Inc. the national leader in patient access solutions. Since 2004, HEOPS has been and is currently a strategic partner to many of the nation’s largest managed care organizations. HEOPS has established relationships with 40+ unique statewide health plans spanning more than 250 engagements, outreaching to over 500,000 providers nationally. HEOPS is one of a kind.

HEOPS is a market innovator in expedited network development and high-profile provider negotiations; HEOPS has cultivated unparalleled operational insight, intellectual capital, and experiential knowledge across the country through high volume, high quality experience and the perspective of best practices across market leaders.