Day 1: Provider Payment The 2020 Health Meeting Webcast Series features ten days of ten Health tracks, allowing attendees to create their own Health Meeting experience by mixing and matching which days and webcasts fit their professional development needs. Included in this recording are: Hospital Price Transparency Regulation: The Perspectives and Potential Impact for Both Hospitals and Health Insurers and Regulators
Day 1: Provider Payment
The 2020 Health Meeting Webcast Series features ten days of ten Health tracks, allowing attendees to create their own Health Meeting experience by mixing and matching which days and webcasts fit their professional development needs. Included in this recording are:
Hospital Price Transparency Regulation: The Perspectives and Potential Impact for Both Hospitals and Health Insurers and Regulators
In late 2019, the Department of Health and Human Services announced that by Jan. 2021, hospitals would be required to reveal their negotiated prices with insurers for their top services. The rule was met with resistance and caution from associations representing both hospitals and insurers. We will explore why these organizations are so cautious about committing to patients the ability to know negotiated prices upfront, especially when this data is eventually revealed to patients upon invoice. Is the concern the cost and difficulties of implementation? Or perhaps a desire to keep the current status quo? And is this all worth the patient confusion and frustration that results, especially with the increasing likelihood of high-deductible plans? We will explore hospital transparency and its potential impacts to hospital and health insurer financial performance, the overall cost of care, product design and member behavior.
Bundled Payments: Is the Effort Worth the Reward?
Bundled payments have exploded in popularity over the past several years, with thousands of providers nationwide participating in Medicare, Medicaid, and commercial bundled payment arrangements. These alternative payment arrangements can offer potential rewards to both payers and providers, but they also require substantial investment and aren’t without their own risks. In this session, we will examine the potential opportunities that bundled payments offer both payers and providers, as well as critically examine the costs associated with developing and implementing these types of arrangements. We will use case studies that include commercial payer representatives, provider representatives and an analytic perspective from Milliman's own experience.
Transformative Provider Payment Models
This session will discuss several transformative provider payment models. These include a variety of Value-Based Risk Arrangements redefining the relationship between provider and payer. With these arrangements, the providers are moved from a fee-for-service payment model to one that focuses on reducing the total cost of care. These arrangements also include mechanisms to ensure quality does not suffer. Through data analytics, providers look for innovative ways to reduce unnecessary utilization while optimizing the most effective clinical practices. The presentation will include examples of case studies where these techniques have been established. One case study will highlight what Geisinger has done through their integrated delivery system with primary care redesign,which moves unnecessary care out of the emergency room and back to the primary care setting. We will demonstrate how to reduce the overall cost of care by driving care to the right setting, at the right time and at the right cost (similar to the triple aim). To help keep the session engaging, we will use polling to survey the audience's understanding and experience with value-based models at the beginning and the end of the session.