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Wednesday, March 20 • 10:00am - 11:00am
Track 5: INDUSTRY SESSION - Optimizing Outcomes Today and Tomorrow: Performance Monitoring of MCOs to Realize the Triple Aim

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Since the introduction of the Health Maintenance Organization Act of 1973, there have been numerous iterations of Managed Care Organizations (MCOs). From CHINs to HIEs, each iteration evolved in the hopes to improve community health and the experience of care while reducing cost. While providers prioritized the improvement promised by the Triple Aim, technology teams, vendors, and other agencies worked diligently to develop technology solutions that would meaningfully augment that improvement. Today, MCOs are faced with a unique challenge to optimize population health outcomes, amidst evolving Medicaid dynamics, while continuing to manage disparate, siloed systems that augment the care of their populations. As the landscape of data becomes more prolific, an action-oriented perspective on realizing the Triple Aim while leveraging the work and systems of siloed solutions is becoming increasingly more valuable – both for the health of the general population as well as the management of state resources. Moreover, there is additional value to be realized for the community at large when MCO insights and comparisons can inform state, district and territory-level trends including the performance by physician, FQHC, group practice and hospital.

This session illustrates ways in which technology can support and assist MCOs in realizing the Triple Aim through data management systems for surveillance, reporting, strategic planning, and operations used to improve population health outcomes. Attendees will learn about key measures that help drive the Triple Aim value in MCOs:
  • Independent Validation of MCO Performance
  • Quality Measure, HEDIS & Health Homes Measures Monitoring
  • Fraud and Abuse Detection
  • Ability to drive PIP specific for each MCO
  • Benefits of a Single Platform
  • Finally, the speaker will showcase example population health and care coordination programs alongside
  • the insights garnered and shared from the DC Department of Health Care Finance, such as:
  • High or Rising Cost (Patient/Provider Strategy)
  • High Cost Diagnosis or Cost Per Patient Strategy
  • High ER Users and Non-Emergent Use of ER
  • Frequently Admitted Patients or Admissions for Low Acuity
  • Re-Admissions by Facility, Diagnosis
  • Focus on Chronic Care or Annual Wellness
  • Provider or Practice-based Customization
  • Risk-based, Predictive Cost-based, Resource Utilization-based Strategy (By Practice or Provider)
  • RAF-based Educational Strategy
  • Disease-based Quality Performance (Gaps in Care) with Preventive Care for Adults, Pediatrics, and Maternity

avatar for Dr. Sanjay Seth

Dr. Sanjay Seth

Executive Vice President, HealthEC
Dr. Sanjay Seth brings over 30 years of clinical, administrative and consulting experience to the HealthEC leadership team, where he develops strategies to support providers and organizations participating in care delivery programs borne out of Health Reform and the Accountable Care... Read More →
avatar for Kerda DeHaan

Kerda DeHaan

Management Analyst, DC Department of Health Care Finance
Kerda DeHaan currently serves as the administrator for the DC Department of Health Care Finance’s health home program for individuals with multiple chronic conditions. She has over 15 years of experience in the public health and has transferred her knowledge in maternal and child... Read More →
avatar for Juan M. Montañez

Juan M. Montañez

Principal, Health Management Associates, Washington, DC
Juan has more than 25 years of experience and an extensive knowledge base that encompasses information technology, financial planning, business process optimization, strategic planning, cost-benefit analysis, government procurement, and project management. Presently Juan is leading... Read More →

Wednesday March 20, 2019 10:00am - 11:00am PDT
Tubman A & B (3rd Floor)