The new public data allows health plans to identify the right provider partners with which to participate in risk arrangements and to build a network that serves as a strategic advantage in the new world of risk arrangements.
Louisville, KY (PRWEB) October 18, 2015
Bryant Hutson, Senior Client Strategist at RowdMap, Inc., and David Goodson, Vice President, Enterprise Medicare, Health Care Service Corporation, will be speaking on how health plans can use newly released government data to create a risk-ready network to succeed in value-based markets. The presentation, entitled “Network as Strategic Advantage: Curating a Risk-Ready Network to Succeed in a Value-Based Market,” will be delivered at the America’s Health Insurance Plans (AHIP) 2015 National Conferences on Medicare and Medicaid and Dual Eligibles Summit on Monday, October 19, 2015, at the JW Marriott Washington, D.C. http://www.ahip.org/mcmcduals2015/medicare-agenda/#session2
America’s Health Insurance Plans (AHIP) is the national trade association representing the health insurance industry. AHIP’s members provide health and supplemental benefits to 200 million Americans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. AHIP’s 2015 National Conferences on Medicare and Medicaid and Dual Eligibles Summit is a leading event focusing on advocating for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality and innovation.
Success in pay for value programs comes from improving the efficiency, quality and experience of care. Last year, the US spent $850BB on low and no value care from higher intensity, and riskier treatment options that deliver no additional benefits to patients. Thirty cents of every dollar and up to 42% of patients receive his care every year. This low and no value care is driven by a Fee for Service (FFS) economic model where doctors and hospitals are paid more for doing more, and higher intensity treatment. This unnecessary spending far outweighs fraud, waste and abuse, but is not identifiable from traditional utilization reviews and unit cost analysis.
CMS has made historic data releases including the largest data set of doctors and hospitals in history to support identifying provider practice patterns with national and regional benchmarks in order to transition the delivery of care to value based payments. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-01.html
RowdMap, Inc. Senior Client Strategist, Bryant Hutson, and Health Care Service Corporation (HCSC) Vice President of Enterprise Medicare, David Goodson, will deliver a presentation on how health plans can use these public data sets to determine whether and how they will experience success in Pay for Value arrangements with provider partners. The government data also allows payers to benchmark providers and determine which providers will make the best partners for risk arrangements and then negotiate with them from shared government benchmarks. HCSC is an Independent Licensee of the Blue Cross and Blue Shield Association, and is the largest customer-owned health insurer in the United States and fourth largest overall, operating through our Blue Cross and Blue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. HCSC affiliates with subsidiaries such as TMG Health and Medecision. HCSC is a leader in using government benchmark data to develop value-based care models to spur greater collaboration and accountability among various stakeholders.
“As the market moves to value-based arrangements health plans that can identify providers who will succeed in risk arrangements will have a competitive advantage. Curating a network of providers who succeed in value-based arrangements is becoming a distinctive, strategic advantage that drives success. The new data allows leading health plans such as HCSC to intelligently make these decisions.” Bryant Hutson, Senior Client Manager, RowdMap, Inc.
Those interested in learning more are encouraged to contact RowdMap, Inc. directly or visit RowdMap, Inc. at the America’s Health Insurance Plans (AHIP), 2015 National Conferences on Medicare and Medicaid and Dual Eligibles Summit on Monday, October 19th, 2015 at the JW Marriott Washington, D.C.
About RowdMap, Inc. :
An Ernst and Young EY Entrepreneur Of The Year® winner, RowdMap helps health plans, government payers, providers, and hospital systems develop Risk-Readiness (SM) strategies to excel as they transition from fee-for- service to pay-for value. As CMS sunsets fee-for-service payments, RowdMap's Risk-Readiness (SM) Platform helps payers and providers identify and manage unwarranted and unexpected variation. RowdMap identifies ideal provider arrangements based on provider practice patterns and population characteristics within a geography. Payers and providers then use RowdMap to build strategies around these new risk relationships. RowdMap helps them enter new markets, segment populations, identify waste, design products, and understand referral patterns. RowdMap's platform comes preloaded with government benchmarks out of the box no IT integration required. RowdMap's Risk-Readiness (SM) Platform works across all market segments and has significantly larger returns than traditional, medical economic approaches.