Thursday, October 4
1:45 pm - 3:00 pm Concurrent Sessions
Managed Care Operations
Raising the Bar on Pharmacy Benefit Management Quality
James R. Lang, PharmD, MBA, Vice President of Pharmacy, Blue Cross Blue Shield of Michigan
Lorna D. Taylor, Contract Specialist , U.S. Office of Personnel Management
Moderator/Speaker: Janice Anderson, RPh, Director of Pharmacy Programs, URAC
URAC has created the first-ever accreditation programs for pharmacy benefits management to address the need for quality standards in the rapidly expanding PBM market. In this session, learn more from members of URAC committee members and staff about the new PBM accreditation, which includes standards relating to organizational integrity, clinical quality and benefits management programs, pharmacy network access, and consumer education and support. The panelist will also discuss the usefulness of standards in the selection of PBM vendors - why they are relevant and how they translate to usefulness in the market.
Care Coordination
Sponsored by an educational grant from Healthways, Inc.
Evaluating Improved Chronic Care Delivered by Disease Management to Health Disparities Populations
Patty Orr, RN, MSN, EdD, Senior Vice President Clinical Integrity, Healthways
William Vennart, MD, Vice President and National Medical Director, CareAdvantage, Inc.
This session features a case study on disease management participants living in health disparities zones for adherence to diabetes standards of care. Additionally, a health plan describes the use of a tool that incorporates a case mix and severity adjusted cohort of individuals within the same plan design to minimize the impact of common sources of bias in evaluating care management programs.
Health Information Technology
The Social Media Revolution: How Healthcare Bloggers and Private Online Portals Are Changing The World
Craig Froude, Executive Vice President, WebMD Health Services
Steven Krein, CEO, OrganizedWisdom LLC
Emerging technologies, social media and user generated content are putting consumers in control like never before. This session explores how health focused social networks, blogs, wiki’s and community sites are one of the biggest challenges and opportunities in searching for new ways to improve quality and deliver value. The speakers also explore how personalized online decision support applications are a catalyst for more informed healthcare decisions by offering transparency into cost and quality of services.
3:45 pm - 5:00 pm Concurrent Sessions
Managed Care Operations
Essentials of Prescription Drug Management
Matthew Brams, MD, Medical Director, Interface, EAP
Michael Lewandowski, Account Manager, Pharmaceutical Strategies Group
Mary Lushina, RN, Senior Vice-President, Managed Care Services & COO, Employers Occupational Health Inc.
Fred Newman, CEO, Interface, EAP
This session identifies the benefits of pharmacy benefit administration in a workers compensation environment including savings, as well as measures addressing drug safety, drug utilization management, and the use of pharmacy data to address physician over-prescribing and identify cases of fraud and abuse. Additionally, speakers explain how to reduce costs and increase productivity through integrated behavioral health management and prescription intervention.
Care Coordination
Sponsored by an educational grant from Healthways, Inc.
Developing a Value-Driven Measurement System for Successful
Care Management Collaboration
Joann Albright, PhD, Senior Vice President, Quality, Research, & Outcomes, Magellan Health Services
In an era in which health care is fragmented, care management remains paramount. The speakers in this session describe how a collaborative approach between case managers and pharmacists helped to improve member medication compliance. The speakers also provide the process steps, challenges and rewards of embedding an empirically driven measurement system into a case management program.
Health Information Technology
Roles of Various Stakeholders in Managing Health Care Costs with Access to Quality Transparency
Guy D'Andrea, President, Discern Consulting
John Weis, President and Co-Founder, Quest Analytics LLC
While using quality data is standard in most other purchase decisions, health care industry purchasers continue to select health plans without comparing the quality outcomes of the providers in the health plan. This session demonstrates how standardized quality and cost analysis can be used by employers to measure and compare outcomes of providers for health plan selection, and by health plans to create high performance network options. The speakers also discuss how provider "pay-for-performance" has emerged as a strategy to build market incentives for health care quality and efficiency.
Friday, October 5
10:45 am - 12:00 pm Concurrent Sessions
Managed Care Operations
A Complexity-Based, Systems Approach to Clinical Quality Improvement
Peter Bradford, MSN, Director of Quality and Utilization Management, Healthways’ WholeHealth Networks, Inc.
Wendy Faust, RN, BSN, Process Excellence Leader, Healthways, Inc.
In this session, a complementary and alternative medicine (CAM) firm discusses the complexity centered, systems approach to quality improvement and risk identification. A case study details the use of specific Lean/Six Sigma tools and methodology to improve clinician productivity and overall member contact levels in a healthcare telephonic delivery model. Speakers will discuss the process utilized as well
as the impact to member outcomes.
Care Coordination
Sponsored by an educational grant from Healthways, Inc.
Improving the Management, Access and Coordination of Care for Individuals with Co-Existing Behavioral and Medical Conditions
Mindy Legere, LMFT, Manager Health Services Programs, WellPoint Behavioral Health
Rebecca Sigafus, MSW, LSW, Director of Quality Improvement, InteCare, Inc.
Kirk Wheeler, PH., HSPP, Director of Clinical Operations, InteCare, Inc.
Individuals with chronic medical illnesses demonstrate a higher prevalence of co-occurring mood and anxiety disorders and often experience complications from their medical illness that place them at greater risk for negative clinical outcomes. This session examines a program that uses licensed behavioral health clinicians to help coordinate appropriate treatment for these members while ensuring coordination of care between medical and behavioral health providers. This session also features two performance improvement projects focused on areas of concern and interest for both Behavioral Healthcare and Managed Care Organizations regarding how to develop and improve communication and coordination of care between the medical and behavioral provider communities.
Health Information Technology
Leveraging Technology to Support Case Management Programs
Karen Black, RN, QI Coordinator, Arkansas Blue Cross Blue Shield
Barbara Earing, LICSW, CCN, Manager of Case Management, Beacon Health Strategies
Speakers in this session outline the design and administration of a web-based tool which enables medical and case management staff to manage the flow of information like policies and procedures, data and reports related to quality improvement projects, and educational resources necessary to do their jobs efficiently. The speakers also describe how a team of clinicians and IT professionals developed a customized documentation system that allows for tracking of data that measures clinical case management outcomes used to support improvements in an Intensive Case Management program.