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CULTURAL: An innovative culture and readiness for change
FINANCIAL: Willingness to invest and open to taking on risk
INFRASTRUCTURE: Integrated, PCP-led care, with strong provider management (including change management) and robust technology and data capabilities
MEMBER SERVICES: Able to differentiate itself along care, access, and cost, provide easy and integrated access to information and services, and create a positive customer experience
IQL18 focuses on successful strategies for succeeding
in risk-based payment models, including Medicare
Advantage. Meeting participants will depart San Antonio with
methodologies and tactics to address risk-based contracting,
payer contracting alignment, change management and
transformation, physician burnout, compensation plan
alignment, and more.
This year’s conference also will include meetings for several
AMGA Leadership Councils, networks of individuals in
leadership positions within AMGA member medical groups.
The following councils will meet in conjunction with IQL18:
CEO/Chair/President; Chief Administrative Officer/Chief
Operating Officer; Chief Medical Officer/Medical Director;
Quality Directors/Officer; and Chief Nursing Officer.
Healthcare vendors are invited to exhibit and provide
educational grants to support the conference.
AMGA invites you to take advantage of exclusive sponsorship/
exhibitor opportunities at the upcoming AMGA 2018 Institute for
Quality Leadership (IQL18) at the Hyatt Regency San Antonio Riverwalk
in San Antonio, Texas on November 13-15, 2018.
AMGA 2018 Institute for Quality Leadership
Medicare Advantage and Risk: Delivering on the Promise of Value
November 13-15, 2018
Hyatt Regency San Antonio RiverwalkSan Antonio, Texas
amga.org/IQL18
IQL18 focuses on successful strategies for succeeding
in risk-based payment models, including Medicare
Advantage. Meeting participants will depart San Antonio with
methodologies and tactics to address risk-based contracting,
payer contracting alignment, change management and
transformation, physician burnout, compensation plan
alignment, and more.
This year’s conference also will include meetings for several
AMGA Leadership Councils, networks of individuals in
leadership positions within AMGA member medical groups.
The following councils will meet in conjunction with IQL18:
CEO/Chair/President; Chief Administrative Officer/Chief
Operating Officer; Chief Medical Officer/Medical Director;
Quality Directors/Officer; and Chief Nursing Officer.
Healthcare vendors are invited to exhibit and provide
educational grants to support the conference.
AMGA invites you to take advantage of exclusive sponsorship/
exhibitor opportunities at the upcoming AMGA 2018 Institute for
Quality Leadership (IQL18) at the Hyatt Regency San Antonio Riverwalk
in San Antonio, Texas on November 13-15, 2018.
AMGA 2018 Institute for Quality Leadership
Medicare Advantage and Risk: Delivering on the Promise of Value
November 13-15, 2018
Hyatt Regency San Antonio RiverwalkSan Antonio, Texas
amga.org/IQL18
Pharmacy Services
• A clinical pharmacy team that is integrated into primary care will focus on improving quality metrics, medication adherence, mediation reconciliation/patient safety, and increasing generic utilization, as well as reducing hospital readmission rates and the use of high-risk medication
• Physician champions, a qualified program director, and data-based priorities are fundamental to building out pharmacy services that improve cost, quality, and provider satisfaction
• Medicare Advantage (MA) contracts show promising results; MA offers a good point-of-entry for physician groups and health systems looking to take early steps in risk-sharing
• Useful learnings for an organization in the early steps of developing a successful MA contract model to consider include:
Freezing the hierarchical condition category (HCC) denominator
Using an inhouse staff member who knows an organization’s culture to operationalize the call center and train staff
Improving EMR functionality around HCC diagnoses. Best practice advisory (BPA) alerts are important, but developing appropriate BPA workflows can be a challenge
• Differences in the provider lens and the health plan lens with respect to assessing attribution, risk, and value – as well as the different data sources they access and differences in how they evaluate success – can create initial challenges in developing risk-share agreements
Taking time to understand attribution can help providers understand the patient population they are accountable for and maximize reimbursement for their care
In particular, providers should note that attribution is based on claims data, understand and reconcile the attribution of patients, and reconcile denominators for accurate performance percentages
• Strong physician engagement and performance with respect to HCC scores and formulary prescribing heavily impacts performance in risk contracts and shared savings; without a careful focus on HCCs, benchmarks will not be met and savings won’t be generated
EXPANDING THE TRADITIONAL CARE TEAM
RISK IN THE VALUE-BASED WORLD
AMGA 2018 INSTITUTE FOR QUALITY LEADERSHIP INSIGHTS:
DELIVERING ON THE PROMISE OF VALUEThe last decade of healthcare reform has highlighted the importance of alignment & integration as bedrock to successful value-based health care. Successful partnerships will require leadership a culture supporting the volume-to-value shift, a full suite of service offerings, investment in human and IT resources, and inter-party trust.
• A trusted relationship between health systems and payers is increasingly recognized as not just a desirable factor of value-based partnerships, but a critical factor of their success
• Large employers are increasingly opting to bypass insurers and negotiate contracts directly with providers
• A frontline partnership challenge results from use of multiple (and often disparate) data sources and data-review & reporting methodologies. Quality measures are typically complex, and the number, type, and technical specifications can vary even for the same measure, creating confusion
CROSS-INDUSTRY COLLABORATIONS
TO LEARN MORE ABOUT THE KINETIX GROUP, ITS PROJECTS AND EVENTS, PLEASE VISIT:
thekinetixgroup.com linkedin.com/company/the-kinetix-group twitter.com/thekinetixgroup
DEVELOPED BY
KEY CHARACTERISTICS FOR POTENTIAL DIRECT-CONTRACTING PARTNERS INCLUDE:
IQL18 focuses on successful strategies for succeeding
in risk-based payment models, including Medicare
Advantage. Meeting participants will depart San Antonio with
methodologies and tactics to address risk-based contracting,
payer contracting alignment, change management and
transformation, physician burnout, compensation plan
alignment, and more.
This year’s conference also will include meetings for several
AMGA Leadership Councils, networks of individuals in
leadership positions within AMGA member medical groups.
The following councils will meet in conjunction with IQL18:
CEO/Chair/President; Chief Administrative Officer/Chief
Operating Officer; Chief Medical Officer/Medical Director;
Quality Directors/Officer; and Chief Nursing Officer.
Healthcare vendors are invited to exhibit and provide
educational grants to support the conference.
AMGA invites you to take advantage of exclusive sponsorship/
exhibitor opportunities at the upcoming AMGA 2018 Institute for
Quality Leadership (IQL18) at the Hyatt Regency San Antonio Riverwalk
in San Antonio, Texas on November 13-15, 2018.
AMGA 2018 Institute for Quality Leadership
Medicare Advantage and Risk: Delivering on the Promise of Value
November 13-15, 2018
Hyatt Regency San Antonio RiverwalkSan Antonio, Texas
amga.org/IQL18
Mental Health Services
• Mental health integration delivery strategies have improved the efficient management and outcomes of chronic diseases and complex comorbid conditions when:
Mental health is organized along the team-based care model
Standardized screening tools are used to understand the complexity of cases before allocating staff and resources
Implementation teams help promote uptake of effective interventions into routine practice
