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There is a new day coming. It won't happen overnight, but in bits and pieces the health care system, like it or not, is being moved in a different direction. It is no longer about volume, units of service, FFS payment for activity, and pay now and audit later. It is increasingly about value, outcome, bundled or global payment, and the end of "pay and chase" when it comes to right payment.

One of the most significant changes in the Medicare and Medicaid program recently has been the introduction of "recovery audit contracting" (RAC) as a way of assuring that proper payments are being made for Medicare and now Medicaid services. Contractors are now incentivized with contingency fees to find improper payments to providers of government health care services. And the Affordable Care Act (ACA) provided a renewed sense of vigor and urgency to the process of rooting out waste, fraud, and abuse. Congress likes the concept. And the Administration counts on it for needed savings.

But the new era is not just about payment and finances. CMS now publicly reports hospital 30-day Medicare readmission rates as a measure of hospital performance and "quality" with new financial penalties beginning in FY 2013 and beyond for hospitals with unacceptably high rates. Fair or not, properly defined or not, the penalties can be serious, and transparency and payment strategies are now seen as key tools for both reducing health care costs and improving health care quality.

Finally, the Federal government and many national commercial payers are now experimenting with new value-based purchasing designs based on hospitals' demonstrated quality and financial performance, including the quality of the patient experience. Re-tooling and redesign are the new watchwords. Engagement of boards, medical staff, and patients are the new imperatives.

The Summit will bring together the leading national experts in payment policy, care delivery, operations, and technology and innovation from government, academia, the research community, health plans, hospitals, and consumer organizations. Highly successful models will be highlighted. Networking opportunities will abound. Special training programs are offered for both RAC and readmissions, giving hospitals the chance to send teams at reduced rates. In short, with so much at stake, this is a "must attend" event for health plans, health systems, hospitals, and their health care and patient partners.


This is a conference that stretches across virtually all aspects of hospital and health system operations and the provider partnerships that are important to them in this new valuebased world. Those who would benefit from this conference and its training programs include:

  • Employers and employer coalitions
  • Health plans
  • Hospital and health system chief executive officers, chief operating officers, and chief financial officers
  • Hospital and health system medical directors and directors of nursing
  • Patient safety officers
  • Compliance officers
  • Discharge planning and social services managers
  • RAC Liaisons, coders, and patient accounts staff
  • Health care attorneys
  • Practicing physicians and physician organizations
  • Physician assistants, nurse practitioners, nurse case managers and other allied health professionals on a primary care team
  • Community clinics and neighborhood health centers
  • Patient advocate representatives
  • Organizations representing vulnerable populations and individuals with special needs
  • Disease management organizations
  • Pharmaceutical companies and pharmacy benefit managers
  • Health care information technology managers
  • Accreditation organizations
  • Federal, state, and local government health agencies
  • Vendors and consulting firms specializing in audits and appeals, revenue cycle management, transitions of care, health literacy and health coaching, risk adjustment, predictive modeling, clinical documentation improvement, patient safety, telehealth and remote patient monitoring, and quality measurement

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