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There are numerous questions to address for health plans intent on improving patient safety by reducing the preventable errors made by hospitals, such as death or disability resulting from medical errors. Health plans must determine which errors to focus on, develop and introduce appropriate contract language, and determine how they will audit hospital claims.

Hear a provocative discussion of rapidly evolving never-event payment policies, which are now in place at Aetna, Inc., Anthem of Virginia, WellPoint, HealthPartners, Inc., Pennsylvania Medicaid and other payers, in addition to CMS.

You’ll get information and strategies on:

• Under what circumstances should never-event payment policies be used?
• Which errors should be targeted in hospital contracts? Which should be avoided?
• How can health plans determine when a never event has occurred?
• Which services associated with never-events should health plans pay for?
• What new payment infrastructure is required for health plans to monitor never-events and determine what should and should not be reimbursed?  
• Should never-event language be incorporated into physician contracts as well? And if so, how?

Speakers

CHARLES CUTLER, M.D. is Aetna’s chief medical director for national accounts. Prior to assuming this role, Dr. Cutler was Aetna’s national medical director for quality and clinical integration, where he was responsible for national quality strategy, accreditation, patient safety activities, quality measurement and improvement, and integrating clinical activities across the company’s portfolio of products. He was previously the chief medical officer at the American Association of Health Plans, Washington, D.C., and was responsible for clinical aspects of health care policy, chronic disease initiatives, and development of collaborations of health plans and other stakeholders to improve quality of care.

JAY SCHUKMAN, M.D., medical director of Anthem Blue Cross Blue Shield of Virginia, has been with the insurer since 1999. Previously, he was the medical director of a physician-owned health plan associated with the Kansas Medical Society.  Between 1978 and 1994, Dr. Schukman was a family practitioner in Kansas. He received his medical degree from the University of Kansas in 1975 and completed a residency in family medicine in 1978 at the Kansas University Medical Center in Kansas City, Kan. He completed a Master’s degree in administrative and preventive medicine at the University of Wisconsin.

LEAH BINDER is CEO of The Leapfrog Group, a voluntary program aimed at helping the health care industry better understand that  “big leaps” in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care. Ms. Binder previously was vice president of Franklin Community Health Network based in  Farmington, Maine and also served as executive director of the Healthy Community Coalition (HCC) and Franklin Health Access.

Moderator: Steve Davis is managing editor of AIS's industry-leading newsletters, Health Plan Week and Inside Consumer-Directed Care.

Designed Especially For

• Health plan and insurance company
• CFOs
• Contracting directors
• Medical and clinical-services directors
• Legal affairs directors
• Provider-relations managers
• Provider group
• Administrators
• CFOs
• Directors of managed care contracting
• Business development directors
• Attorneys and consultants
• Actuaries

Written Materials