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The Medical Home model is intended to provide comprehensive primary care and facilitate partnerships among patients and physicians and care teams. In the Medical Home, each patient has a personal physician who is responsible for directing all aspects of the patient’s care and coordinating across the entire health care system. But dozens of very tricky specific questions flow from this very general idea. And the answers could possibly have a profound impact on the quality of patient care and the bottom lines of U.S. health plans.

Hear two of the nation’s top Medical Home experts describe sensible first steps that health plans and providers could take to create, partner with and reward Medical Home practices.

• Health plan executives will learn how to respond to demands that they show initiative in the creation of Medical Home pilot projects, including the pressure to pay for them.
• Providers will learn how to find the crucial win-win that payers are demanding.

Get hands-on guidance on:

• How health plans are being pressured to create and fund new models of primary care, including the Evalue8 RFP process and the new Patient-Centered Primary Care Collaborative
• How to define a minimum feature set of a Medical Home
• History of CMS and other pilots to determine financial viability of new models
• Using Toyota lean-manufacturing concepts to develop a model of the “Lean Medical Home”
• How to build a Medical Home pilot, including appropriate reimbursement models
• How to construct the Medical Home platform to enable evolution and adaptations — improving the model for different populations, settings, providers, and specific objectives
• How to design a model to ensure cost control as well as quality improvements
• Enrollment criteria for Medical Homes: All patients? Only the highest 20% of utilizers? The highest 5%?
• Experience from the field: What seems to work? What doesn’t?

Speakers

JOE GIFFORD, M.D. is senior medical director of The Regence Group, a Blue Cross Blue Shield affiliate serving 3 million members in the Pacific Northwest/Mountain region. Dr. Gifford is a frequent speaker on innovation in health care at national conferences and leadership events. He has executive experience in the information technology sector as well as on both the provider and payer sides of health care. Prior to joining Regence, Dr. Gifford co-founded QuickCompliance, a health care Internet media company now part of the Discovery Channel, and served as director of product management at ChannelPoint, an insurance software company, founded by engineers from Sun Microsystems, now controlled by TriZetto. Dr. Gifford has authored a variety of publications in clinical research and health care services, and has created online training programs for many large organizations, including CMS and the Department of Defense. He received his clinical training at the University of Washington after receiving his M.D. degree from the University of California at San Diego. Dr. Gifford is a board-certified emergency physician.

PRANAV KOTHARI, M.D. is the co-founder of Renaissance Health, an organization developing new models of care to improve health care affordability, quality and experience, including alternative care models for the underserved and uninsured. Dr. Kothari is a lead developer of the Ambulatory Intensive Caring Unit (AICU) and the Video Visit Booth concept, innovative models of care (developed with the California HealthCare Foundation and Mercer) that are being piloted with purchasers/payer/provider partnerships, including with the Boeing Company and UNITE HERE. Dr. Kothari co-founded the original Renaissance Health internal medicine “lab” practice – a very early Medical Home model. He also organized the Innovators Roundtable, a Robert Wood Johnson Foundation-supported roundtable of primary care innovators. Prior to Renaissance Health, Dr. Kothari led the Harvard Forums on Health, a cross-discipline national series on American health care challenges and solutions. Dr. Kothari has executive experience with The Advisory Board Company, leading research and consulting initiatives in clinical service lines and consumer-centric new product development and lead strategy for The Atlantic Media Company. He received his M.D. from the University of Michigan and clinical training at Georgetown University.

Moderator: Jill Brown, managing editor of The AIS Report on Blue Cross and Blue Shield Plans and contributing editor of Health Plan Week.

Designed Especially For

• Health plan and insurance company
• CFOs
• Provider network and contracting managers
• Medical and clinical-services directors
• Provider-relations managers
• Product development and marketing executives
• Provider group
• Administrators
• CFOs
• Directors of managed care contracting
• Business development directors
• Attorneys and consultants
• Actuaries

Written Materials