Hospital readmissions for preventable problems exemplify the dysfunction and fragmentation in the health care system. For private health insurers, readmissions offer an opportunity to improve health care quality and keep costs in check. By penalizing hospitals for unnecessary readmissions, insurers contend providers might be more willing to embrace alternative reimbursement models such as bundled payments and accountable care organizations. But navigating the issue is fraught with potential landmines. Hear executives from Cigna Corp., Geisinger Health Plan and Highmark, Inc., explain how they are working to reduce hospital readmissions.
The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.
CMS estimates nearly one in five Medicare patients are readmitted within a month of discharge. In an effort to reduce readmissions for preventable problems, more than 2,000 hospitals that provide services to Medicare beneficiaries now face penalties if those patients are readmitted too soon. Some private carriers are following the government’s lead by getting tough on readmissions. But health systems worry that they will be incorrectly penalized if held accountable for patients who return for medical conditions unrelated to the original admission. Moreover, they say, commercial carriers are looking beyond the three conditions targeted by CMS — myocardial infarction, heart failure and pneumonia — and are including all admissions, which makes compliance much more difficult.
Hear a dynamic panel discussion that provides deep insight into these and other related questions about how to reduce readmissions and win buy-in from providers:
PAGE BABBIT is director of provider engagement, performance and partnerships at Highmark, Inc., where she is accountable for advancing the development of strategic design and deployment of new health care delivery strategies, including patient-centered medical homes, accountable care organizations (ACOs) and fee-for-value programs, which contribute to provider transformation. She is responsible for the execution of major business initiatives and health services strategies, focusing primarily on identifying and developing optimal provider partnership opportunities. Ms. Babbit previously was director of clinical informatics and process improvement at The Western Pennsylvania Hospital, where she directed operations for process improvement, infection control and the patient and family education center.
NICK GETTAS, M.D., is chief medical officer of regional accounts at Cigna Corp., where his responsibilities span sales, quality and provider networks, including collaborative accountable care relationships and total medical cost management. Dr. Gettas is a board-certified family physician and a cum laude graduate of the University of Toronto, Faculty of Medicine, with many years of clinical, teaching and administrative experience. He joined Cigna in 1998. His responsibilities within Cigna have spanned Medicare and commercial populations, insured and self-insured products, and national and regional accounts clients.
GUY D’ANDREA is president and founder of Discern, LLC. Since starting the consulting firm in 2004, Mr. D’Andrea has worked with leading health care organizations nationwide — including The Leapfrog Group, Bridges to Excellence and the National Business Coalition on Health — to design, implement and evaluate pay-for-performance and value-based purchasing strategies. He specializes in assessing the return on investment from these programs and has built ROI models for several clients. Prior to launching Discern, Mr. D’Andrea spent seven years as vice president at URAC, where he was responsible for the development of the firm’s accreditation programs, including quality standards for PPOs, utilization management organizations, case management organizations and consumer-directed health care. Prior to URAC, he spent five years working on managed care regulatory and policy issues with the American Association of Health Plans (now AHIP) and the Maryland Association of HMOs.
DOREEN SALEK, R.N., is director of population management partners for Geisinger Health Plan where she is responsible for leading the Beacon Community Case Management program. She has worked at Geisinger for 15 years, including service as a registered nurse in the Adult Intensive Care Unit, as well as experience in hospital and professional billing and coding, project management, and medical management. In her current role she is focused on transitions of care across the continuum, as well as strategies around enhancing quality and reducing readmissions, as well as innovations, such as telemonitoring. Ms. Salek earned her Bachelor of Science from Colorado State University and her nursing diploma from the Geisinger School of Nursing. She holds certifications as a Certified Coding Specialist and Certified Professional Coder.
CDs (and accompanying written materials) are shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes). You should receive your order within two weeks.* Shipping and handling cost is $12.
The On-Demand Recording will be delivered as a link within a PDF file of the accompanying written materials. Shipping will NOT be charged for this item.
Rush Orders: Please call us at 800-521-4323 to place a rush order.* We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.
*On-Demand recordings will be available within a week of the conference and CDs will be available within two weeks.
Listeners will also receive practical written information to supplement information covered by the Webinar speakers. A copyright release in the Printed Materials will permit you to make photocopies for each person listening to the Webinar and/or the On-Demand Recording.