PLENARY KEYNOTE PRESENTATIONS: MAY 14-15, 2018

Monday, May 14

Current State of Pop Health: Perspectives from a Payer, Administrator, and Provider

7:00 am Registration & Morning Coffee

8:00 Organizer’s Welcome and Chairperson’s Welcoming Remarks

Micah Lieberman, Executive Director, Conferences, Cambridge Healthtech Institute (CHI)



8:05 Chairperson’s Remarks

Harry Saag, MD, Medical Director, Network Integration, NYU Langone Health



8:10 Using Analytics to Predict Outcomes, Target High-Risk Populations and Improve Quality

Gowtham Rao, MD, PhD, Chief Medical Informatics Officer, BlueCross BlueShield of South Carolina

This presentation discusses how we utilized internal capabilities and technology in population health, data science and business intelligence to better predict outcomes, target high-risk populations and to improve outcomes. This presentation will share how we successfully deployed the program using open-source tools and new technology that was built in-house to improve population health management, risk modeling, and patient stratification.

8:40 Initiatives in Women's Health Innovation: Reduce Readmissions and Avoidable ED/OR Utilization, Improve Continuity and Access

Katy Mahraj, Director of Innovation, Women's Health, Center for Health Care Innovation & Department of Obstetrics and Gynecology, Penn Medicine

At Penn Medicine, we are transforming care delivery by the Department of Obstetrics and Gynecology and its partners to define and create the future of women’s health care. A novel partnership between the Department of Obstetrics and Gynecology and Center for Health Care Innovation means committed resources to measurable impact in the areas of value-based care, defined as better care, better health, lower cost, and enhanced patient and provider experience. This presentation will present key initiatives in women's health innovation to reduce readmissions, reduce avoidable Emergency Department and Operating Room utilization, improve continuity, and increase access. This presentation will discuss lessons learned from each initiative and reflect on best practices in taking innovation to scale in a large, academic health system.

9:10 Mercy Virtual Utilizing a Portfolio Approach of Virtual Care Solutions: Reimagining Population Health

Randall Moore, MD, MBA, President, Mercy Virtual

Mercy Virtual, externally described as a hospital without beds, or walls, was developed to catalyze system transformation to differentiated quadruple aim performance. Utilizing a portfolio approach of virtual care solutions, progressively integrated into traditional care, augments and extends person/population centric care continuums where and when needed, 24/7/365. Further, virtual care consumer centricity, in partnership with integrated care systems, can build a roadmap from FFS volume driven care, to fully aligned system risk and accountability. Bringing care to people, instead of asking people to come to care, enables early, proactive higher value care and health optimization to mitigate the need for and intensity of late, reactive care.

9:40 INTERACTIVE PANEL: Integrating Data and Predictive Analytics into Pop Health to Enable Value-Based Care

Joe KimuraJoe Kimura, MD, MPH, CMO, Atrius Health


Gowtham RaoGowtham Rao, MD, PhD, Chief Medical Informatics Officer, BlueCross BlueShield of South Carolina


Randall MooreRandall Moore, MD, MBA, President, Mercy Virtual


Katy MahrajKaty Mahraj, Director of Innovation, Women's Health, Center for Health Care Innovation & Department of Obstetrics and Gynecology, Penn Medicine




Mahek_ShahMahek Shah, MD, Senior Project Leader and Senior Researcher, Value Measurement For Healthcare Delivery, Harvard Business School




Though it is now possible to accurately identify in real-time which patients are at greatest risk for health status decline, hospitalizations, missed appointments, and other adverse clinical events, emerging technologies and frank hype can distract from the aim of measurably improving outcomes by integrating predictive models seamlessly into clinical and operational workflows. This panel will discuss:

  • Examples of developing and integrating several predictive models into the front-line workflows of clinical care
  • What technical foundations are required, and what are successful examples of model development?
  • How were clinical and operational support obtained, and how was program evaluation performed?

10:10 Coffee Break with Exhibit Viewing

Tuesday, May 15

The Future of Pop Health and Care Delivery in a Value-Based World

7:30 am Registration & Morning Coffee

8:00 Organizer’s Welcome and Chairperson’s Welcoming Remarks

Micah Lieberman, Executive Director, Conferences, Cambridge Healthtech Institute (CHI)



8:05 Chairperson’s Remarks

Uli Chettipally, MD, CTO, CREST Network, Kaiser Permanente



8:10 Back to the Future: Changing Care Delivery through New Models of Care Delivery

Sachin Jain, MD, MBA, CMO, CareMore Health System/Anthem

Patient care that is based on the burden of illness the US faces will require new models of care. This talk will talk about the evolution towards new models of managing acute and chronic illness, new workforce models, and novel methods of integrating technology to improve care delivery.

8:40 Population Health Management in the Primary Care Setting: Integrating IT Solutions to Address Patient Needs and Provider Workflow

Steven Atlas, MD, MPH, Associate Professor, Medicine, Harvard Medical School, Director, Practice-Based Research & Quality Improvement, Massachusetts General Hospital

Primary care delivery has traditionally centered on office-based encounters between a patient and provider. Focusing on population health will not only require new IT solutions but a renewed focus on patient-centered redesign. To be successful, team-based provider workflow needs to evolve to meet patient expectations and measures of high quality, efficient care.

9:10 Considering Care Delivery Transformation and Strategy Within an ACO

Scott Berkowitz, MD, MBA, Senior Medical Director, Accountable Care, Office of Johns Hopkins Physicians

Accountable care organizations (ACOs) present an opportunity to promote value-based care. JMAP, the Johns Hopkins Medicine (JHM) ACO, is a Track 1 Medicare Shared Savings Program ACO, and herein we describe the JHM approach to care delivery transformation. This will look at CMS efforts around care delivery and payment reform, include a review of ongoing JMAP/JHM initiatives to improve patient care and population health, as well as a discussion on the ongoing annual strategic planning process.

9:40 INTERACTIVE PANEL: Critical Steps in Being Successful in Managing Medicare and Medicaid Risk

Dominique Morgan-SolomonDominique Morgan-Solomon, President, Morgan-Solomon Consulting, Population Health Subject Matter Expert, Merck


Alan JonesAlan Jones, Strategy & Network Development Director, Sutter Health


Steven AtlasSteven Atlas, MD, MPH, Associate Professor, Medicine, Harvard Medical School, Director, Practice-Based Research & Quality Improvement, Massachusetts General Hospital


Scott BerkowitzScott Berkowitz, MD, MBA, Senior Medical Director, Accountable Care, Office of Johns Hopkins Physicians


Sachin_JainSachin Jain, MD, MBA, CMO, CareMore Health System/Anthem


Janet O’HollarenJanet O’Hollaren, COO, Northwest, Kaiser Foundation Health Plan and Hospitals


Scott SarranScott Sarran, MD, CMO, Government Programs, Clinical Strategy, Health Care Service Corp.





As more health care delivery organizations sign on to managing Medicare and Medicaid populations, at-risk, what are they key elements to ensuring value and sustainability while managing their care? There are financial and risk considerations, models of delivery, data and analytic needs to ensure success. This short panel will discuss:

  • What are the high level “must haves” to be effective in taking Medicare and Medicaid risk?
  • How important is community engagement, patient outreach and innovation in achieving successful outcomes?
  • What are the biggest pitfalls to avoid when creating a successful value based care delivery system?

10:10 Coffee Break with Exhibit Viewing