VIRTUAL EVENT
Summit Series
Vital conversations about the business of healthcare delivery
Summit Virtual Series
Due to significant demand from our clients and partners we will be hosting a virtual Summit to bring together top managed care executives, legal experts, and renowned thought leaders to discuss the state of our industry and how we can chart a successful path through our challenges.
The virtual event will consist of a series of several webinars over the coming months. Each session will hit on the same theme: unprecedented challenges in the managed care space. This includes discussions around the contracting climate, constraints over how and where to deliver care, difficulty collecting on claims, rising labor and supply costs, and more.
Our next virtual session will take place on Tuesday, May 7 from 12 pm – 1pm CT. Clint Hailey, SVP and Chief Managed Care Officer at Tenet Health, will discuss his thoughts on strategies health systems can consider to navigate tough payor challenges, and adapt to a complex operating environment. Register for this session here.
Summit Session Speakers
All Virtual Summit Sessions
Clint Hailey – Tenet Healthcare
Adapting to Complexity: Contract Strategies for Health Systems in the Face of Payor Challenges
Reimbursement declines. Regulatory and legislative threats. Changing public sentiment. Disruption. There’s no shortage of challenges facing health systems. That’s why it’s more important than ever for them to innovate, pursue their contractual rights, and improve their contracts with new solutions.
Clint Hailey, SVP, Chief Managed Care Officer at Tenet Healthcare, is helping his health system do just that. Join us for a ‘insider’ conversation with Clint, where we will discuss his thoughts on strategies health systems can consider to navigate tough payor challenges, and adapt to a complex operating environment.
This session is a unique opportunity to hear from one of the country’s most respected managed care leaders about the challenges hospitals face, and strategies they can deploy to respond.
Nate Kaufman – Kaufman Strategic Advisors
Face Reality and Act No Matter How Uncomfortable It May Be: Strategies for Succeeding in a Totally Irrational Market
The healthcare industry is going through an unprecedented transformation. But this transformation is not the conventional wisdom of ‘volume to value’ or ‘population health.’ Rather the transformation is the result of the confluence of underfunded government and commercial reimbursements, the migration of inpatient procedures to the outpatient setting, and hyperinflation and shortages in critical clinical personnel and supplies.
There are a few health systems and service lines that are outperforming the industry. As the saying goes, “Success leaves clues.” At the same time many health systems and industry player are investing in “innovative concepts” such as value-based care and risk-based products that have resulted in significant losses and no material competitive advantage. Health systems that cannot differentiate between valid beneficial strategies, aka clues for success, and the latest passing fad are experiencing significant degradation in financial performance, which in some cases may be irreparable.
This presentation will use data to paint realistic scenarios for the future, (which in some cases are contrary to the conventional wisdom) and then provide real-life, practical, proven strategies for success.
Shawn Fitzgibbon – BDC Advisors
Contract Portfolio Alignment: Addressing and avoiding payer market share advantage resulting from reimbursement rate disparities
There is no time to soon to pursue a multi-year rate parity strategy to address the unintended consequences of an imbalance in payor reimbursement rates. Whether you’ve arrived at this point from historically low rates that have not trended in pace with the portfolio or have faced a entrenched dominant payer, you’re now contending with single payer marketplace advantage, consolidation of market share and a perpetuating uncompetitive market characterized by untenable payor leverage and challenging corrective actions.
Shawn Fitzgibbon, Managing Director and Payer – Provider Practice Leader, BDC Advisors, will discuss payer engagement and negotiation strategies to “level the playing field” without unnecessarily disadvantaging an individual payer but rather enabling a competitive marketplace for employers and individuals, while maintaining access and establishing fair reimbursement.
Your market position, early engagement, the magnitude of rate change, current portfolio trend, and payer selling cycles need to be recognized in relation to how and when you’ll achieve your objective. This is a long game approach that will position you for success well into the future.
Jarrett Lewis – Public Opinion Strategies
In-Depth Look: How Americans Perceive the U.S. Healthcare System
Healthcare touches every single American, regardless of gender, race, age, education, or political party affiliation. And it is one of the most complex economic, social and policy issues. It is also an industry that has undergone a significant transformation over the last few years, precipitated by the COVID-19 pandemic and an industry that continues to face changes to financing models, acceleration of consumerism, new entrants, a redesign of care delivery and a proliferation of data. Alongside these changes is a constant stream of new policies and regulations at the federal and state level.
All of this taken together requires a deep examination of American attitudes on the healthcare industry and a particular focus on health systems and hospitals. Informed by hundreds of thousands of interviews with voters, consumers and patients across America every year, Jarrett Lewis will discuss how Americans view the U.S. healthcare system and hospitals and how shifting attitudes may drive policy changes in Washington D.C and state capitals across the country.
Jarrett will also speak about the current political environment and key trends leading into the 2024 election, as his firm counts 8 Governors, 12 members of the U.S. Senate and 51 members of the U.S. House as clients.
Meri Gordon and Adam Dietrich – Polsinelli
Payor Games: Increased Denials, Underpayments, Non-Payment, and The Impact on Healthcare Providers
Payors are increasingly finding more ways to deny claims. Making matters worse, a lack of transparency leaves healthcare providers with little to no insight into the source of the denials, how to dispute them, or how to keep them from happening in the future. Meri Gordon and Adam Dietrich, Shareholders at Polsinelli, have devoted their practice to addressing these payor games head-on. In their roles, they’ve gained a deep understanding of the healthcare legal landscape and routinely represent clients in connection with an array of managed care disputes and litigation.
On Thursday, 11/9 from 11 am – 12 pm CT, Meri and Adam discussed recent trends in managed care contract denials, including an exploration of the underlying factors, effective strategies for addressing denials (from a contracting and litigation perspective), and the legal implications associated with these challenges.
Nick Stefanizzi — Northwell Direct
Direct-to-Employer Relationships as a Catalyst for Growth
Health systems are facing increased financial and operational pressures driven by the lingering effects of the COVID-19 pandemic, rising costs to deliver care, evolving reimbursement models, and bad payer behavior. It’s important that we shift our collective thinking, adopt a proactive approach, and seriously consider revenue diversification and growth strategies that previously may have been considered too disruptive.
Nick Stefanizzi, CEO of Northwell Direct, shares some lessons learned in launching a leading health system owned direct-to-employer business and the benefits these relationships can provide to both employers and health systems. Not only can these relationships provide a valuable alternative revenue source, improve market share, and enable an alternative pathway to care for the community served by a health system, but they can also support a recalibration in the balance of power between health systems and the traditional insurance companies, which will be increasingly important as negotiations continue to grow more and more acrimonious.
Following this session, you’ll have with a fresh perspective on how to address the burdens the nationwide provider organizations have been grappling with and a new outlook on how health systems can have a transformative impact on how care is organized, delivered, and financed through direct-to-employer relationships.
Stuart Kilpinen and Bob Beverwyk — Trinity Health
Flipping the Script On Negotiations
With 89 hospitals spanning 22 states, and thousands of physicians across primary and specialty practices, Trinity Health is one of the country’s largest not-for-profit health systems.
Mr. Kilpinen, SVP of Payor Strategy & Product Development, and Mr. Beverwyk, VP of National Payor Contracting, will share insights about the dynamics and trends they have experienced in recent negotiations with both national and regional payors.
They will also discuss Trinity Health’s effort proactively educate key audiences about the mounting challenges healthcare providers face, as well as the lack of real partnership and fair payments from payors that are essential to addressing them.
John Poziemski – Kaufman Hall
The Payer-Provider Reset: Building Relationships in a Shifting Landscape
In today’s challenging macro-economic environment, payer-provider partnerships are shifting away from aspirational goals of creating long-term value to more practical considerations. Organizations are asking each hard questions about value creation, the capabilities they seek in partner organizations, and the nature of joint opportunities. In this session, John Poziemski from Kaufman Hall will explore how health systems and health plans can craft effective, sustainable partnerships in an uncertain future.
Read full recap of Kaufman Hall’s session here.
Jeff Leibach – Guidehouse
Contracting Tactics from the Other Side: What to Expect in your Negotiations
This session aims to provide healthcare providers with comprehensive insights into managed care contract denials, including an exploration of the underlying factors, effective strategies for addressing denials, and the implications associated with these challenges.
Dan Hoemke – VillageMD
Disruptors in the Funnel Wars
Session details and registration link coming soon.
These sessions will be ideal for:
- Health system executives responsible for payor relations, networks, or employee relations, who want to learn the latest trends and successful strategies from across the country that can be adapted to your market.
- Executives from health services and tech companies who want to deepen their understanding of their buying audience and gather candid feedback on what’s working and what’s not.
- Management consultants, attorneys, and thought leaders who want to network with executives from some of the best hospitals and health systems in the U.S.
- Communications executives inside healthcare provider organizations who are increasingly faced with navigating challenging public narratives surrounding negotiations, consolidation, and healthcare costs.
