The implementation of the Affordable Care Act and adoption of value-based reimbursement is forcing payers to rethink their relationships with providers. A healthcare economy based on outcomes requires greater communication and collaboration between both sides in order to be profitable while delivering high-quality care at a lower cost. In the midst of the transition from fee-for-service to value-based reimbursement, payers must work with their provider partners to improve trust, address cost structures, identify appropriate incentives, and make care management the top priority.
In this presentation, iCare-Independent Care Health Plan Chief Medical Officer, MD, MJ, will share strategies essential to finding the sweet spot of the payer-provider relationship that ultimately benefits the health of plan members.
We will include strategies for:
Enabling open and transparent communication with provider partners
Reducing provider friction associated with credentialing by centralizing information
Keeping provider in network by reducing complex administrative and business processes
Incentivizing ensure continuous quality improvement into the future
Responding to emerging regulatory and policy changes impacting reimbursement
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Linda Ellis, MD, MJ, MA
Chief Medical Officer
Independent Care Health Plan
Dr. Linda Ellis is Chief Medical Officer at Independent Care Health Plan in Milwaukee, WI, serving dually eligible Medicare and Medicaid beneficiaries, all of whom are at or below 100% of the federal poverty level. Dr. Ellis is responsible for utilization and disease management, population health initiatives, and oversight of medical and pharmacy services. Dr. Ellis is board certified in Anatomic, Clinical, and Pediatric Pathology, and has served as an academic pathologist for over 20 years. While in practice, Dr. Ellis completed a master’s of jurisprudence degree in health law and policy at Loyola University Chicago School of Law and a master’s of arts degree in bioethics and health policy, also at Loyola University
Healthcare Payer Industry Practice Lead
Cate McConnell is the Healthcare Payer Industry Practice Lead at Appian, where she is responsible for bringing the power of Appian software to health insurance companies. Cate has an extensive background in healthcare, serving as Product Owner for Payer Services at Change Healthcare (formerly McKesson Health Solutions) and Senior Manager and Partner Candidate at Deloitte Consulting. Numerous years of experience with healthcare organizations such as Anthem, Kaiser Permanente, Capital Blue Cross, Centers for Medicare and Medicaid Services, and others give Cate a deep understanding of healthcare systems and solutions. Cate earned an MBA from Duke University’s Fuqua School of Business, and holds the CPHIMS certification from HIMSS. She is active in the Technology Association of Georgia’s Health and Product Management groups, as well as GA HIMSS and HFMA.