2019 Innovations in Healthcare Contracting and Network Development 

September 19-20, 2019

Orlando, FL

Event Overview

The 2019 Innovations in Healthcare Contracting and Network Development event will feature strategies to fully implement value-based payments into your existing plans. You will gain the tools you need to improve quality and lower cost. Sessions will include Value Based Contracting, Network Development, Social Determinants in Contracts, Telehealth, Ancillary Service Contracts and More. Don’t miss the opportunity to learn the latest methods in contracting and network development.

Renaissance Orlando
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6677 Sea Harbor Dr.
Orlando, FL 32821
(407) 351-5555

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Top 5 Reasons to Attend

  1. Gain the Latest information on Integrating Ancillary Services into your Network and Contract.
  2. Learn How to Successfully Negotiate Contracts with Value-Based Payments.
  3. Hear Strategies for How Social Determinants are impacting your Network and Contracts.
  4. Develop the Best Plan on how new Technologies are Included in your Plan.
  5. Explore the How America's Aging Population is Changing the way Managed Care Looks Like for End of Life Care.

Attendee Profile

Senior-Level Healthcare Executives with responsibilities in the following areas:

  • Director Payor Contracting & Network Development
  • Contracting & Network Development
  • Hospital Contracting
  • Value Based Contracting (healthcare)
  • Medicare Contracting
  • Director of Network Management
  • Medical Director Network Manager
  • Director, Provider Network
  • VP Network Management
  • Network Contract Manager
  • Director Provider Contracting
  • Director, Network Development
  • Hospital Contract Manager
  • VP Contracting Reimbursement
  • Contracting and Network Service
  • Director National Provider Contracting
  • Manager Provider Contracting
  • Contracting
  • Contracting and Compliance
  • Contract Management
  • Network Performance
  • Managed Care
  • Payer-Provider Relations
  • Payer Relations

Thursday, September 19th, 2019 | Day 1

8:00 AM - 9:00 AM

Registration & Breakfast

9:00 AM - 9:15 AM

Chairperson’s Opening Remarks

9:15 AM - 10:15 AM

Keynote Address: Achieve Success in Value Based Contracting & Delivery—Essential Population Health MSO Capabilities, Tools & Services

In this session, we will grapple with challenges many ACOs (Medicare MSSP and Commercial) continue to experience in achieving the promising rewards of value-based transformation.  We will explore the key drivers of change as well as ensuing challenges and opportunities—with focus on VBC contracting, payment models, population health capabilities and like-minded physicians to deliver on the promises of Medicare, Medicaid and commercial value-based programs. 

  • Understand how value-based transformation drives the need for new capabilities/tools/services and creates opportunities for critical payer-provider collaboration.
  • Examine the crucial need for an effective population health MSO infrastructure, encompassing episodes of care/bundled payments… a clinical, business/risk and health IT platform, which enables risk contracting and management, payment, care coordination, network collaboration, quality and efficiency. 
  • Examine and distinguish the changing roles of primary care, independent and affiliated CINs/IPAs, and preferred provider networks of specialists and acute/post-acute health systems.

Ralph Tang - President, MD/VA IPA
Wellcare Health Plans/Collaborative Health Systems

10:15 AM - 10:30 AM

Networking & Refreshment Break

10:30 AM - 11:30 AM

Executing Successful Contracts with Value-Based Payment Arrangements

While value-based contracting isn’t new, moving away from decades of fee-for-service has been a slow road to pave. Getting all parties incentivized to move to value-based models has created challenges for many plans. In this session, we will address how to create proper lines of communication and transparency to ensure it’s a win for all parties, with the end goal of better care for less overall cost. In this discussion, we’ll explore the five value-based reimbursement models coming in 2020, and:

  • Focus on the need to be transparent between hospitals, physicians and health plans
  • Incentive Based Contracting – focusing on primary care and care management
  • Increased options for End-of-Life care
  • How to integrate newly approved services into your contract and network
  • Best practices for tying quality and cost to performance

Daniel Roberts, M.H.A. - Chief Operations Officer
Chess Health Solutions

11:30 AM - 12:15 PM

Case Study in Healthcare Transparency: Horizon BCBS NJ Leaders in the Road to Transparency

12:15 PM - 1:30 PM

Networking Lunch

1:30 PM - 2:30 PM

Holistic Healthcare and The Role of Social Determinants

Genes vs. zip codes - which is more important for contracts in the future? This session will explore the impact of social determinants have on contract development. Learn how this new model of assessment increases your ability to assess risk.

  • Learn how to adequately address social determinants of health and what resulting contract changes are needed
  • Explore methods of data collection for accurately assessing social determinants
  • Examine how appropriately analyzing social determinants starts with identifying a patient’s needs and measuring their impact
  • Gain tools for overcoming challenges to social determinants tracking as you map out your contracting and network development goals

    Patrick Edlin - Director of Medicare Advantage

2:30 PM - 2:45 PM

Networking & Refreshment Break

2:45 PM - 3:45 PM

Data Metrics, Managing Data Efficiently and Still Having Time for the Rest of Your Job

This discussion will focus on implementing effective strategies for managing the high volume of data management needed in managed care. Identify key systems to help with all your data needs, compliance reporting, provider performance, rate changes, and beyond. Explore how to build trust, while legitimizing the data at the same time. We’ll examine how to create greater cost-savings while keeping improved performance as the end goal.

  • How to benchmark provider performance
  • Tracking success of incentives
  • Maintaining Compliance in Data Management

3:45 PM - 5:00 PM

Panel: Avoiding Sticker Shock, The Move to Pricing Transparency, Pro and Cons of this Information Going Public

With mounting pressures to create pricing transparency throughout healthcare, we must look at its impact on contracting and network development. The components of your contracts and hard-won negotiations will be transparent to all. This session will explore how the move to transparency will impact future contracting. Hear opinions from both sides of aisle.

  • Learn how to share pricing and quality information with providers
  • Explore fixed pricing at capitated health systems like Kaiser Permanente
  • Establishing better negotiations with the possibility of full transparency

Friday, September 20rd, 2019 | Day 2

8:00 AM - 9:00 AM

Networking Breakfast

9:00 AM - 9:15 AM

Chairperson’s Recap of Day One

9:15 AM - 10:30 AM

Featured Panel: Effective Network Development, Trends to Watch with Cost and Care Top of Mind

Tiered, narrow, skinny, wide, high preforming – the names may change, but are the networks really changing? Join us to review vendor outsourcing options to vendors for niche market needs and learn from others in managed care how successful networks are built and maintained. We’ll discuss:

  • The necessary data needed to determine the needs of your plan’s population
  • How to develop an optimal network, while balancing between primary care and specialty care
  • Understand how to create the various networks in a value-based environment
  • Discover the benefits of a high-performance network
  • Is building a network in-house the best option?
  • Hear examples of what is working and what isn’t, and how to best avoid potential contracting pitfalls

Nicole Bradberry - President, Florida Market
Naviss Healthcare

Ralph Tang - President, MD/VA IPA
Wellcare Health Plans/Collaborative Health Systems

Johnathan Randle CHC, MBA - VP Chief Compliance Officer Medicare Advantage
Mutual of Omaha

10:30 AM - 10:45 AM

Morning Networking Break

10:45 AM - 11:30 AM

Integrating New Ancillary Care into Contracts and Network Development

The list of approved CMS ancillary care grows annually, making it one of the fastest growing sectors of healthcare. It can be a great generator of income for the provider while still adding an overall cost savings. We’ll discuss how adding ancillary services to your contract not only benefits providers and patients alike, as well as:

  • How to help providers integrate ancillary services into their practice so referrals stay in house
  • Possible legislation changes in the coming years and how to ensure you organization is prepared
  • Learn which services are included and how to get providers on board
  • Understanding what services are billable
Mark Ordeman - Sr Director Risk Contracting and Ancillary

11:30 AM - 12:30 PM

Telehealth and Virtual Care - Contracting with Technology in Mind

With the adoption of the Chronic Care Act, reimbursements have increased for Telehealth and Virtual Care services. In this session, you will learn how to contract telehealth with value-based contracts and outcomes top-of-mind. Gain insight into which contracts benefit the most from this service, and their impact on rural, chronic, and post-surgical care.

  • Learn which contracts benefit from telehealth
  • Explore telehealth as a cost-effective option and what types of care benefit most from this technology
  • Gain strategies for building your network to include hybrid methods of coverage to include in-office and virtual care
  • Study how telehealth is impacting Opioid care and how to build patient trust in its applications

12:30 PM - 1:30 PM

Networking Lunch

1:30 PM - 2:30 PM

Alternative Payment Models Across Post-Acute, End-of-Life, Home Health and Palliative Care

New approvals by CMS have created layers of new items to add to contracts and ultimately impact your plan. In this session, we will discuss:

  • Effectively contract home health care in the final stages
  • Custodial services include everything from hospice care and long-term acute care to nursing facilities and urgent care
  • Utilizing approved care to personalize patient needs
  • The best contracts for ensuring providers have an integral role care cost management
  • Creating high-touch services like personalize concierge services
  • Providing high-value services without impacting the total cost of care

2:30 PM - 3:30 PM

Medicare and Hospital Contracting, Large and Small





Speakers & Faculty

Patrick Edlin

Patrick Edlin

Director of Medicare Advantage
Ochsner Health System

Mark Ordeman

Mark Ordeman

Sr. Director Risk Contracting and Ancillary
Wellcare Healthplans

Johnathan Randle

Johnathan Randle

VP Chief Compliance Officer Medicare Advantage
Mutual of Omaha

Ralph Tang

Ralph Tang

President, MD/VA IPA
Wellcare Health Plans/Collaborative Health Systems

Emily Chen

Emily Chen


Daniel Roberts

Daniel Roberts

Chief Operations Officer
Chess Health Solutions

Nicole Bradberry

Nicole Bradberry

President, Florida Market
Naviss Healthcare





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Contact Michael Goldberg at (561) 221-6202
or mrg@dgevents.com

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