Evaluation and Implementation of the Likelihood of Hospitalization Model in Kaiser Permanente

Attendees will receive an overview of Kaiser Permanente and their approach to population management, see an evaluation of the LOH model, learn how to use data to look for opportunities that impact outcomes, and learn how Kaiser Permanente is using the LOH model for care management programs. Attendees will gain a better understanding of the impact of adding clinical data to the LOH model, as well as the challenges and opportunities of implementing a predictive model in a large organization.

Welcome / Opening Remarks State of the Company Address

The Vision of DxCG Science

Learn about the new research at the forefront of our science, the new DxCG Classification System, and how our science is impacting health care.

DxCG Today

This session will look back at DxCG’s past and walk through changes that have resulted from the joining of Urix and DxCG. Included will be a viewing of the new look for DxCG and an overview of the direction for DxCG products and applications.

Safeguard Your Pharmacy Benefit Program with RiskSmart™ Audit

Luncheon Keynote: The Role of Risk Adjustment in Physician Payment Reform

Topic: TBA

Predictive Modeling for Underwriting Commercial & Medicaid Plans

Topic: TBA

GERMANY’S ROLE IN ADOPTING & IMPLEMENTING RISK ADJUSTMENT

Adapting the DxCG Model for Risk Adjustment between German Sickness Funds

The German social insurance system will undergo a major reform in 2009. A central health fund will be installed to collect payment from insured, employers and government subsidies. Sickness funds will receive risk adjusted payments from the central health fund for enrolled members. The risk adjustment will be based on the DxCG model, but reduced to 50 to 80 disease states. The legislation mandates the simultaneous use of (outpatient) diagnoses and pharmaceutical prescriptions.

DxCG Predictive Models; the Preserver of Germany’s Statutory Health Insurance

DxCG based predictive models will be introduced in Germany’s outpatient care to measure morbidity and to adapt the amount of money given to physician associations in 2009. In addition, Germany’s risk structure compensation scheme is to be improved by taking into account the direct morbidity of insurees (diagnoses and pharmaceuticals) based on DxCG predictive models. To keep a balance between competition and solidarity in Germanys Statutory Health Insurance, powerful risk adjustment models are an important factor and DxCG based models will be implemented.

MORNING BREAKOUT SESSIONS

Track A

Track B

Track C (Invitation Only)

Building Effective Wellness Programs using Integrated Health Care Information and Analytical tools

Health care costs are rising and there are endless propositions on how to curb the price-rise. One solution included into all proposals is a greater emphasis on wellness and preventive benefits. MAHCP has designed and implemented a software system that makes it possible to offer effective, data-driven wellness benefits that produce quantified savings. Analytical algorithms, including DCG predictive models are the center-piece of this system. Presentation would include demonstration of the software with discussion of how it helps in achieving stated goals.

SPEAKER: Bernard Khomenko, Assistant Director, Montana Association of Health Care Purchasers

Using Risk-Adjusted HRA Data to Create Wellness Programs

How effective are wellness programs? Speaker Ian Duncan of Solucia, Inc. presents a study that covers practical outcomes from wellness programs and their measurement. The objectives of the study are to better understand the value of Health Risk Assessments data to explain health care claim costs, identify a method for prioritizing members for interventions, and quantify costs and changes in cost associated with health risk assessment attributes.

SPEAKER: Ian Duncan, FSA, FIA, FCIA, MAAA, Solucia, Inc.

Product Advisory Team

CHAIR: Anthony Reagan, Product Director, DxCG

MORNING BREAKOUT SESSIONS (CONTINUED)

Track A

Track B

Track C (Invitation Only)

Diabetes Gaps in Care

The Monroe Plan is using RiskSmart along with other data sources to create a rank ordered listing of members with diabetes, who are predicted to use the ER or Inpatient services in the next six months. The Monroe Plan is also working on models to determine future ER/Inpatient use based on RiskSmart™ data, HCC data and LOH statistics, as well as internal gaps in care measures.

SPEAKER: Severin Flanigen, Biostatistician, The Monroe Plan for Medical Care

Understanding Disease Burden and the Risk of Diabetes Among American Indians and Alaskan Natives

SPEAKER: Joan O’Connell, PhD, Health Services Center, University of Colorado Denver Rong Yi, PhD, Senior Scientist, DxCG

Risk Adjusting Episodes

SPEAKER: Jo Anne Lutz, Director of Channel Partners

Effective Risk-Adjusted Metrics for Physician Reimbursement

SPEAKER: Lori Weyuker, ASA, Weyukergroup

GENERAL SESSION
Topic: TBA

SPEAKER: Client Speaker TBA

Blues Roundtable

CO-CHAIRS:
Diane Laurent,
SVP, Business Development, Urix

Anthony Reagan, Product
Director, DxCG

GENERAL SESSION
CaseSmart™ for the Urix Analytic Platform

SPEAKER: Jo Anne Lutz, Director of Channel Partners, Urix

Closing Remarks

SPEAKER: Mike Coyne, President, Urix