Panel Presentation

(V6-01) Planning for MACRA, Health Reform Regulatory and Reimbursement Changes

Monday, April 24
11:30 AM - 12:30 PM
Location: W230 BC

As part of the Medicare Access & CHIP Reauthorization Act ("MACRA") and other regulatory and reimbursement innovation created following the Affordable Care Act (the "Act"), health systems will increasingly look to opportunities to effectively implement telehealth and remote patient monitoring ("RPM") interventions. This presentation will provide an overview of MACRA and payment reform measures presenting opportunities for telehealth and RPM activity in the health care industry, and will offer practical guidance on health systems strategies for pursuing telehealth and RPM in the present environment by focusing on five fundamental areas. Among other items, the presentation will address the following:

• Overview of Alternative Payment Models:
 Description of alternative payment models and potential for telehealth and RPM to demonstrate value.
 How alternative payment models create opportunities for reimbursement, including opportunities to further network adequacy performance in Medicaid for managed care networks.
• Overview of MACRA:
 How CMS plans to implement and measure value-based care.
 How telehealth services are categorized as "patient facing" and tools that apply in meeting practice improvement activities, population health management, patient engagement, and care coordination.
• Practical Solutions:
 How value-based care and payment reform impacts relationships with hospitals and health care professionals, including billing and collection activities.
 What telehealth, RPM and other digital health interventions should consider in light of evolving CMS guidance.
 How proposed modifications to Medicare under MACRA may eventually change provider-based reimbursement.
 What steps you can take to provide flexibility for alternative reimbursement methodologies.
• Risk Mitigation:
 How opportunities for greater integration that MACRA promises may present new risk management issues for hospitals, such as increased tort exposure; and
 How transaction structures may change during the course of a negotiation and proposed alternatives to meet business team objectives for integration and collaboration.

Learning Objectives:

Claire Castles

Jone Day

Claire Castles advises clients across the health care industry on compliance strategies and regulatory issues and in proceedings before federal and state government agencies. Her areas of practice include licensing and certification, payment and reimbursement, health privacy, Emergency Medical Treatment and Active Labor Act (EMTALA), Medicare conditions of participation, contracting and transactional matters, internal investigations, and government investigations and audits.

Claire's experience includes advising hospitals and large academic medical centers in operational and administrative responses to state immediate jeopardy and privacy breach findings and Centers for Medicare and Medicaid Services' surveys and deficiency findings, including threatened termination actions. She also assists clients in responding to Health and Human Services Office of Inspector General audits, recovery audit contractor (RAC) and other program safeguard contractor (PSC) audits, and advising clients on repayments to private payors and the Medicare and Medicaid program.


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Randy Moore

Mercy Virtual

As president of Mercy Virtual, Dr. Randall (Randy) Moore and his team are pioneering a new model of care using the power and potential of telemedicine to expand access and improve outcomes, while reducing costs.
Dr. Moore’s experience includes more than 30 years working as both an academic clinical physician as well as a business executive. A common theme across his work is realizing the value of shifting care from a reactive, provider-based model, to a true patient-centric model that extends a continuum care into the daily lives of patients.
Before joining Mercy, Dr. Moore focused on the development and implementation of transformational health care models through his consulting firm. Working in major health care systems such as Intermountain Health, Ascension Health and Presence Health, his work focused on evolving from traditional fee for service to optimizing value of population health.
As CEO of American Telecare, the company developed innovative solutions to enable health care teams to extend care beyond the walls of the hospital and clinic environment. By identifying the needs of the 5% of the population who use as much as 50% of all health care resources, he and his team were able to show how a telemedicine-enabled care model delivers rapid gains in team efficiency, effectiveness and most importantly, improved outcomes and quality of life for patients.
Dr. Moore graduated with Alpha Omega Alpha honors from Johns Hopkins School of Medicine, before completing his training in internal medicine at the University of Minnesota, where he was chosen Chief Resident, and served on the faculty for nine years. His education also includes study at the University of London, graduate studies at the University of Minnesota, and earning his MBA from the Kellogg Graduate School or Management at Northwestern University.


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(V6-01) Planning for MACRA, Health Reform Regulatory and Reimbursement Changes

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