Pathways to Success:  Ride the Wave

In CMS's continued push toward value-based care, this session will discuss the evolution of the ACO program, specifically, the Pathways to Success (P2S) track. This will include a broad overview of the P2S program and CMS's goal to put more risk in the hands of providers. We will review some of the challenges faced by provider groups who are evaluating or currently participating in the program including the financial opportunities and risks. At the conclusion of this session, attendees will be able to: • Compare and contrast the ACO programs implemented by CMS in the advancement of value-based care • Identify key risks provider groups face when evaluating or participating in value-based care • Apply knowledge to evaluate the financial feasibility of participating in the P2S Program

Julie Witt, FSA,MAAA,FCA

Director, Actuarial Consulting

Julie is a senior director in the Provider Actuarial Services practice of Optum. She joined Optum in 2016 and has nearly 30 years of experience in the health insurance industry, having worked for both insurance companies and consulting firms. Her primary focus has been on individual medical and small group pricing, including extensive experience with provider network valuation and pharmacy, and Affordable Care Act (ACA) compliance. Julie’s primary role at Optum includes working with health plans and health care providers on the impact of the ACA legislation on providers, including value-based care models. Projects include modeling changes in member/patient mix, contract reimbursement, patient cost and risk, as well as market analysis for payers and providers to understand the impact of networks and markets. Most recently, she has been involved in assessing the financial risk to providers under MACRA. Julie is a Fellow of the Society of Actuaries, and a Member of the American Academy of Actuaries and Conference of Consulting Actuaries. She received her Bachelor of Science degree in mathematics from the University of Wisconsin–Whitewater.

David Byron, FSA,MAAA

David Byron is a Senior Director in the Provider Risk Advisory practice with 14 years of experience working with payers, providers, and employers as a health actuary. His focus at Optum is with healthcare provider organizations and their analytics risk management strategy for various lines of business including commercial, Medicare Advantage, and Medicare. David’s additional experience includes employee benefit consulting, commercial pricing, financial budgeting & planning as well as various financial modeling and forecasting.Prior to joining Optum, David worked at a major employee-benefit consulting company where he advised large employers and evaluated the financial impacts associated with benefit design, budgeting, forecasting, and reserving. In addition, he worked at a regional health plan and managed the medical portfolio for small group market including design, innovation and pricing.David is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. He graduated from the University of Connecticut with a Bachelor of Arts degree in Mathematics.

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Webcast Session
08/13/2020 at 1:00 PM (EDT)  |  Recorded On: 08/24/2020
08/13/2020 at 1:00 PM (EDT)  |  Recorded On: 08/24/2020
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