June 13, 2016 12:00 AM

Webinar: 5 Steps to 5-Star Success for Payers and Providers

Now available on-demand

About the Webinar

Can higher quality, lower cost, and better patient and physician satisfaction be achieved? The 5-Star model proves it's possible - even in a virtually integrated delivery network with diverse provider structures. Join top executives from Lumeris and Essence Healthcare, one of the nation's most successful value-based care delivery models and a 5-Star rated Medicare Advantage Prescription Drug health plan, to learn:

How medical loss ratios can be managed to reward physicians for better consumer care at reduced costs to the plan

How collaboration between payers and providers is integral to achieving the Triple Aim plus One (including physician satisfaction) and a 5-star CMS rating

How 5 Stars can be achieved with a virtually integrated network and various contracted provider groups.

Dr. Debbie Zimmerman

Chief Medical Officer

Essence Healthcare & Lumeris

As chief medical officer for Essence Healthcare, Debbie Zimmerman, M.D., is responsible for clinical quality, medical and pharmacy management, and physician practice transformation for Essence's 5-Star rated Medicare Advantage Prescription Drug (MAPD) health plan. In her role for Lumeris, Dr. Zimmerman builds the clinical strategy for the organization and manages consulting services, clients' clinical initiatives, and the clinical content and analytics in the Lumeris Accountable Delivery System Platform (ADSP). In addition, Dr. Zimmerman provides oversight for the Accountable Delivery System Institute (ADSI), a program that educates prospects and clients on Lumeris' proven population health management solutions and strategies for transitioning from volume- to value-based care. Dr. Zimmerman's experience with new care delivery models, as well as provider and consumer engagement, has enabled clients to manage under value-based contracts by establishing Population Health Services Organizations (PHSOs). Dr. Zimmerman has more than 25 years of payer and physician experience and has served in medical leadership roles at health plans, including Cigna, Group Health Plan and Health Partners of the Midwest. Prior to joining Essence Healthcare, she was chief medical officer of Mercy Health Plans, a provider-sponsored plan owned by Sisters of Mercy. In addition, she is an accomplished entrepreneur, having co-founded a successful disease and complex case management firm. Dr. Zimmerman practiced internal medicine for 15 years. She's licensed to practice in Missouri and Illinois.

Richard Jones

President & CEO

Essence Healthcare

Richard Jones is the CEO of Essence Healthcare, one of the nation's first accountable delivery systems and a 5-Star rated Medicare Advantage Prescription Drug (MAPD) health plan by the Centers for Medicare and Medicaid Services (CMS). With over 25 years of experience in the healthcare industry, Richard is a knowledgeable business executive and certified public accountant. He previously served as chief financial officer of Essence Group Holdings Corporation (including Essence Healthcare), national president of United Healthcare Medicare and Medicaid lines of business, president and CEO of Coventry Healthcare of the Midwest, and chief financial officer of Coventry Corporation.

Daniel Pribe

Vice President and Principal Actuary

Lumeris

Daniel Pribe is an actuarial executive with more than 12 years of experience working in actuarial sciences for healthcare organizations. Dan focuses on assessing the value Lumeris brings to its clients through its population health management solutions. Healthcare organizations that follow Lumeris' playbook for population health management are guaranteed to see improved clinical and financial outcomes, as evidenced by the 5-Star rating awarded to Essence Healthcare, a Lumeris client, by the Centers for Medicare and Medicaid Services (CMS). Dan's ability to work with healthcare executives in strategic planning, forecasting, market and product development, and risk management helps organization's meet financial objectives. Prior to joining Lumeris, Dan worked with providers, payer organizations and large employers to help them navigate through and understand the financial implications of the Affordable Care Act.

Christina Galoozis

Custom Content Specialist

Modern Healthcare

Christina is a seasoned journalist, writer and editor with more than a decade of experience in media. She currently oversees Modern Healthcare's custom division for which she moderates panels and creates sponsored content for the Modern Healthcare audience. In the past, Christina has served as editorial director of three national magazines, a business editor at a Chicago investment bank, and a freelance writer/producer for various media outlets, including a stint at Modern Healthcare's sister publication Crain's Chicago Business. Christina holds a B.A. in magazine journalism from Indiana University with minors in French and political science.

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