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Revenue and Reimbursement with Outcome-Based Payment Models; ACA and Commercial Payers

Healthcare Consulting

 Revenue and Reimbursement with Outcome-Based Payment Models; ACA and Commercial Payers
CPE Credit

Program Type: Recorded Webinar (Audio, PPT Presentation)
Program Level: Intermediate
Prerequisites: Previous training or research on subject matter being taught.
Advanced Preparation: None
Delivery Method: Group Internet-Based
CPE Credits: Two (2) Hours
Fields of Study: Management Services
Item Number: 14PHC1203
Shipping Weight: 0lbs. 0oz.
Price: $110.00
Program Description

The webinar will cover the top four to five payment methods under the Affordable Care Act healthcare reform bill (otherwise known as "Obamacare"). These methods include outcome-based payments, population health, bundled payments, global payments, shared savings plans (SSP), value-based purchasing, and accountable care organizations (ACOs) in contrast to the traditional fee-for-service/CPT code-based medical reimbursements. The presentation will also cover growing alternative revenue models in healthcare, particularly with practice-based physicians, that being Direct Care Medical, Direct Pay Medical, and Concierge Medicine.

This webinar will also discuss how alternative models impact revenue, growth, and the valuation of medical practices, allied health, and hospitals.

The healthcare system economics are changing dramatically and these payment and revenue models will fundamentally change the financial makeup of the U.S. medical industry.

Learning Objectives

After completing this webinar, attendees will be able to:

- Compare medical practices with varying revenue models for growth modeling, risk mitigation, and valuation
- Investigate the key revenue drivers for medical provider businesses and assess value
- Define population health and what it means for practive valuation
- Explain ACO, clinical integration networks (CIN), and patient-centered medical home (PCMH) business models and how they impact medical industry finance
- Differentiate between the roles of payers, providers, hospitals, and networks in a post-reform healthcare system
- Define "risk adjustment" from an ACO, hierarchical condition categories (HCC) system perspective and how such a perspective impacts system revenues and profitability
- Assess margins, cash flow, cash management, and actuarial assessment with new value-based purchasing models
- Financially model medical service delivery with employed and independant physicians
- Illustrate new procurement methods and costs under population health budgeting models

Who Should Attend

This webinar is best attended by medical doctors, medical practice adminstrators, healthcare quality assurance team leaders, hospital CEOs, COOs, CFOs and administrators, professional services providers to healthcare entities, healthcare payers, group purchasing organizations, and ACO managers, Medicare Advantage systems, attorneys in transactional services for healthcare clients, CPAs, investment bankers, and venture capitalists in the healthcare space.


David Crais, CMPE, PMP
Mr. David Crais is a certified medical practice executive with over 20 years experience in bringing medical products, biotech, and medical services to market. He has raised over $30 million in venture capital, participated in an IPO with Careside on the American Stock Exchange in 1999 as head of sales and marketing, and earned licenses in securities and investment banking with Merrill Lynch.

He holds or has held certificates or licenses in project management, business process management, economic development, health information technology, tech transfer, LEAN and Agile, health insurance, real estate, and product development. He was recognized by the Joslin Diabetes Innovation Center for innovation in diabetes services and chronic disease management.

Mr. Crais has served as president or CEO of several medical startups and growth companies in Los Angeles, Chicago, and New Orleans in stem cell, surgical device, medical practice, and diagnostic verticals. Mr. Crais created the Diabetes Assessment and Management Centers and led a successful exit to medical industry partners.

Mr. Crais was an original member of i-STAT where he grew with the company from pre-revenue to its sale to Abbott Diagnostic in 1998. He led a joint venture with Roche Diagnostic in Canada in 2002 for Careside, launched genomic testing with Quest Diagnostics in 2003, helped launch the GEM Premier 3000 with Instrumentation Labs.

Mr. Crais has developed medical practices and services, and most recently chaired the 2014 ACO Summit in Austin, TX. He co-founded the New Orleans chapter of Health 2.0.

Mr. Crais is a graduate of Loyola University New Orleans with a degree in the history of science and technology. He sits on the LSU Business School advisory board and is a board member or director of several companies and non-profits, and was co-founder and board member of the International High School of New Orleans, an international baccalaureate charter school founded after Hurricane Katrina with a grant David helped administer from the Walton Family Foundation. Mr. Crais resides in New Orleans with his wife and two children.