Session at Health Datapalooza in the Payer and Risk-Owner Track entitled, "Creating a virtuous cycle: designing networks to mitigate no-value care from fee for service and create value-based wins for both payers and providers using CMS benchmark data." Value Proposition: Designing and Curating a Pay-for-Value Ready Network   Moderator: Joshua Rosenthal, Co-Founder and Chief Scientific Officer at RowdMap, Inc.   Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer at Health Care Service Corporation Health Datapalooza is an AcademyHealth event sponsored by The Department of Health and Human Services (HHS), the Robert Wood Johnson Foundation (RWJ) and RowdMap, Inc.

1. OWNING RISK IS TOUGH, BUT IT’S WHERE THE ACTION’S AT
Once upon a time plans had large group commercial populations with years of consistency and
providers simply delivered services for a fee. But government programs like Medicare
Advantage, Marketplace / Exchange and Medicaid, have populations changing every year, or
even every month and providers managing a population's health over time.
Changing populations and dynamic payment models may make it tough to predict and achieve
member outcomes in a financially sustainable way precisely when providers are getting in the
game to take on risk.
Public health data are providing solid case studies of achieving member health and happiness
with sustainable financial models for all players in this new game.
If you are managing risk, considering taking on risk, or investing in or providing products or
services to anyone bearing risk, camp out in these sessions to learn how to use public data and
internal resources to:
§ Effectively leverage analytic approaches to manage risk
§ Accurately assess risks and project costs
§ Effectively align providers and incentivize care delivery
CREATING A VIRTUOUS CYCLE:
DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE FROM FEE FOR SERVICE
AND CREATE VALUE-BASED WINS FOR BOTH PAYERS AND PROVIDERS
USING CMS BENCHMARK DATA
Value Proposition: Designing and Curating a Pay-for-Value Ready Network
Moderator: Joshua Rosenthal, Co-Founder and Chief Scientific Officer at RowdMap, Inc.
Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle
Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief
Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer
at Health Care Service Corporation
“The value
propositions for
public data either
disintermediate or
innovate owning risk
– either way they
can’t be ignored.”
Session Participants
Joshua Rosenthal, PhD, Co-Founder and Chief Scientific Officer at RowdMap, Inc.
Jonathan Blum, EVP at CareFist and Former Principal Deputy Administrator at CMS
Sachin Jain, MD, Chief Medical Officer and Chief Operating Officer at CareMore
Steve Ondra, MD, Chief Medical Officer at Health Care Service Corporation
Chair & Vice Chair
Kavita Patel, MD, Brookings Institute and
Former Director of Policy, The White House
Niall Brennan, Chief Data Officer, CMS

2. CREATING A VIRTUOUS CYCLE:
DESIGNING NETWORKS TO MITIGATE NO-VALUE CARE
FROM FEE FOR SERVICE AND CREATE VALUE-BASED WINS FOR
BOTH PAYERS AND PROVIDERS USING CMS BENCHMARK DATA
Value Proposition: Designing and Curating a Pay-for-Value Ready Network
Moderator: Joshua Rosenthal, Co-Founder and Chief Scientific Officer at RowdMap, Inc.
Panelists: Jonathan Blum, EVP at CareFirst Blue Cross BlueShield and Former Principle
Deputy Administrator at Centers for Medicare and Medicaid Services; Sachin Jain, Chief
Medical Officer & Chief Operating Officer at CareMore; Steve Ondra, Chief Medical Officer
at Health Care Service Corporation
Description:
High-performing networks are not enough to succeed in value based arrangements and
classic triple aim measures miss a major key to success: reducing low-value care. 30 cents
of every dollar paid goes to low-value care, or procedures and prescriptions that do not
produce any additional positive outcomes.
Low-value care accounts for roughly 3% of GDP and drove billing in Fee-for-Service
economic arrangements.
The key to succeeding in value based programs and risk arrangements is identifying and
reducing low-value care.
Newly released CMS data allows anyone to determine design and curate a network of
providers to succeed in value based programs.
Join this session to see real-world, operational examples of a virtuous cycles where payers
and providers successfully reduce low value services and share the positive results.
No-Value
Care (30%)
Necessary Utilization
(70%)
Care That Doesn’t Produce Better Outcomes
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
Low Value Care
Drives Billing in
Fee for Service
“#1 Weakness of FFS
Payment System
Is Excess Use of Low Value
Services”
Dr. Patrick Conway,
Chief Medical Officer, CMS