Whitney MillerNetwork Development Specialist Intern

Very Nice to Meet You!

  BR born….TX raised…BR to stay

  LSU 5th-Yr. Senior

  May 2015 Graduate

  Nutritional Sciences - Dietetics

  Previously, Pennington Biomedical Student Worker

My Goals!

  Graduate & Employment

 MBA

  Focus on Health Care Administration & Mgt.

  Overall Totality of Healthcare & Population Management

  Industry Enhancement

Healthy & Blue Beginnings!

Spanishtown Market

LSU CCELL “Happy Award”Nov. 12, 2014

...Onsite & Official!

  October 2, 2014

  Network Development

  Senior VP: Sabrina Heltz

  VP: Kevin Egge

  Director: Shannon Taylor

Network Development !v  Purchasers of healthcare for BCBSLA by:

  Build networks of physicians/facilities to provide care to BCBS members

  Contract

  Strategize

  Negotiate

  Work with providers to provide the highest quality, cost-effective care

  Adapt to the market – Evolving provider types/trends

Network Development Specialist Intern!  Assist managers, network specialists, and network reps

  Develop and maintain relationships with providers

  Build plans for members

  Creating Medicare Advantage for 13 parishes

  Effective January 1, 2016

  Filed to CMS by February 1, 2015

  Participate in NAD/Reimbursement weekly mtgs; & others

  Learn the market; Learn the business

  Learn BCBSLA

Me, Myself, & Medicare!v  CMS approval requires an intensive application process à

Prepare 1 year in advance

  Tracking solicitations

  Recording contracts recieved

  Examining sufficiency and deficits of providers

  Monitoring gap closure

v  Must create a provider network that demonstrates to CMS A/A to Medicare population served

Medicare Targets Markets !

MedAdvantage Tracking !  Built a tracking database spreadsheet of Solicited

Providers

  Provider Tracking

  Divide by 3 markets with 13 parishes

  Sorted by provider specialty

  Hospital Tracking

  Sorted by hospital services

Provider Tracking !

•  Market •  Parish •  Specialty •  Provider

My System of MedAdvantage !

  Track filing adequacy through database

  Weekly updates

  Provider contracts

  Gap Closure

  Continuing deficits

Extra Pair of Hands Filling Gaps !

  Research time and distance requirements

  Define hospital services à A/A

  Assist with phone calls to providers

“Eyes and Ears” of the Network Reps!

  Help them focus their efforts!

  Who do they need to focus on?

  What area is lacking?

  What specialty is not accounted for?

  Who, what, and where they do not need to worry about?

QBPC Statewide Collaborative !v  Quality Blue Primary Care

  November 6, 2014

  Presented by Dr. Peter Tooth; Dr. Kenny Cole

  Observed Break-Out Sessions

v  Fee-for-Service à Outcome-based Payment

v  Volume à Performance

“Flipping” the Room !

  Doctors & Staff (Quality Navigators) to Patients

  Not patients to doctor

  Relationships, not appointments

  Care, not treatment

  Quality...before Specialty

Atlantic Conference !  “Inventing the Future of Healthcare” Forum

  Where the industry stands

  Where is should be headed

  Plans for improvements

  Requirements for reform

  Blue Cross LA is leading the way in Louisiana!

Continuing Work… !

  Continue with Medicare Advantage until filed

  Field provider contracting inquiries

  Train on Emptoris – creating physician contracts

  Train on physician contracting language and provisions

What Our Success Will Look Like!

  Long Term:

  Successful development and maintenance of high quality – low cost networks

  Proving High Value Plans to BCBSLA members

  Short Term:

v  Meeting CMS approval

v  Filing Medicare

Personal Fulfillment !  Gained Perspective

  Built a Network

  Generated Confidence

  Learned “My Place”   Achieved one small goal

 Created “Career Drive”

Some Gained Perspective! ...or how to say it.!

  B = Broadening

  L =Learning

  U =Understanding

  E = Exceeding

More Than a Color!