This event will be held live via Zoom.

9am-12pm – Payer Panel Session
1 - 3:30 pm Education
5.5 hours total/5.5 CEUs

Presenters include: representatives from BCBS-MN, UCare, Preferred One, Medica, United Health Care, HealthPartners, Lori Froehling PT, MSPT; Craig Johnson PT, MBA; Dave Nelson PT; Eric Preslaski PT, MSPT and Jeffery Vrudny PT.

Event Description

This course brings together representatives from the payer community in Minnesota for a morning payer panel followed by an afternoon educational session. The healthcare system is turning towards value-based payment models and it is important to recognize that physical therapy is an integral part of the healthcare ecosystem and this shift towards value-based payment. We must find a way to succeed with these changes. What is our role in improving the healthcare system and ensuring we are part of the solution? How can we demonstrate our value to patients, payers, other providers, and members of society as the tide is turning?

In the morning session, the payers will share their perspective on these topics through prepared remarks and Q&A format. This three-hour session will allow payers to present their material and leave time for questions from attendees. The afternoon education session is designed to discuss key topics impacting quality and payment for physical therapy services. The topics include:

•  Variation in Practice 
•  Documentation and Billing 
•  Outcomes as a Measure of Quality 

The afternoon will consist of presentations and interactive discussion, sharing a common theme of showing how proper practice, billing, documentation, and outcomes demonstrates the value of physical therapy, currently and in a value-based care environment. The goal is to gain understanding of the importance of addressing these topics and how they fit together to better manage care delivery and decrease burden to receive payment.  

Variation in Practice: Assessing and reducing practice variation 

• Importance of clinical practice audits for volume of care provided.
• Adequate documentation to justify utilization of services. 
• Use of billing codes and units that comply with payer policy. Demonstrate that intensity of the service matching the condition and goals of the patient. 
• Steps to mitigate variability such as staff education. 

Documentation and Billing: Best practices to optimize reimbursement

• Principles of defensible documentation
• Identify pitfalls and poor habits
• Demonstrating skill and why services provided should be reimbursed
• Documenting to support billing 

Outcomes as a Measure of Quality: Demonstrating value to patients and payers through outcome measures 

• Using outcomes in clinical decision making to improve continuity of patient care.
• Demonstrating the value of physical therapy services.
• Using outcomes to improve education and managing patient conditions. 

Even with best of intentions, sometimes we can take the road that is influenced by financial or operational pressures which can dilute our ability to tell the physical therapy value story. The connection of these topics and how they impact each other will be a common theme through this course.

Learning Objectives

• Outline factors that contribute to variations in practice and demonstrate how physical therapy providers can address variation in their own practice.
• Explain the importance of measuring quality and outcomes, and how it benefits patients, therapists, practices, and payers.
• Summarize the best practice for documentation and billing that improves timely payment, reduces denials, and demonstrates value. 

Pricing

Speaker Biographies

David Elton
United Health Group
 
For 25 years, David Elton has supported the UHG mission of developing a more modern, progressive and effective health system that provides extraordinary value for society. The UHG tenure has consisted of 15 years in the Optum Physical Health business, 5 years in Optum Behavioral Health and currently in the UHG Ventures group within Optum Labs. A common thread among all roles while at UHG has been translating “big data” into information that identifies and prioritizes opportunities to improve value, reduce variation in care and improve alignment with high quality clinical guidelines.

Shaun Frost, MD, MHM, FACP
Health Partners

Dr. Frost is currently Associate Medical Director for Care Delivery Systems at HealthPartners Health Plan in Minneapolis, Minnesota. In this role he works on designing, deploying, and managing innovative payment methodologies and provider network configurations focused on improving population health, patient experience, and care affordability. He is also Clinical Associate Professor of Medicine at the University of Minnesota Medical School, and he cares for patients as a hospitalist at Regions Hospital in St Paul, Minnesota. Dr. Frost has previous healthcare delivery leadership experience, having served as the President of the Society of Hospital Medicine, Northeast Region Chief Medical Officer for Cogent Healthcare (now Sound Physicians), and Director of Non-teaching Inpatient Services at the Cleveland Clinic Foundation. In 2021 he was recognized by the Society of Hospital Medicine as a “Master of Hospital Medicine”, one of only 33 hospitalists to have been bestowed this designation since it was first awarded in 2010.

Julia Joseph-Di Caprio, M.D., M.P.H.
UCare Senior Vice President and Chief Medical Officer

Dr. Joseph-Di Caprio is responsible for setting and implementing a market-leading agenda for population health and clinical operations excellence for UCare’s 550,000 members. She is a key member of the senior management team and provides strategic direction and operational oversight for UCare's Health Services Division that includes Equity and Inclusion, Medical Directors, Clinical Services, Mental Health and Substance Use Disorder Services/Special Needs and Basic Care, Credentialing, Appeals and Grievances, Quality Management, Population Health, Health Services Analytics, Disease Management and Pharmacy to ensure high-quality, cost-effective care for UCare members. 

Dr. Joseph-Di Caprio represents UCare in outside activities such as local and national associations, work groups and committees. For example, she co-chairs the Health Equity Committee of the Minnesota Council of Health Plans and is vice chair of the national Alliance of Community Health Plans Medical Director group. Her extensive professional career in the Twin Cities community includes 22 years at Hennepin County Medical Center (now Hennepin Healthcare System) where she began as a Pediatric and Adolescent Medicine Specialist and advanced to several physician leadership roles, including Chief of Pediatrics. Joseph-Di Caprio also has been a Medical Director for Medica, Senior Medical Director of Care Management for HealthEast, and Fairview Health Services Medical Leader, Connected Care. 

Community service is a hallmark of Joseph-Di Caprio’s career. She serves on the Boards of Directors for University of Minnesota’s MPhysicians, Planned Parenthood North Central States, and Mental Health Resources. She is a long-time Assistant Professor for the University of Minnesota Department of Pediatrics and sees patients monthly at NorthPoint Health and Wellness Clinic in Minneapolis.

Joseph-Di Caprio has a B.S. in Physiology from McGill University in Montreal, Quebec Canada, an M.D. from the University of Illinois, and an MPH from the University of Minnesota.

Neil Wahlstrom, MBA, FACHE, PT
Medica

Neil joined Medica in 2019 as the Director of Clinical Value.  Neil has been a licensed clinician for 24 years, having practiced in multiple settings including hospital OP, group private practice, and acute care.  Beyond working as a provider, Neil has been a leader for multi-specialty physician practices and the post-acute care continuum, as well as an internal consultant for Providence Health on the west coast, consulting on process improvement, revenue expansion, and cost containment in medical centers and out-patient services.  Before joining Medica, he was the Executive Director for Home Health Services for Providence in Eastern Washington.  His background as a clinician combined with financial acumen and Lean Six Sigma drive a desire for the right care, at the right time, in the right place, at the right price.  
Neil enjoys being active, from fishing to barefoot water skiing, biking to weight lifting.  He is a Fellow in the American College of Healthcare Executives, active in his church and enjoys time with family.  He likes all things Big 10 and NFC North and is easily distracted by Minnesota High School hockey.  


Cheryl Newgren
Benefit Policy Consultant, Minnesota Medicaid 

Cheryl Newgren has been with the Department of Human Services (DHS) for over 14 years and has worked as a Medicaid Benefit Policy Consultant for eight years. She is responsible for policy work in several health care service areas, which include outpatient rehabilitation (speech, occupational and physical therapies, audiology), acupuncture and chiropractic, and hearing aids and speech devices. She is currently covering immunizations and vaccinations as well.

Cheryl has regular workgroup meetings with Minnesota Rehabilitation Association members. She works collaboratively with them to streamline MN Medicaid written policy for rehab therapy services, address related provider and community concerns, clarify/rectify billing issues, explain DHS initiatives and more.

Cheryl’s professional passions are research, writing and editing, which stems from an educational background in communications.  Cheryl’s previous positions with DHS includes work as a Provider Trainer and Communications Team member, where she wrote and edited various communications such as Provider News and Provider Updates. Cheryl has a Bachelor of Arts in Professional Communication from Metropolitan State University.

She enjoys gardening and travelling to new places in her RV and loves to spend time with her two-year old granddaughter. 


Karen Amezcua
Blue Cross and Blue Shield of Minnesota

Karen Amezcua is the Senior Director of Provider Partnerships at Blue Cross and Blue Shield of Minnesota where she oversees the overall management of statewide provider relationships including strategic partnerships, payment arrangements and value-based and innovative contracting for both commercial and government markets.  Ms. Amezcua assisted in the development and rollout of new value-based payment methodologies including total cost of care and quality incentives.  Karen has almost 20 years’ experience in health care with time spent on the care delivery side where she held positions in Payer Contracting, Quality Improvement and most recently was the Senior Director of Accountable Care.  Ms. Amezcua earned her B.A. in Philosophy from the Metropolitan State University.