NEJM Catalyst
Upcoming Webcast

Navigating Payment Reform for Providers, Payers, and Pharma

November 2, 2017
1:00pm - 5:00pm EDT


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This gathering of outstanding speakers and moderators from the health care provider, payer, and pharmaceutical sectors will uncover the fault lines in payment reform and discuss how to create a health care system that works well for all stakeholders – not least patients.


Agenda

1:00 PM

Welcome and Introduction

1:05 PM

Opening Talk: Leemore Dafny

1:20 PM

Session 1: Collaborating to Reign in Pharma Pricing

2:35 PM

Session 2: Providers Taking Real Risk to Realize Change

3:50 PM

Session 3: How Payers are Negotiating a New Path for Transformation

4:50 PM

Closing Remarks


Speakers

Amitah Chandra

Amitah Chandra, PhD

Malcom Weiner Professor of Public Policy, Harvard Kennedy School

Leemore Dafny

Leemore Dafny, PhD

MBA Class of 1960 Professor of Business Administration, Harvard Business School, NEJM Catalyst Theme Leader and Event Host

Robert Galvin

Robert S. Galvin, MD

Chief Executive Officer, Equity Healthcare, Operating Partner, The Blackstone Group

Lynn Garbee

Lynn Garbee, MBA

Senior Director, Reimbuersement and Collaborative Care, Cigna

Robert Huckman

Robert S. Huckman, PhD

Albert J. Weatherhead III Professor of Business Administration and Faculty Chair, Health Care Initiative, Harvard Business School

Aaron Kesselheim

Aaron S. Kesselheim, MD, JD, MPH

Associate Professor of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Director, Program On Regulation, Therapeutics, And Law (PORTAL)

David Lansky

David Lansky, PhD

President and Chief Executive Officer, Pacific Business Group on Health

J. Michael McWilliams

J. Michael McWilliams, MD, PhD

Warren Alpert Associate Professor of Health Care Policy, Harvard Medical School, Department of Health Care Policy, Associate Professor of Medicine, Brigham and Women’s Hospital

Namita Mohta

Namita Seth Mohta, MD

Clinical Editor, NEJM Catalyst, Hospitalist, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital

Dr. Griffin Myers

Dr. Griffin Myers, MD, MBA

Co-founder and Chief Medical Officer, Oak Street Health

Michael Sherman

Michael S. Sherman, MD, MBA, MS, CPE, FACPE

Senior Vice President and Chief Medical Officer, Harvard Pilgrim Health Care

1:00 PM

Welcome and Introduction


Namita Seth Mohta, MD

Clinical Editor, NEJM Catalyst, Hospitalist, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital

1:05 PM

Opening Talk: Leemore Dafny


It’s nothing more than Econ 101: you get what you pay for. Three key subsectors of the U.S. health care ecosystem—providers, payers, and pharmaceuticals—have been heavily shaped by the economic incentives facing them. Changing these sectors requires changing payment approaches, which is precisely what change agents in all three sectors are attempting to do. What do we know, what don’t we know, and where is payment reform likely to yield substantial payoffs?


Leemore Dafny, PhD

MBA Class of 1960 Professor of Business Administration, Harvard Business School, NEJM Catalyst Theme Leader and Event Host

1:20 PM

Session 1: Collaborating to Reign in Pharma Pricing


Drug prices are skyrocketing, not only for new products but also for generics. Market-based solutions don’t seem to be working. How should provider and payer organizations respond to, and collaborate with, pharmaceutical companies? Are risk-based agreements between pharma companies and health systems the future? This session features a leading health care researcher, a payer’s chief medical officer responsible for pharmaceutical contracts, and a physician-researcher specializing in pharmacoeconomics.


Amitah Chandra, PhD

Malcom Weiner Professor of Public Policy, Harvard Kennedy School

Aaron S. Kesselheim, MD, JD, MPH (Moderator)

Associate Professor of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Director, Program On Regulation, Therapeutics, And Law (PORTAL)

Michael S. Sherman, MD, MBA, MS, CPE, FACPE

Senior Vice President and Chief Medical Officer, Harvard Pilgrim Health Care

2:35 PM

Session 2: Providers Taking Real Risk to Realize Change


For all the talk in recent years of health care reform and value-based payment, provider organizations haven’t actually changed much. Fee-for-service payment remains predominant. Truly taking risk requires deep change in care delivery. Tweaking the same old delivery system simply defers change.


Robert S. Huckman, PhD (Moderator)

Albert J. Weatherhead III Professor of Business Administration and Faculty Chair, Health Care Initiative, Harvard Business School

J. Michael McWilliams, MD, PhD

Warren Alpert Associate Professor of Health Care Policy, Harvard Medical School, Department of Health Care Policy, Associate Professor of Medicine, Brigham and Women’s Hospital

Dr. Griffin Myers, MD, MBA

Co-founder and Chief Medical Officer, Oak Street Health

3:50 PM

Session 3: How Payers are Negotiating a New Path for Transformation


Are private payers developing innovative collaborations with providers and implementing payment reforms, or are they free-riding on public-sector initiatives? In this session, leaders from a payer and the segment’s key customers – employers – will assess the performance of the payer sector, and discuss how payers and employers can drive deeper change.


Leemore Dafny, PhD (Moderator)

MBA Class of 1960 Professor of Business Administration, Harvard Business School, NEJM Catalyst Theme Leader and Event Host

Robert S. Galvin, MD

Chief Executive Officer, Equity Healthcare, Operating Partner, The Blackstone Group

Lynn Garbee, MBA

Senior Director, Reimbuersement and Collaborative Care, Cigna

David Lansky, PhD

President and Chief Executive Officer, Pacific Business Group on Health

4:50 PM

Closing Remarks


Leemore Dafny, PhD

MBA Class of 1960 Professor of Business Administration, Harvard Business School, NEJM Catalyst Theme Leader and Event Host

Amitah Chandra

Malcom Weiner Professor of Public Policy

Amitah Chandra, PhD


Harvard Kennedy School

Amitabh Chandra is the Malcolm Wiener Professor of Public Policy, Director of Health Policy Research at the Harvard Kennedy School of Government. He is a member of the Congressional Budget Office’s (CBO) Panel of Health Advisors and is a Research Associate at the National Bureau of Economic Research (NBER).

Professor Chandra is an elected member of the National Academy of Medicine, the first-prize recipient of the Upjohn Institute’s Dissertation Award, the Kenneth Arrow Award for best paper in health economics, and the Eugene Garfield Award for the impact of medical research. In 2012, he was awarded the American Society of Health Economists (ASHE) medal. The ASHE Medal is awarded biennially to the economist age 40 or under who has made the most significant contributions to the field of health economics.

His research focuses on productivity and innovation in health care with an emphasis on oncology and hospital care, medical malpractice, and racial disparities in health care. His research has been supported by the National Institute of Aging, the National Institute of Child Health and Development, and the Robert Wood Johnson Foundation, and has been published in Science, the American Economic Review, the Journal of Political Economy, the New England Journal of Medicine, the Journal of the American Medical Association, and Health Affairs. He is the Chair Editor of the Review of Economics and Statistics, and a former editor of the Journal of Human Resources, Economics Letters, and the American Economic Journal.

Chandra has testified to the United States Senate and the United States Commission on Civil Rights. In 2011 he served as Massachusetts’ Special Commissioner on Provider Price Reform.
His research has been featured in the New York Times, the Washington Post, CNN, Newsweek, and on National Public Radio. He has been a consultant to the RAND Corporation, Precision Health Economics, Microsoft Research, and the Institute of Medicine. He serves on the advisory boards of Maxwell Health and Kyruus, and is a co-founder of HealthEngine.

Leemore Dafny

MBA Class of 1960 Professor of Business Administration, Harvard Business School

Leemore Dafny, PhD


NEJM Catalyst Theme Leader and Event Host

Leemore Dafny is the MBA Class of 1960 Professor of Business Administration at the Harvard Business School. Prior to joining the Harvard faculty in 2016, she served as Director of Health Enterprise Management and Professor of Strategy at the Kellogg School of Management at Northwestern University. Her research examines competitive interactions among payers and providers of healthcare services, and the intersection of industry and public policy. Dafny’s work has been published in academic journals such as the American Economic Review and the New England Journal of Medicine, and featured in popular media such as The New York Times and The Wall Street Journal.

Current projects include studies of consolidation in the U.S. hospital industry and the kidney dialysis industry, products and pricing on the public health insurance exchanges, copayment coupons for prescription drugs, and the implications of for-profit ownership of insurance companies.

Dafny graduated summa cum laude from Harvard College and worked as a consultant with McKinsey & Company prior to earning her PhD in economics from the Massachusetts Institute of Technology. She has won several teaching awards as well as Kellogg’s leading research prize, the Stanley Reiter Best Paper award. Dafny is a Research Associate of the National Bureau of Economic Research, Editor of The International Journal of Health Economics and Management, and a Board Member of the American Society of Health Economists and the Health Care Cost Institute.
Dafny’s expertise spans both the public and private sectors.

She currently serves on the Panel of Health Advisers for the Congressional Budget Office. In 2012-2013, she was Deputy Director for Healthcare and Antitrust in the Bureau of Economics at the Federal Trade Commission in Washington, DC. Dafny advises companies, government agencies, and nonprofits on a variety of issues including antitrust matters, strategic decisions, and public policy.

Robert Galvin

Chief Executive Officer, Equity Healthcare

Robert S. Galvin, MD


Operating Partner, The Blackstone Group

Dr. Robert Galvin is the Chief Executive Officer of Equity Healthcare, which oversees the management of health care for firms owned by private equity companies. EH encompasses 50 companies with health care spending of $2 billion annually. EH is a wholly owned subsidiary of the Blackstone Group, where Dr. Galvin is an Operating Partner. Before joining Blackstone, Dr. Galvin was Executive Director of Health Services and Chief Medical Officer for General Electric (GE) for 15 years.

Dr. Galvin is a nationally recognized leader in the areas of employer-sponsored insurance, quality measurement, and payment reform. His work has been published in the New England Journal of Medicine, JAMA, and Health Affairs, and he was a co-founder of the Leapfrog Group and founder of two other groups, Bridges to Excellence/PROMETHEUS and Catalyze Payment Reform (CPR), all innovative non-profits that have helped define value-based purchasing.

Dr. Galvin is a member of the National Academy of Medicine and is Chairman of the Board of CPR. He also serves on the boards of two for-profit companies, Team Health and Real Endpoints. He has received awards for his work from the National Business Group on Health, Healthcare Financial Management Association, and National Coalition for Cancer Survivorship. He is Professor Adjunct of Medicine and Health Policy at Yale and a fellow of the American College of Physicians.

Lynn Garbee

Senior Director

Lynn Garbee, MBA


Reimbuersement and Collaborative Care, Cigna

Lynn Garbee is Senior Director of Reimbursement and Collaborative Care for Cigna. In her role, she is responsible for overall strategy and operations of Cigna’s value-based arrangements, including large group accountable care arrangements, hospital pay-for-performance, and specialty care collaboratives. In addition, she has oversight of overall pricing and reimbursement as well as the governance of claims editing and pre- and post-pay solutions.

Before joining Cigna, Ms. Garbee led the Solution Design team for McKesson Health Solutions, helping payer clients in addressing claims payment challenges and preparing for value-based reimbursement. Previously, she led the claims consulting team and used analytic techniques to enable payers to optimize usage of their McKesson Health Solutions products.

Previously, Ms. Garbee directed operations for several entrepreneurial health care ventures focused on value-based reimbursement, specifically episodes of care, and headed the payment policy team and the contract management area of a major health plan. She spent several years in actuarial and benefits consulting and also managed health and welfare benefits of a Fortune 500 company. Ms. Garbee holds Bachelor of Arts degrees in Health Care Policy and Economics from Brown University and a Master of Business Administration in Health Care Management and Operations from the Wharton School of Business.

Robert Huckman

Albert J. Weatherhead III Professor of Business Administration and Faculty Chair, Health Care Initiative

Robert S. Huckman, PhD


Harvard Business School

Robert Huckman is the Albert J. Weatherhead III Professor of Business Administration at Harvard Business School, the Faculty Chair of the HBS Health Care Initiative, and the Chair of the MBA Required Curriculum. He currently teaches the second-year MBA course entitled “Transforming Health Care Delivery” and has previously taught both required and elective courses in Technology and Operations Management. Professor Huckman is the Faculty Chair of HBS’ executive education program entitled Managing Health Care Delivery. He is also a Research Associate at the National Bureau of Economic Research and the Co-Chair of the management track of Harvard’s doctoral program in health policy.

Professor Huckman’s research focuses on operational improvement and consumerism in the health care industry. His articles have appeared in publications including the American Economic Review, Harvard Business Review, Health Affairs, the Journal of the American Medical Association, Management Science, and the New England Journal of Medicine. He is an Associate Editor of Management Science.
Professor Huckman received a PhD in Business Economics from Harvard University and an AB in Public Policy, summa cum laude, from Princeton University, where he was elected to Phi Beta Kappa.

Prior to his graduate studies, Professor Huckman was a Principal and Founding Equity Member of Stamos Associates, Inc., a strategy and operations consulting firm serving clients in the health care industry. In 1997, Stamos Associates was acquired by Perot Systems, Inc. Professor Huckman has also worked at Booz Allen & Hamilton, Inc.

Aaron Kesselheim

Associate Professor of Medicine, Brigham and Women’s Hospital/Harvard Medical School

Aaron S. Kesselheim, MD, JD, MPH


Director, Program On Regulation, Therapeutics, And Law (PORTAL)

Aaron Kesselheim, MD, JD, MPH, is an Associate Professor of Medicine at Harvard Medical School and a faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital. Within the Division, Aaron created and leads the Program On Regulation, Therapeutics, And Law (PORTAL, www.PORTALresearch.org), an interdisciplinary research center that focuses on intersections among prescription drugs and medical devices, patient health outcomes, and regulatory practices and the law.

Aaron has testified before Congress on pharmaceutical policy, medical device regulation, generic drugs, and modernizing clinical trials, and has been asked to serve on select advisory committees for the FDA and National Academies of Science, Engineering, and Medicine.

Aaron also serves as a Visiting Associate Professor of Law at Yale Law School, where he teaches a yearly course on Food and Drug Administration Law, and as a faculty member at the Harvard Medical School Center for Bioethics. He is the author of over 250 articles in the peer-reviewed medical and health policy literature and serves as Editor-in-Chief of the Journal of Law, Medicine, and Ethics.

David Lansky

President and Chief Executive Officer

David Lansky, PhD


Pacific Business Group on Health

David Lansky, PhD, is the President and Chief Executive Officer of the Pacific Business Group on Health (PBGH) — directing efforts to improve the affordability and availability of high-quality health care. Since 2008, he has led the coalition of 60 large employers and health care purchasers representing more than 6 million Americans, including Wells Fargo, Intel, Safeway, Walmart, Boeing, CalPERS, and the state of Washington Health Care Authority.
A nationally-recognized expert in accountability, quality measurement, and health IT, Lansky has served as a board member or advisor to numerous health care programs, including the National Quality Forum, federal Health IT Policy Committee, Catalyst for Payment Reform, Joint Commission, National Patient Safety Foundation, Leapfrog Group, and the Medicare Beneficiary Education Advisory Panel.

Lansky currently is the Vice Chair of the Health Care Transformation Task Force. He also serves on the Guiding Committee of the HHS Learning and Action Network, the Congressional Budget Office Health Advisors Panel, and the Board of the Alliance for Health Reform.
From 2004 to 2008, Lansky was Senior Director of the Health Program at the Markle Foundation (NY), and from 1995 to 2004, he established the Foundation for Accountability (FACCT), a public-private venture developing quality measures and web-based tools to help consumers and purchasers assess the value of health care services and providers.

Lansky was a senior policy analyst for the Jackson Hole Group during the national health care reform debate of 1993–94. He led the Center for Outcomes Research and Education at Oregon-based Providence Health System from 1988 to 1993.
He is the author of more than 30 peer-reviewed papers on outcomes research and quality measurement and holds a PhD from the University of California, Berkeley.

J. Michael McWilliams

Warren Alpert Associate Professor of Health Care Policy, Harvard Medical School, Department of Health Care Policy

J. Michael McWilliams, MD, PhD


Associate Professor of Medicine, Brigham and Women’s Hospital

J. Michael McWilliams, MD, PhD, is the Warren Alpert Associate Professor of Health Care Policy at Harvard Medical School. He is also an Associate Professor of Medicine at Harvard Medical School and a practicing general internist at Brigham and Women’s Hospital. Dr. McWilliams’ research focuses on health care spending, quality, access, and disparities in aging populations. The overarching goal of his work is to inform the development of payment and delivery systems, insurance coverage, markets, and regulatory policy that support value and equity in health care, with a particular emphasis on the Medicare program. He is currently leading research funded by the NIA, NCI, AHRQ, Robert Wood Johnson Foundation, Office of the Assistant Secretary for Planning and Evaluation, and Laura and John Arnold Foundation on a range of related topics, including Accountable Care Organizations and other new payment models, provider consolidation, health care prices, risk adjustment, low-value care, the role of organizations in technology diffusion, and coverage expansions in the South.

He is a former recipient of a Paul B. Beeson Career Development Award in Aging Research and a Clinical Scientist Development Award from the Doris Duke Charitable Foundation.

Dr. McWilliams received his BS with highest distinction in Biology as a Morehead Scholar from the University of North Carolina at Chapel Hill, his MD magna cum laude from Harvard Medical School, and his PhD in Health Policy from Harvard University. He completed his residency in general internal medicine at Brigham and Women’s Hospital and was an AHRQ post-doctoral fellow in health services research at the Harvard School of Public Health. Dr. McWilliams has received the Mack Lipkin, Sr. Associate Award, Milton W. Hamolsky Junior Faculty Award, Best Published Research Paper of the Year Award, and Outstanding Junior Investigator of the Year Award from the Society of General Internal Medicine. He has also received the Dissertation Award, Noteworthy Article of the Year Award, and Alice S. Hersh New Investigator Award from AcademyHealth. He is an elected member of the American Society for Clinical Investigation and Comments Editor for the Journal of General Internal Medicine.

Namita Mohta

Clinical Editor, NEJM Catalyst

Namita Seth Mohta, MD


Hospitalist, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital

Namita Seth Mohta, MD is the Clinical Editor for NEJM Catalyst, a new venture launched by The New England Journal of Medicine/NEJM Group to advance the dialogue amongst leaders to drive innovations in health care delivery. As a key member of the leadership team, she has responsibility for editorial strategy and content quality. Dr. Mohta is the Clinical Lead for the ACO at The New England Quality Care Alliance Physicians Organization affiliated with Tufts Medical Center. She works with the network to define strategy, implement system-wide clinical initiatives, and develop analytic tools to successfully improve outcomes.

Prior to these roles, Dr. Mohta served as the Medical Director for Population Health Management at Partners Health Care. There she was a part of the initial leadership team responsible for the development and implementation of innovative, Partners-wide programs to successfully improve quality of care, and lower costs for the populations they served under alternative payment contracts such as the Medicare Pioneer Accountable Care Organization. Her responsibilities included implementation of Partners’ primary care strategy to evolve practices toward patient-centered medical homes as well as the care management program for their most medically complex, high-risk patients. Dr. Mohta was the clinical lead for Partners’ strategy to improve care for the often vulnerable Medicaid population. Prior to this role, Dr. Mohta was Clinical Director of Partners Business Planning, responsible for system-level, clinical strategy projects. She also has industry experience as a management consultant with the Boston Consulting Group.

Dr. Mohta practices as a Hospitalist at the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, and attends on the academic teaching service. Her clinical interests include improving end-of-life care in the inpatient setting. Academically, she is faculty at the Center for Healthcare Delivery Sciences at BWH and at Harvard Medical School. She completed her Internal Medicine and Primary Care residency training at the Brigham and Women’s Hospital. Dr. Mohta is a graduate of Yale College and Yale School of Medicine.

Dr. Griffin Myers

Co-founder and Chief Medical Officer

Dr. Griffin Myers, MD, MBA


Oak Street Health

Dr. Griffin Myers, Chief Medical Officer, is a board-certified physician responsible for the excellence of health care delivery at Oak Street Health. Oak Street Health is a growing organization of primary care centers serving adults on Medicare in the Midwest. Dr. Myers is also a co-founder of the company.

At Oak Street Health, Dr. Myers has successfully guided the company’s growth into additional markets and explores additional partnerships to broaden the company’s reach. He has built the medical group and developed an innovative clinical informatics program. He is a frequent speaker and publisher on behalf of the company and a rising voice in the health care industry.

Prior to Oak Street Health, Dr. Myers was a Clinical Fellow at Harvard Medical School, where he did his Residency and a Resident Physician at Brigham and Women’s and Mass General Hospitals. He also worked as a Project Leader at The Boston Consulting Group.

Dr. Myers is BS graduate of Davidson College, has an MBA from the University of Chicago Booth School of Business, and an MD from The Pritzker School of Medicine at the University of Chicago. He is a diplomate of the American Board of Emergency Medicine and an Adjunct Instructor of emergency medicine at Northwestern University’s Feinberg School of Medicine. Dr. Myers is also a Fellow at Doximity, a Thought Leader for the New England Journal of Medicine’s Catalyst publication, and a Presidential Leadership Scholar.

Dr. Myers lives in Chicago with his wife. When not working, he enjoys making craft cocktails and training for Iron Man competitions.

Michael Sherman

Senior Vice President and Chief Medical Officer

Michael S. Sherman, MD, MBA, MS, CPE, FACPE


Harvard Pilgrim Health Care

Dr. Michael Sherman serves as Chief Medical Officer and Senior Vice President for Harvard Pilgrim Health Care. Dr. Sherman is responsible for Harvard Pilgrim’s medical trend management, provider engagement strategy, medical informatics, wellness and health promotion initiatives, care and disease management services, pharmacy services, NCQA accreditation, and quality and utilization management programs, and he has been a leader in driving adoption of outcomes-based provider and pharmaceutical contracts. He also serves on the faculty of Harvard Medical School’s Department of Population Medicine, as Chair of the Board of Managers of the Harvard Pilgrim Health Care Institute, and on the Advisory Board of the Institute for Clinical and Economic Review (ICER). Dr. Sherman also is the current Chair for AHIP’s CMO Leadership Council, comprised of chief medical officers from health plans throughout the United States.

Prior to joining Harvard Pilgrim, Dr. Sherman held leadership roles at Humana, UnitedHealth Group, and Thomson Medstat (now IBM Truven). He holds a BA and an MS in Biomedical Anthropology from the University of Pennsylvania and received his MD from Yale and MBA from the Harvard Business School. Dr. Sherman is a diplomate of the American Board of Anesthesiology and American Board of Medical Management, and he practiced as a cardiac anesthesiologist prior to pursuing his MBA.

A fellow of the American College of Physician Executives, Dr. Sherman was also appointed by then Governor Deval Patrick to represent the health plan perspective on the Massachusetts Statewide Quality Advisory Committee.

Dr. Sherman is a frequent speaker at national and regional conferences and has lectured as part of the Harvard Business School executive education program on value measurement in health care. He currently serves on the board of directors and as Co-president of the Harvard Business School Healthcare Alumni Association, as well as on the board of advisors for the Harvard Business School Healthcare Initiative, the board of directors for the Personalized Medicine Coalition, and the board of overseers for Boston’s internationally renowned Museum of Science.