Fall 2021 Conference Agenda
Sept. 29–Oct. 1
Marriott Marquis Washington D.C.

Register Now! 
NAACOS conferences are the only events organized exclusively by ACOs.
We will continue to update the agenda! Check back for more information soon. 
Wednesday (pre-conference workshops): 1:00–4:00 pm ET
Thursday (Main Meeting): 7:30 am6:00 pm ET
Friday (Main Meeting): 7:30 am3:00 pm ET

Thursday, September 30

7:30 – 8:15 am

Building a Partnership to Positively Impact Patient Care 
Speakers: Tom Boggs, Bridges Health Partners and Greg Gadbois, naviHealth

Health systems and ACOs understand the importance of avoiding unnecessary utilization and mitigating readmissions to drive significant savings and improve patient outcomes. One of the most successful methods in doing so is for health systems to create a strong care transitions program and high-quality PAC network. In this session, hear from a clinically integrated network leader and a post-acute leader as they outline practical strategies in building a successful partnership to positively impact patient outcomes and reduce costs. Learn about the significant obstacles they overcame as partners, including a lack of data exchange and systemic changes in light of the pandemic, as well as tips for optimizing the patient journey.  

Sponsored by naviHealth


7:30 – 8:15 am

Networking Session

Apixio invites you to attend our networking session.  Feel free to stop by, grab some breakfast, and connect with fellow attendees and the Apixio team to learn how our AI-powered solutions are changing how health care is measured, care is delivered, and discoveries are made. 


Sponsored by Apixio


7:30 – 8:15 am

Empowering Providers: Using Data to Enable Continuous Performance and Quality Improvement
Alysen Casaccio and Jeff Iasilli, Mingle Healthcare, and Amy Kotch and Maria Nikol, Salient Healthcare

Join the Salient Healthcare team as they discuss the importance of empowering providers to be successful in value-based care models. It is imperative to provide timely and actionable information in the hands of clinical teams. Learn how to use data to enable continuous performance and quality improvement, which as of recent, has come to the forefront due to regulatory changes. 
Sponsored by Salient Healthcare


8:30 – 10:00 am

Welcome: Clif Gaus, NAACOS

Opening Plenary: Jon Blum, CMS

Our conference will kick off with insights into CMS’s policy for value-based care models from CMS Principal Deputy Administrator and COO, Jon Blum.  Join us to learn about the future direction for federal value-based payment policy. 

Presentation of Champion in Healthcare Value Awards: Allison Brennan, NAACOS

Liberty Ballroom

10:00 – 10:30 am



10:30 am –12:00 pm

What's Ahead for Direct Contracting
Chair: David Pittman, NAACOS
Speaker: Christy Cawthon, Southwestern Resources Accountable Care Network; Pauline Lapin, CMMI; Andrea Osborne, VillageMD; Kraig Smith, Nevada Care Connect

Direct Contracting, announced with great fanfare just before the spring 2019 NAACOS conference, will enter its second performance year in 2022. With now multiple cohorts and types of entrants, we have a better understanding of what to expect from Direct Contracting. This session will examine what changes we might see in the model, what DCEs’ focus should be on, challenges and opportunities, and how to overcome obstacles.


10:30 am –12:00 pm

Strategies to Improve Care for Beneficiaries with Complex Needs
Rob Mechanic, Institute for Accountable Care
: Kevin Biese, UNC Senior Alliance ACO; Francis Balucan, Vanderbilt University; Matt Zavadsky, MedStar911 

High-need, high-cost (HNHC) individuals with multiple chronic conditions, functional limitations, and complex social needs account for a high proportion of Medicare spending and a disproportionate amount of potentially preventable spending. The needs of HNHC patients often are not well addressed by a health system and culture focused on specialized and facility-based care. This session will discuss three strategies that ACOs could implement use to reduce unnecessary acute care for HNHC populations: on-demand acute care delivered by paramedics; extensivist clinics that offer hospital-level services in an ambulatory setting; and geriatric emergency departments (GEDs) that work to triage elderly patients to alternative care settings where appropriate.


10:30 am –12:00 pm

Hospital at Home 2.0: Best Practices from the Field
Debbie Welle-Powell, Essentia Health
Speakers: Doug Clarke, Medically Home; Pamela Saenger, Mount Sinai Health System; Margaret Van Oosten, UnityPoint

This session will provide a brief review of CMS hospital at home ([email protected]) programs and private payer programs and new innovations from the field. Speakers will share best practices for an effective [email protected] program, including technology, clinical operations, finance, and patient engagement. They will also review key performance indicators for ongoing monitoring and improvement, as well as help attendees understand the pros and cons of “buying” vs. “building” a program.


12:00 –1:30 pm

Lunch Plenary
Tom Kloos, Optimus Health Partners and Atlantic ACO
Dr. Robert Pearl

Hear from Dr. Robert Pearl about his new book, Uncaring. In this important and timely book, he shines a light on the unseen and often toxic culture of medicine. Today’s physicians have a surprising disdain for technology, an unhealthy obsession with status, and an increasingly complicated relationship with their patients. All of this can be traced back to their earliest experiences in medical school, where doctors inherit a set of norms, beliefs, and expectations that shape almost every decision they make, with profound consequences for the rest of us. ACO attendees will receive a complementary signed copy of the book on site.

Book-Signing Sponsored by Olio

Liberty Ballroom

1:30 – 2:00 pm

Exhibits Open
Pick Up Book - Sponsored by Olio


2:00 – 3:30 pm

Critical Policy Updates for ACOs
Chair: Allison Brennan, NAACOS
Speakers: Jennifer Gasperini and David Pittman, NAACOS

In this session, NAACOS staff will review recent policy updates pertaining to ACOs and Direct Contracting Entities (DCEs) for 2022. In addition, the session will review key congressional issues for ACOs to be aware of as well as what to expect from the new administration for the value-based care movement. 


2:00 – 3:30 pm

Leveraging ACO Infrastructure for Entire Organization
Tony Reed, ChristianaCare ACO
Speaker: Dan Elliott, ChristianaCare ACO; Mark Gwynne, UNC Senior Alliance; Rose Kakoza, ChristianaCare ACO; Carrie Nelson, Advocate Aurora Health

Population health management is an iterative process, improvement in overall performance is dependent upon how quickly the critical success factors can be addressed and replicated across the entire organization. Learn for leading healthcare organizations on how they are leveraging their ACO infrastructure to expedite value based success across all populations and lines of business.


2:00 – 3:30 pm

Post COVID Lessons Learned
Chair: Rob Fields, Mount Sinai Health System
Speaker: Emily Brower, Trinity Health; Arshad Rahim, Mount Sinai Health System

The pandemic challenged delivery systems large and small to rethink not only the day-to-day management of patients but also finances, technology, policies and procedures and whole host of other variables that are part of what we do as providers. In this session, we will have leaders from various parts of the country discuss not only how they adapted to the rapidly changing environment but also what changes will carry forward and how did value-based operations contribute to the overall mission of their organizations. 


3:30 – 4:00 pm


Liberty IJKL Ballroom and Liberty Foyer

4:00 – 4:45 pm

Smarter Medicine at Scale: How Strong Data Models and Predictive Analytics Can Lead to Better, Tailored Interventions
Speaker: Jesse James, CHESS Health Solutions

Join Dr. Jesse James, MD, MBA, and Chief Medical Officer of CHESS Health Solutions as he discusses the importance of building robust data models and leveraging advanced analytics to support clinical teams and improve patient outcomes. Learn how clinical data feeds predictive analytics to address potential challenges before they arise and tailor interventions that reduce care costs without compromising quality.

Sponsored by Innovaccer


4:00 – 4:45 pm

ACOs 2021: The Continuing Impact of COVID and Perspectives on Year-to-Date Performance
David Clain and Josh Gray, HDAI

In the midst of a pandemic resurgence and enormous pressure on ACO administrators, it’s hard to find the time to reflect on the first six months of 2021. How are costs trending as of mid-year and how did COVID disrupt primary and specialty care? Using Medicare claims data through June 30, you’ll learn where there are positive and negative trends. You may be surprised by some of the findings. You’ll also hear about how ACOs can apply predictive analytics and CMS’s new Beneficiary Claims Data API (BCDA) to identify and intervene with high-risk patients.  

Attendees who are interested may request a customized analysis which will benchmark their 2021 cost and utilization performance against those of other ACOs.

Sponsored by Health Data Analytics Institute


4:00 – 4:45 pm

Why Your Providers Aren’t Risk Adjusting and What You Can Do About It
Howard Follis, Juxly

ACOs have trouble getting their providers to fully risk adjust their patients. HCC coding and HEDIS care gap closure is a non-intuitive and slow process. As a result, providers leave risk suggestions unaddressed. By optimizing risk adjustment inside their EHR workflows, providers can be left to do what they do best - caring for their patients. Juxly offers a solution that allows providers to perform risk adjustment and HCC coding easily and efficiently directly within the EHR. During this presentation, we will show you how the Juxly Platform at one of our ACO partners increased coding accuracy and raised average RAF scores by 40%. We will also talk about our ACO Package feature set and show you how the Juxly Platform ingests CCLF data to cleanly display risk reconfirmations within the application.

Sponsored by Juxly


4:45 – 5:00 pm



5:00 – 5:45 pm

Plenary: ACOs and Health Equity: Promise or Peril?
: Katherine Schneider, Two Canoes Health, LLC
Rob Fields, Mt. Sinai Health System
Gary Jacobs, VillageMD Center for Government Relations and Public Policy 

In this fireside chat, join thought leadership on the critical imperative for ACOs and other Alternative Payment Models to be a leading part of the solution for better health equity for the nation.   We will provide a sneak peek at some Institute for Accountable Care data on patient diversity in Medicare ACOs (spoiler alert: opportunity for improvement!) and discuss:

  • equity as not only a mission but also a business strategy
  • the need to adjust, but not over adjust, for social determinants of health in APM metrics, 
  • how public-private partnerships and investment can and must drive better access for all systems and policies transforming US healthcare from volume to value and population health outcomes.  

Liberty Ballroom

5:45 – 6:45 pm


Sponsored by The Garage

Foyer and Liberty Ballroom

Friday, October 1

7:30 – 8:15 am

What Can Five Million Texts Teach Us about COVID-19 Patient Engagement?
Speakers: Anna Basevich and Rich Parker, Arcadia

We're still in the middle of the single greatest patient engagement challenges of our lives – getting patients vaccinated against COVID-19 and keeping them safe and healthy, administering preventative care and managing chronic conditions, as the virus upends communities across the country. After five million texts and countless workflows mixing predictive algorithms, automation, and human intervention, we've uncovered key best practices for running a tech-enabled patient engagement program.  We'll share successful strategies for stratifying populations and running highly targeted outreach campaigns that build trust, generate engagement, reduce burden on practice staff, and get patients in for vaccinations.

Sponsored by Arcadia


7:30 – 8:15 am

Improving Post-Acute Network Performance: How One ACO Reduced Readmissions and Saved $1.6M with Post-Acute Data Transparency 
Speakers: Margaret Latrella, St. Joseph’s Health Partners and Phyllis Wojtusik, Real Time Medical Systems

As post-acute care (PAC) spend continues to rise and CMS moves forward with the new Interoperability and Patient Access Final Rule, it is essential for ACOs to take proactive measures in finding innovative, cost-effective solutions to meet future demands of healthcare. Yet, disparate EHR systems between acute and post-acute providers continues to pose challenges in the ability to access live patient data across care settings to improve both clinical and financial outcomes. During this presentation, learn how one ACO created a high performing post-acute network by obtaining live patient data to implement standardized care pathways, improve care transitions, better manage patient outcomes, and ultimately reduce total costs within their post-acute network.

Sponsored by Real Time Medical Systems


7:30 – 8:15 am

No Patient Left Behind: How Lab Partnerships can Impact Population Health Initiatives
Speaker: Chris Garcia, Labcorp

Population health initiatives are a key component of health care provision today. They require a complex coordination of efforts across multiple disciplines and organizations to achieve positive health outcomes. We’ll explore what a strategic partnership with a lab can bring to the table, and some examples of how they can drive and/or support key population health initiatives. This presentation will include information around: coding, care gaps, quality measures, laboratory data.

Sponsored by LabCorp


8:30 – 9:30 am

Plenary: Future of Quality Measurement and Improvement in Value Based Payment
Moderator: Rob Fields, Mount Sinai Health System
Speakers: Lee Fleisher, CMS Center for Clinical Standards and Dana Safran, National Quality Forum

This session will discuss the future of quality measurement and how to drive continuous improvement in value based payment models. Leaders in quality measurement will discuss issues such as the move to digital quality measurement, as well as measuring equity and resiliency in the health care system. 

Liberty Ballroom

9:30 – 10:00 am



10:00 – 11:30 am

How Medicare Advantage Experience Drives ACO/Direct Contracting Success
Chair: Emily Brower, Trinity Health
Speakers: Yates Lennon, CHESS; Raj Naik, Best Value Healthcare; Daniel Wendorff, Mount Carmel Health Partners

Join experienced leaders who will share how they borrow from their success in Medicare Advantage to inform their Medicare ACO/Direct Contracting strategy…and vice versa.  Speakers will share what initiatives were easier to spread, and where they needed different approaches to improve outcomes for the different populations.  Practical learning and time for discussion will make for an interactive session.


10:00 – 11:30 am

ACOs Approaches to Addressing Health Equity
Jen Perloff, Institute for Accountable Care
Speakers: Patt Richesin, Kootenai Accountable Care; Tracey Wilkie, UMASS Memorial ACO; Debbie Welle-Powell, Essentia Health 

ACOs, with their emphasis on patient-centered, high-quality care, are well positioned to address issues related to health equity. For many beneficiaries, race/ethnicity, socio-economic status or rural geography have led to limited access and deferred care, resulting in chronic health problems or disparities in health outcomes. Despite the tremendous promise of ACOs, results related to health equity have been mixed. This session focuses on the work of ACOs who are leaders in this field, creating new data systems and program models specifically focused on identifying and addressing disparities. Each ACO will address the motivation for addressing health equity, describe specific activities/initiatives, and discuss the business case for this work. 


10:00 – 11:30 am

Transitioning to eCQM Reporting
Chair: Megan Reyna, Advocate Aurora Health
Speaker: Paula Burleson, Novant Health; Michael Van Scoy, Essentia Health

In this session, ACOs will discuss what they are doing to prepare for the move away from quality reporting using the Web Interface, to electronic clinical quality measures (eCQMs). The session will review recent policy updates driving these changes and discuss strategies ACOs are implementing now to prepare for the transition. 


11:30 – 11:45 am



11:45 am – 1:15 pm 

The Future of Digital Health for ACOs
Chair: David Pittman, NAACOS
Speakers: Adam Brown, Mount Sinai Health System; Bradd Busick, MultiCare Connected Care; Meghan O'Toole, The Office of U.S. Senator Brian Schatz; Anna Taylor, MultiCare Connected Care

The use of telehealth and remote monitoring has skyrocketed since the COVID-19 pandemic, and many health systems have embedded the technology’s use into everyday practice. In this session, we’ll discuss where the policy and practice will take digital health tools, including hearing from ACOs about their outlook on telehealth and remote monitoring, what they hope to accomplish, and how.


11:45 am – 1:15 pm 

Physician Compensation Models that Support Transition to Value
Chair: Kim Kauffman, Best Value Healthcare
Speakers: Rob Fields, Mount Sinai Health System; Stephen Nuckolls, Coastal Carolina Quality Care; Ashish Parikh, Summit Medical Group

Three very different organizations will share how they modified provider compensation to achieve their shared value-based care goals.  Audience questions and idea sharing will be encouraged during this conversational session


11:45 am – 1:15 pm 

Clinical Integration within your ACO/CIN:  Managing the Challenges of Keepage and Leakage
Chair: Tom Kloos, Atlantic ACO and Optimus Health Partners
Speakers: James Barr, Atlantic and Optimus ACO; Kim Busenbark, Wilems Resource Group; Heather O'Toole, Innovation Care Partners; Jack Cappitelli, Summit Health Management

Hear from 3 successful ACO’s and clinically integrated networks  on how they approached the challenges of integration,  the data and tools used, and how it is presented to physicians, the  pitfalls and challenges, and a compliance officers views on how and if we can promote integration without running afoul of regulatory issues. We will leave plenty of time for questions and an interactive discussion.


1:15 – 3:00 pm

Lunch Plenary
Open Mic with CMS 

Speakers: John Pilotte and Amy Bassano, CMS

This session includes a town hall format and is an important way for ACOs and CMS to have an open dialogue about the Medicare ACO program, including discussion on evolving policies and how ACOs fit into CMS’s overall goal of improving Medicare payment and healthcare delivery. This is an excellent opportunity for ACO executives to pose questions and receive answers directly from CMS leaders and to hear the newest developments straight from the agency.

Liberty Ballroom