AHIP Institute 2015

AHIP Institute 2015

“Collaborating to Take Costs Out of the Business of Healthcare”

Breakfast Session, Thursday, June 4 at 7:30 AM

The need to streamline the business of healthcare is universal and urgent. All stakeholders are aligned around the imperative to reduce cost, and more efficient business processes are a fundamental way to address this need. Collaboration, technology and innovation will help achieve this goal.

Join CAQH as our guest for breakfast at a session that will explore how greater collaboration among health care stakeholders is streamlining the business of healthcare and taking costs out of the system. A panel of health plan representatives will discuss how industry-wide initiatives are simplifying provider data collection, electronic funds transfer enrollment, coordination of benefits, and the exchange of electronic administrative transactions.

Learn about collaborative projects that are advancing the efficiency of their own operations, improving provider relations and reducing millions in costs for the healthcare system at large. 

Meet the panelists [Click to expand for bio]:

Jay Eisenstock, Senior Director, Provider eSolutions, Aetna

Jay Eisenstock has over 30 years of management and technology consulting experience along with significant health insurance industry knowledge. He is currently senior director of Aetna’s Provider eSolutions Organization, charged with supporting the full spectrum of electronic interactions between Aetna and the provider community. In previous roles at Aetna, Mr. Eisenstock led the company's efforts to achieve HIPAA compliance for electronic transactions.

Prior to joining Aetna, Mr. Eisenstock was vice president of the web development and business intelligence line of business for a technology consulting firm. He also held various leadership and technology positions with Electronic Data Systems Corporation (EDS).  He is a member of the CAQH Index advisory council, serves the Workgroup for Electronic Data Interchange (WEDI) as a director, and the Electronic Health Network Accreditation Commission (EHNAC) as a commissioner.

He was selected by the Certification Commission for Healthcare Information Technology (CCHIT) to be one of twenty participants in its Health Information Exchange Work Group. Mr. Eisenstock was honored with the Workgroup for Electronic Data Interchange (WEDI) Leadership in Technology award. He was also recognized as one of 11 top executives and thought leaders in the healthcare IT industry by eMids Technologies and Healthcare Payer News in 2011.

Mr. Eisenstock earned a master’s degree in business administration from the University of Massachusetts.

Sean Killeen, Executive Director, Claims Payment Integrity & Cost Containment, Kaiser Permanente and Kaiser Foundation Health Plan, Inc.

Sean is responsible for providing leadership and strategic direction for Kaiser Permanente’s Claims Payment Integrity/Cost Containment operations, which includes Code Editing, Clinical Review, Coordination of Benefits & Other Payer Liability, and Recovery Audit processes.  In this capacity, he directs Kaiser’s efforts to achieve new levels of efficiency and effectiveness in the avoidance and recovery of claim overpayment - utilizing a shared services delivery model supporting 7 regional Kaiser health plans - and integrating advanced analytics, technology, and industry leading vendors with claim payment operations.

He joined Kaiser Permanente in 2003 as Director - Financial Planning & Analysis for Health Plan Operations, before taking on the work in cost containment beginning in 2005.  Prior to joining Kaiser, Sean worked in various management and leadership roles in the Transportation, Logistics, Real Estate and Finance industries.

Sean has a bachelor's degree in Geology and Applied Mathematics and a master's in business administration, both from the University of California at Berkeley – as well as a master’s of science in Marine Geophysics from the Scripps Institution of Oceanography.

Kelly Toman, Staff Vice President, Clinical Quality Compliance and Credentialing, Anthem

Kelly Toman is an industry veteran with extensive experience in accreditation; credentialing; quality management; and provider contracting, servicing and communications. During her four-year tenure as staff vice president, clinical quality compliance and credentialing at Anthem, Toman has led numerous successful  NCQA accreditations for all Anthem government business health plans and nearly 100 external audits, including NCQA, AAAHC, HSAG, EQRO, IPRO, and others. She has delivered meaningful improvements in all credentialing metrics associated with regulatory and accreditation requirements, and has managed credentialing for several new health plans and state program integrations on behalf of Anthem.

Prior to joining Anthem, Toman served Cigna Healthcare for more than three years as implementation and business project manager. Before that, she served Great-West Healthcare as national director, healthcare management. She has also worked in related roles for Aetna, Inc. and Horizon Blue Cross Blue Shield and as a business analyst focused on modeling with Capgemini Consulting.

 

 Moderator

Robin Thomashauer, Executive Director, CAQH

Robin Thomashauer is the executive director of CAQH, a non-profit alliance that is the leader in creating shared initiatives to streamline the business of healthcare.  She has overseen the strategy and operations of the organization since its inception, over 15 years ago.

Under her direction, CAQH has collaborated with health plans, hospitals and healthcare providers to develop, implement, and manage initiatives that reduce costs and eliminate unnecessary administrative burden. These efforts include the Committee on Operating Rules for Information Exchange (CAQH CORE®), CAQH ProView™, SanctionsTrack®, COB Smart®, EnrollHub™, and the CAQH Index™.

Ms. Thomashauer has more than 30 years of broad experience in strategy, managed care operations and hospital administration.  Before joining CAQH she was a director in the health care practice at PricewaterhouseCoopers (PwC), with a primary focus on payer organizations.  Prior to her position with PwC Ms. Thomashauer held senior management positions with Kaiser Permanente, as well as in several teaching hospitals.

Ms. Thomashauer holds an M.H.S.A. in Health Care Administration from The George Washington University, and a B.A. in Social Sciences from Colgate University.  She is a Diplomate in The American College of Healthcare Executives.

 

Giving back to help others. In the spirit of collaboration, please print this page and bring it to the session. CAQH will donate $10 on your behalf to Doctors without Borders.

 
Audience: