Session Abstract – PMWC 2020 Silicon Valley


Data analytics are vital to the success for healthcare payers to reduce resources and cost, and improve beneficiary experience while providing better patient care. The majority of that data is unstructured and in many instances difficult to access and analyze. This session will discuss several interesting use cases, opportunities, and challenges that need to be overcome to deliver value to the healthcare payer community.

 Session Chair Profile

M.D., Clinical Informaticist, Stratametrics LLC; Technical Director, HL7 Da Vinci Project

Biography
Viet Nguyen is an internist, pediatrician, clinical informaticist and consultant to government and commercial organizations in developing interoperable workflows and technologies. He has over 15 years of experience in Health IT focused on interoperability standards and product development. Formerly the CMIO for Lockheed-Martin and Leidos Corporation, Dr. Nguyen is a nationally recognized FHIR educator, a FHIR Foundation Board Member, CMO for Logica Health (formerly Health Services Platform Consortium) and Technical Director for the HL7 Da Vinci Project. The Da Vinci Project is a Payer-Provider-Vendor collaboration addressing value-based-care use cases and developing HL7 FHIR-based, standard solutions.


 Speaker Profile

M.D., Director, Analytic Enablement at Highmark Inc., Highmark BlueCross/BlueShield

Biography
Lincoln's data science teams build analytic products across several Highmark business functions including clinical services and revenue cycle. Those products have leveraged advanced analytics to generate personalized member insights that drive efficiencies and savings for the health plan, providers, and members. Aside from workflow app development, his teams have developed several robotic process automations that work side by side with clinicians. Those bots employ image processing and advanced analytics in their work. Several workflow apps employ real time machine learning and natural language processing to enhance identification and stratification of members. Prior to working at Highmark, Lincoln worked as a data scientist at the UPMC Technology Development Center and then at one of their portfolio companies. He graduated from Rutgers Medical School and received his MS from Princeton University working on the use of real time machine learning to stratify and identify members at risk of various outcomes.


 Speaker Profile

M.D., FACS, Medical Director, Quality and Health Policy Division of Advocacy and Health Policy, American College of Surgeons

Biography
Frank G. Opelka is a physician executive, a surgeon and the Medical Director for Quality and Health Policy at the American College of Surgeons. He has focused his efforts on Alternative Payment Models, Interoperability Solutions, Graduate Medical Education, Work Force, and Surgeon Burnout (Emotional Well Being). Dr. Opelka serves on several national initiatives for health care reform including the Health Care Learning and Action Network and the Surgical Quality Alliance. Dr. Opelka is the founder and chair of the Surgical Quality Alliance. He serves as an advisor to several organizations for quality, payment reform and digital health information solutions in support of advancing clinical registries for machine learning and artificial intelligence. Dr. Opelka leads a team building a new performance measure framework for surgical patients. This project is built around patient-centric measures within the five phases of surgical care. In addition, his work promotes surgical patient reported outcomes mapped to the goals patients have in their care. Dr. Opelka serves as an academic surgeon with clinical appointments at George Washington University and formerly as a professor of Surgery for Louisiana State University and as visiting associate professor of Surgery at Harvard University. He serves as a member of editorial boards and reviewer for five international peer reviewed journals. Dr. Opelka has edited several surgical textbooks, published and delivered over 200 scientific manuscripts and presentations.


 Speaker Profile

Executive Director, Data Science, Aetna

Biography
Rajiv leads several technology integration projects within the Analytics & Behavior Change organization at CVS Health, including Aetna’s internal behavior change messaging platform, and Attain, an activity and health app developed in collaboration with Apple. Prior to joining CVS, Rajiv led the Data Science & Engineering organization at Fitbit and spearheaded the development of several machine learning-based initiatives. Rajiv has also worked in the areas of video-on-demand (Netflix, CBS Interactive) and bioinformatics (GE Healthcare).