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Optimizing Your Patients Before Surgery: A Path to BPCI-A Success

By Amanda Connoyer, MSHI, MSN, APRN, FNP-C Regional Clinical Diretor, Fusion5 Shawna Zabkiewicz, RN, BSN, CCM Director, Value Based Care and Case Management, OrthoIllinois Introduction Targeting the optimization of patients’ health before surgery to improve patients’ post-surgical outcomes, reduce or prevent possible perioperative complications, decrease readmissions, and reduce recovery times is a worthwhile endeavor to […]

Nurses to Face Additional Pressure and Increased Documentation Requirements Under PDPM

Frontline nurses may face additional pressure to document and justify skilled care that is reimbursable under Medicare, once changes to the Patient-Driven Payment Model (PDPM) for Skilled Nursing Facilities (SNFs) are fully in place. Changes to PDPM will take effect later this year, on October 1. The purpose of the change is to reduce mistakes […]

Crushing Bundled Payments: Identifying Surgical Candidates

By Jason McCormick Vice President, Partner Services at Fusion5 As we continue our series on the critical elements of a successful bundled payment program, we begin to focus on the normal day-in and day-out processes that can prevent any case from becoming a “bundle-buster.” The first few elements of a successful bundled payment program helped […]

Changes to Stark Law Should Increase Participation in Value-Based Care Programs

CMS Administrator Seema Verma gave her first update on major changes to the Stark Law, which is currently being overhauled to reflect the shift from fee-for-service to value-based care. “Some changes include clarifying regulatory definition of volume or value, commercial reasonableness and fair-market value,” Verma said. Revised regulations will likely be released before the end […]

CMMI Data Shows Fusion5 has Winning BPCI Recipe

By Jason McCormick Vice President, Partner Services at Fusion5 The OrthoForum 2019 Annual Conference was held in San Antonio this past week. Orthopaedic surgeons and practice executives from across America came together to discuss issues facing orthopaedic practices and, overwhelmingly, one theme was consistently heard – bundled payments are on everyone’s mind. Conversations regarding BPCI-Advanced […]

Assessment of Risk: A Central Theme for Success in Value-Based Care Models

By Matthew DeHart, MPH Research, Statistics & Design Engineer Fusion5 Executive Summary Through analysis of Medicare claims data derived from the Centers for Medicare and Medicaid Services (CMS) Limited Data Set (LDS) Standard Analytical Files from 2012-2016 in concert with iterative analysis of Fusion5 risk assessment data we are able to conclude with high confidence […]

Crushing Bundled Payments: Identifying and Engaging a Preferred Provider Network

By Jason McCormick Vice President, Partner Services at Fusion5 At the core of any bundled payment program is the ability to control costs generated by the services that patients receive during the bundle episode period. The provider, or the “episode initiator”, is in control of many of the costs associated with the patient’s surgical intervention, but not necessarily […]

The First Critical Element of Any Bundled Payment Program? Data Review.

By Jason McCormick Vice President, Partner Services at Fusion5 The truth is that, until a few years ago, medical practices were not usually considered the ideal environment for statisticians or anyone who knew what pivot or V-Lookup tables were used for. You were usually hard-pressed to find anyone outside of the accounting department that had […]

Crushing Bundled Payments: 10 Critical Program Elements

by Jason McCormick Vice President, Partner Services at Fusion5 One of the first lessons I learned regarding bundled payments was that everyone had a different definition of the term. To some, bundled payments refer to the proactive payment for a set of services that are provided to a patient, while others may be more in […]

What You Should Know About Managed Care Contracts

Managed Care Contracts – The Basics Providers of health care services establish relationships with managed care organizations (MCOs) to participate in provider networks, health maintenance organizations, integrated delivery systems, value-based care programs and other health plan initiatives via contract. The contract defines and governs the relationship between the parties and sets forth rights and responsibilities. […]

What People Are Saying: Fusion5 Featured in Inc.com!

This article was originally published in Inc. This is not the type of startup story you typically read about in Inc. This is not a group of computer science majors living three-to-a-mattress and surviving on Ramen until their app suddenly becomes worth billions of dollars. This is not another subscription box service. This is a […]

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PETER LOUGEE

Chief Solutions Officer
Peter is a nationally recognized expert on post-acute and value based care. He has held multiple executive positions in operations, sales, and business development, and spent more than twelve years serving as a senior executive at one of the largest nursing home providers in the country. His experience also includes leading the largest skilled nursing company in Texas through the first version of BPCI.
Peter is a proud Texan and graduated from Southern New Hampshire University with a degree in Marketing.

 

Thanks for contacting us! We will be in touch shortly.

 

REMAY

CHIEF HAPPINESS OFFICER
As Chief Happiness Officer, Remay puts the “fun” in functional. Her exuberance and sweet nature bring out the best in the team. She rarely takes no for an answer, and takes charge of getting her colleagues out of their chairs and into the fresh air for regular walking meetings.
She has a Pawchelors Degree in Fetch and is currently working on her PhDog in Lawn Leadership. Remay takes pride in her ability to make anyone smile, and has yet to meet a squirrel she won’t chase.

 

DAN PAQUIN

CHIEF STRATEGY OFFICER
Dan has significant experience in the healthcare sector, including considerable experience with the Centers for Medicare & Medicaid Services (CMS), including the development of the original Bundled Payment for Care Improvement (BPCI) initiative. He is a widely recognized expert on government healthcare programs, having implemented long-term-care Medicaid programs for the states of Kentucky and Florida.
Dan is also considered an expert in the management and financial performance of Managed Care Organizations (MCOs), and is responsible for developing and implementing corporate strategy at Fusion5.

 

KATHY KRESS

CHIEF FINANCIAL OFFICER
Kathy has served as a senior financial executive at some of the largest companies in the United States. She is considered an expert in mergers and acquisitions (M&A), corporate strategy development, capital markets, and business restructuring. As a divisional financial leader for Walmart, Kathy was charged with the financial performance of the company’s Consumer, Health and Wellness business.
Kathy earned her MBA from the Stephen M. Ross School of Business at the University of Michigan.

 

MICHAEL J. LEVOSHKO

CHIEF INFORMATION OFFICER
Mike has more than 25 years of experience as a value based care entrepreneur and innovator. He has held leadership positions in managed care and behavioral healthcare organizations serving the public, private, and employer group sectors. He is also the co-founder and Chief Technology Officer of Senior Whole Health, which was named the fastest-growing privately held company in the United States by Inc. magazine. 
Mike studied Mechanical Engineering at Northeastern University and is widely recognized as one of the nation’s foremost thought leaders on healthcare technology.

 

DENISE GALLAGHER

CHIEF OPERATING OFFICER
Denise has a proven track record of healthcare innovation and entrepreneurship and has served in leadership positions at Aetna, Coventry, AmeriGroup, and AmeriChoice. Her work in healthcare innovation has taken her from Alaska to Massachusetts, and she was instrumental in the success of NHP of Rhode Island, the first Federally Qualified Health Center (FQHC) in the nation. 
Denise is also the co-founder of Senior Whole Health, named by Inc. magazine as the fastest- growing privately held company in the United States.

 

GERALD RUPP, PHD

CHIEF INNOVATION OFFICER
Jerry is a healthcare executive, innovator, and educator with more than two decades of experience developing and administering healthcare-delivery and payment-model reform, including bundled payments. Additionally, Jerry served in an advocacy role at the Centers for Medicare and Medicaid Services (CMS), and was the Executive Director and Vice President of Research at the Institute for Science and Health.
Jerry has served as a professor of anatomy and has authored over 30 peer-reviewed articles. He received his PhD in cell biology and anatomical sciences from SUNY – Buffalo.

 

SUE CAITO

CHIEF CLINICAL OFFICER
Sue brings over 25 years of clinical experience to the world of value based care, bundled payments, and BPCI. Her focus on innovation resulted in the successful development of a BPCI case-management program within a multi-disciplinary practice that led to measurable improvement in quality outcomes for more than 50,000 Medicare orthopedic patients.
Sue is the author of multiple published articles on readmissions reduction and graduated from Webster University with her degree in nursing.

 

JAMES GERA

CHIEF EXECUTIVE OFFICER
Jim is a proven innovator and value based care entrepreneur. Prior to serving as CEO of Fusion5, Jim achieved remarkable results as a senior executive at several healthcare organizations. Over the past several years, Jim has focused on programs and opportunities within healthcare reform and has served as chairperson for several CMMI grant reviews. 
Jim is also an accomplished musician and received his MBA from the Southern Illinois University at Edwardsville.