Form CMS-10584 LAN Summit Registration Form

When you have completed the form, click "Submit Registration" once, and you will see a confirmation page. Your registration data will be submitted and a copy sent to the email address you provide.

Top of Form

Register to attend
*First Name:			*Last Name:
*Organization:			*Title:
*State:		*Primary Organization Type:
*Phone:			*Email:
*Major Areas of Interest	________________		Your Goals: What do you hope to take away from this Summit?	_________________

Primary Organization Type options:

• Health Plan (insurer)

• Bottom of Form

• Academic Health Center

• Integrated Health System

• Hospital

• Community Clinic

• Practitioner Network

• Health Care Provider or Clinician

• Private Employer/ Purchaser

• Federal Agency or Department

• State Agency or Department

• City or Local Agency or Department

• Consultant and/or IT vendor

• Patient/Consumer/Advocate

• Professional Society or Association

• Foundation

• College or University/Independent Think Tank/Research Institution

• Pharmaceutical Company

• Medical Device/Medical Products Manufacturer

• Other

• Please List

Major Areas of Interest options (select all that apply)

• Accountable Care Organizations

• Pay for Performance

• Building Alliances to Implement Change

• Payment Reform Best Practices

• Implementing Analytical Tools to Measure Results

• Choosing an Alternative Payment Model

• Communication Strategies

• Challenges to Implementing Payment Reform and How They Were Overcome

• Other

  • Please list