To manage costs and advance value-based care models, health plans and health systems that take on risk need effective care management and population health programs. However, many legacy tools involved in these efforts are frustrating to use and produce fragmented data, hindering successful cost and quality management.

This conversation will examine the current state of care management, including the top barriers and how organizations can break through them. Learn how to:

• Efficiently and proactively identify at-risk individuals
• Empower patients to achieve better outcomes
• Increase collaboration across the care continuum

Panelists

Kenneth Young, President & CEO, Medecision
Dr. Robert Groves, Executive Vice President & Chief Medical Officer, Banner | Aetna
Jessica Chaudhary MD, Medical Director, Carelon

Learn more at https://www.medecision.com/

The executives examined independent market research that surveyed health plan leaders about the current state of UM and what organizations need to transform both Utilization Management and Care Management.
Key findings relative to UM include:

- More than half of survey respondents say fragmented data (57%), data that doesn’t flow into UM workflows (55%), and burdensome data integration are the top barriers to current tools

- 68% say inefficient workflows are their organization’s primary frustration with current tools, followed by high costs associated with data silos (49%), and provider abrasion (40%)

- Why? Because respondents say current tools are not easy to use and they need technologies that are “very effective” at accessing real-time data to drive down administrative and medical costs while improving health outcomes

In addition to sharing the research, the speakers also discussed:

- Data types healthcare organizations should be integrating into UM workflows

- The power of personalization in making UM more trusted by members and providers

- How predictive modeling for risk stratification, as well as UM workflow optimization with AI and automation, can propel UM efficiency, results, and outcomes

- What leaders should understand about regulations relative to UM – including the newly-released ePrior Authorization rule  

Did you know that, despite 95% of health plan executives stressing the importance of personalization, only a third consider their operations highly personalized?

This podcast will examine the results of Medecision's exclusive market research. We will explore the current state of utilization management and care management, the value of a contextually-aware view of members, how personalized experiences are driving impact at the health inflection point and the opportunities to more strategically leverage data.

View the Market Report here. 

The 2021 Star Ratings Power Hour: Bottom-Line Impact and Strategies was recorded on June 30, 2021.

In this episode, Julie Barnes, JD, Founder and Principal of Maverick Health Policy, and Kimberly Swanson, Vice President of Quality and Clinical Integration at Network Health Plan share valuable insights on the new measures and weighting, and ideas for optimizing your technology tools while implementing best practices to improve your member experience.  

In this episode, Julie Barnes, JD, Founder and Principal of Maverick Health Policy, shares valuable insight into the prior authorization rule affecting utilization management and what health plans and healthcare providers should be considering as policies evolve. 

In this episode, we bring together healthcare leaders with vast experience in caring for and engaging underserved and vulnerable populations. 

Our experts include Dr. Jan Berger, founder and CEO of Health Intelligence Partners, Jesse Thomas, CEO of Healthy Blue, and Dr. Terri Steinberg, Medecision’s group senior vice president of analytics and population health and chief medical officer. 

Facilitated by Chris Mahai, president of Aveus, this episode discusses both the challenges and opportunities of restoring trust and engaging with underserved populations.

In this episode, we bring together some of the most thoughtful and visionary healthcare policy experts for an engaging executive-level discussion about post-election policy implications for the healthcare industry.  

Our expert guests include Colin Roskey, Principal and Partner at Lincoln Policy Group, and Krista Drobac, the founder of Sirona Strategies.  Facilitated by Julie Barnes, founder and Principal of Maverick Health, this episode helps connect the dots in our changing political landscape.

In this episode, we speak with health economist, advisor, trend weaver, and author, Jane Sarasohn-Kahn. Jane shares the major trends she’s seeing as COVID reshapes health consumer behavior, including virtual health adoption, digital transformation in all aspects of our lives, and keeping “health at home.” She also analyzes some of the toxic side effects of the pandemic, such as rises in loneliness, depression, and food insecurity.

Designed to leave you thinking about how you can leverage the opportunity to help bring health where it needs to go, Jane has graciously offered to answer any questions our listeners may have. You may contact her by visiting her website, or find her on Twitter @healthpopuli.