In this episode, Dr, Sweta Singh and Jon Shreve explore how artificial intelligence is reshaping case management workflows while keeping human judgment firmly at the center of care decisions. Through real-world perspectives, the discussion examines how AI can reduce administrative burden, synthesize complex clinical information, and support more timely, informed decision-making—without replacing the expertise of case management professionals.

The conversation also dives into the evolving relationship between providers and payers, highlighting how clearer clinical summaries, improved documentation, and standardized data exchange can streamline authorizations and peer-to-peer reviews. From change management and team adoption to transparency, trust, and patient experience, this episode unpacks what it truly takes to integrate AI responsibly and effectively into healthcare operations.

This episode was sponsored by MCG Health: At MCG Health, we believe every patient deserves the right care at the right time. As part of the Hearst Health network, MCG delivers evidence-based clinical guidelines and AI-powered technology that guide case management professionals toward better outcomes for their patients. Over 3,000 hospitals, a majority of health plans, and many state and federal government agencies rely on MCG’s trusted, unbiased clinical guidance and AI to support accurate, efficient, and compassionate care decisions. With rigorous scientific processes at our core and innovation in our DNA, we help caremanagement organizations improve the patient journey while reducing unnecessary administrative burdens. MCG Health — the source of truth for clinical decisions. Learn more at mcg.com.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with Kimberly Browne and Dr. John Eanes to share their insights on pediatric cases.

The conversation explores three complex pediatric cases that highlight the challenges of managing high-risk children with medical and behavioral complexities. The first case involves a four-year-old child with sickle cell disease and multiple comorbidities admitted with fever and respiratory symptoms, raising questions about inpatient versus observation status. The second case is a 16-year-old with a chronic liver condition who overdosed on Tylenol and faced extended hospitalization while awaiting inpatient psychiatric placement. The third case discusses systemic and logistical hurdles in coordinating care for medically fragile children across state lines, including insurance limitations, care transitions, and Medicaid complexities. The panelists reflect on the unpredictability of pediatric recovery, payer negotiations, and the importance of proactive communication with insurers.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with Jennifer Dominow and Marla Kolovitz from Loyola Medicine to share their insights on navigating complex patient transitions.

This episode dives into three complex patient cases that reveal the real-world challenges of case management and utilization review—from surgical complications and readmission dilemmas to high-risk discharges and insurance barriers. The panel explores how legal coordination, interdisciplinary teamwork, and persistent advocacy can make all the difference.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

Recorded live at the ACMA 2025 National Conference, Learning Link Live: Answers to Current Case Management Issues captures an interactive session where healthcare professionals across diverse roles came together to explore real-world challenges in case management. This unique experience, driven by live and remote audience participation, features expert panelists addressing key questions on Care Coordination, Transitions of Care, Utilization Management, Regulatory Models, and Outcomes.

This special session highlights the important role of physician leadership in care management through the Association of Physician Leadership in Care Management (APLCM). APLCM was created to provide education, resources, and support for physicians in care management and is uniquely connected to the American Case Management Association (ACMA), reflecting the collaborative model among nurse case managers, social workers, and physicians. APLCM is inclusive of all practice settings, offering valuable membership benefits whether you are new to case management or a seasoned professional. APLCM membership includes access to all ACMA resources and professional networking opportunities.

To learn more about APLCM, visit www.aplcm.org. For more information about this podcast and other sessions, visit www.acmaweb.org/podcast or reach out to us directly at [email protected] with any questions, topic requests, or feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with ACMA President Patti Velky who joins us for Season 4, Episode 1 to share her insights on navigating complex patient transitions.

The conversation revolves around three case studies highlighting the complexities of patient care transitions, medical necessity decisions, and systemic barriers in healthcare. The first case examines an elderly dementia patient experiencing frequent hospitalizations, emphasizing the challenges of coordinating care and determining the most appropriate long-term setting. The second case features a 30-year-old patient with severe neurological impairments and bowel obstruction, focusing on inpatient versus outpatient treatment decisions and the role of caregivers in medical management. The third case explores a medically complex patient facing insurance denials for a necessary procedure, underscoring the impact of documentation, coding issues, and advocacy in securing appropriate care. The discussion highlights the critical role of interdisciplinary collaboration, proactive care planning, and system navigation in optimizing patient outcomes.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, the conversation revolves around two case studies focusing on the complexities of patient care transitions, particularly in cases of urinary tract infections (UTIs) in patients. The first case discusses a 45-year-old female with a complicated medical history who required inpatient care due to severe symptoms and treatment complications. The second case involves an 80-year-old female with vague symptoms and a history of UTIs, raising questions about the necessity of inpatient care versus observation. The discussion highlights the challenges of medical necessity determinations, peer-to-peer reviews, and the importance of follow-up care in managing patients with UTIs.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the physicians discuss two complex medical cases involving a tonsillar carcinoma patient and a refractory epilepsy patient. They explore the challenges of medical necessity determinations, the importance of thorough documentation, and the peer-to-peer process with insurance payers. The conversation highlights the intricacies of patient care transitions and the need for effective communication among healthcare providers to ensure optimal patient outcomes.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, the conversation revolves around two complex medical cases, focusing on the challenges faced in patient care, particularly regarding insurance authorization and clinical decision-making. The first case discusses an elective arthroscopic knee procedure that led to complications and the subsequent management decisions regarding inpatient versus outpatient care. The second case highlights the struggles of a patient with severe cardiac issues seeking TAVR (transcatheter aortic valve replacement) and the hurdles faced in obtaining insurance approval for a medically necessary procedure. The discussion emphasizes the importance of collaboration among healthcare professionals to navigate these challenges effectively.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, the conversation revolves around the complexities of case management, particularly focusing on a case involving a 14-year-old heart transplant patient and a 32-year-old male with a dental abscess. The discussion highlights the challenges in determining inpatient versus observation status, the importance of monitoring post-transplant complications, and navigating insurance requirements for medical necessity. The participants share insights on clinical decision-making, risk assessment, and the implications of payer policies on patient care.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the physicians discuss two complex medical cases involving patient transitions and payer denials. The first case involves a 66-year-old male with significant eye trauma and multiple comorbidities, leading to a complicated hospital stay and subsequent denial from the payer. The second case focuses on a patient with atrial fibrillation undergoing drug loading, where the necessity of inpatient care is debated. The discussion highlights the challenges of navigating payer requirements, and the importance of thorough documentation and peer-to-peer appeals in ensuring appropriate patient care.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.