Medecision Podcast

Many current utilization management processes lack the transparency, speed and interoperability needed to meet current requirements — and the stakes for health plans are rising as CMS-0057 deadlines loom.

This podcast breaks down new national research on UM practices across payer organizations, offering a clear-eyed view of what’s working, what’s not and where change is most needed.

Leaders will also explore how AI-assisted technologies could help health plans get ahead of future interoperability challenges, including those tied to CMS-0057.

Key insights include:

• Where UM processes are breaking down across health plans and care settings
• How AI-assisted tools could reduce delays and improve alignment now and in the future
• Real-world takeaways to improve speed, transparency and readiness ahead of CMS-0057

Traditional care management strategies are struggling to keep pace with rising administrative burdens, workforce shortages and increasingly complex member needs. Outdated processes — like relying on phone calls — fail to scale engagement and leave care teams overwhelmed.

Health plans are turning to AI-driven technologies, such as co-pilots, to modernize care management. These tools enhance traditional care management by automating outreach, improving data-driven decision-making and expanding digital engagement across all risk levels.

Join industry leaders as they share real-world insights on how AI and automation are transforming care management. Learn how your organization can:

• Expand digital reach and engage more members effectively
• Overcome key challenges, from data quality to adoption hurdles
• Streamline workflows and reduce operational burdens
• Improve member outcomes and measure the ROI of digital strategies

As healthcare evolves, the demand for connected, data-driven, and member- and patient-centric systems is at an all-time high. By 2027, 70% of healthcare organizations are projected to adopt digital-first care management strategies, interoperable workflows, and advanced consumer data platforms to empower individuals, enhance experiences, and build trust, according to IDC.

When providers are seamlessly integrated as essential contributors and collaborators in care management, organizations can unlock significant benefits, including better health outcomes and enhanced operational efficiency.

Join industry leaders from IDC and Medecision for an engaging panel discussion where we will share IDC’s latest research, practical insights, and best practices. These discussions will bridge the gap between payers and providers, laying the groundwork for future-ready care management practices.

Listeners will hear about:

• Techniques for leveraging data interoperability and FHIR-based solutions.
• Best practices for establishing data-sharing transparency.
• Methods for aligning value-based care objectives.
• Approaches for promoting digital tool adoption supported by AI and analytics.
• Frameworks for designing comprehensive wellness and engagement programs.
• Insights into the importance of closed-loop feedback for sustained, coordinated care efforts.

Why Listen? 

Gain valuable insights and practical strategies from leading experts to empower your organization’s digital care management initiatives. This session is essential for healthcare leaders aiming to optimize collaboration and harness the full potential of digital care management solutions.

While traditional telephonic and modern digital self-service care management approaches are necessary for health plans, what both programs need now are data and insights to create deep contextual awareness of health plan members. To be effective at scale, health plans need the technology and automation to strategically leverage all their data to optimize medical costs, reduce administrative expenses, improve outcomes and personalize engagement.

What’s available to empower care management teams to create that contextual awareness? Cutting-edge digital care management tools with capabilities to rapidly deliver real-time data insights that enable care management teams to build highly personalized digital outreach.

During this podcast, attendees will learn:

• The keys to modern digital care management
• The emerging digital tools that can best support members
• Lessons from efforts to deliver true personalization to the member experience

Presenters: 

• Katherine Schneider, MD, MPhil., FAAFP, CMO, Medecision
• Mamata Majmundar, MD, Chief Medical Officer, Evry Healthcare
• Jai Raisinghani, Deputy Chief Information Officer, CenCal Health
• Ria Paul, MD, Chief Medical Officer, Santa Clara Family Health Plan
• Howard Brill, Senior Vice President, Population Health & Quality, Monroe Health Plan for Medical Care

Discover

• The importance of platform thinking in overcoming healthcare data challenges
• Strategies for real-time and flexible data ingestion and integration (the toughest nut to crack)
• Considerations for building in care intelligence
• The critical role of sub-second analytics for immediate access to data
• The benefits of integrating all clinical data sources
• Solutions for incorporating non-clinical data sources to enhance insights
• Why purpose-built healthcare data platforms are more cost-effective and efficient than custom-built solutions

Featuring: The Aerial Data Platform and Clinical Intelligence Engine

Discover how risk-bearing healthcare organizations are leveraging the new Aerial platform to target high-value opportunities like optimizing care management, engaging individuals like a consumer company, improving prior authorization turnaround times, reducing readmissions, boosting STARS ratings, and more. Learn how Aerial’s adaptability sets a new benchmark for data integration and intelligence in healthcare.

Speakers

• Pavel Grebenshikov, Chief Technology Officer, Medecision
• Katherine Schneider, MD, MPhil., FAAFP, CEO, Two Canoes Health, LLC
• Kenneth Young, President and CEO, Medecision

As election year dynamics unfold, the impact on healthcare policy will be significant. This exclusive webinar, presented by Maverick Health Policy and hosted by Medecision, offers you a front-row seat to understand these changes. Our panel of Washington, D.C.-based experts will dissect the latest developments and forecast what these mean for the future of healthcare.

• Election Year Insights: Gain a deeper understanding of how the 2024 elections will impact healthcare legislation and the regulatory landscape.
• Expert Analysis: Hear from leading health policy advisors who specialize in healthcare innovation. 
• Critical Topics Covered:
  • The impact of the presidential election and congressional action on health policy.
  • Latest advancements and issues in AI and utilization management.
  • Federal scrutiny on cybersecurity, data privacy, and the dynamics of M&A in healthcare.
  • Future directions for Medicare Advantage and social determinants of health (SDOH).

Meet Our Panel:

• Julie Barnes, JD – Founder and CEO, Maverick Health Policy
• Eric Schiavone, MPH – Director, Maverick Health Policy

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.