Utilization Management: Addressing Crucial Challenges for Health Plans
Videos Included in the Bundle
SPECIAL WORKSHOP: Ensuring Success with UM Requirements for Health Plan Accreditation
Moderator:
Erik Baldwin, MBA, Director, Pay for Value
GATEWAY HEALTH PLAN
Speakers:
Kirk McDonald, PhD, Program Manager, Clinical Operations
SAN FRANCISCO HEALTH PLAN
Joel Nellis, MPH, NCQA Project Manager, Compliance & Regulatory Affairs
SAN FRANCISCO HEALTH PLAN
Sarah Dencker MSN, RN, Director Utilization Management
NETWORK HEALTH
Special Spotlight: Delayed Care-- Lessons this Health Plan is Learning from the Pandemic and Implications for Future Collaboration
Sarah Grantham, PhD, Chief Operating Officer
INNOVATION HEALTH
Examining the Challenges of Observation Status vs. Inpatient Admission—Health Plan and Hospital Perspectives
Timothy Law, DO, MBA, Senior Medical Director
HIGHMARK
Carissa Tyo, MD, Medical Director, Clinical Decision Unit
UNIVERSITY OF ILLINOIS HOSPITAL
Optimizing Utilization and Care Management by Taking into Account Your Members’ “Health Literacy”: Better Understanding How They Comprehend and Utilize Health Information
Sunil Kripalani, MD, Professor of Medicine; Director, Center for Clinical Quality and Implementation Research; Co-Director, Center for Effective Health Communication
VANDERBILT UNIVERSITY MEDICAL CENTER
Featured Session: Integrating Social Determinants of Health into UM and Care Management Processes to Optimize Outcomes and Improve Value
Jim Milanowski, President and CEO
GENESEE HEALTH PLAN
Mouhanad Hammami, MD, MHSA, Chief Health Strategist
WAYNE COUNTY, MICHIGAN
Former Senior Vice President, Safety Net Transformation, Community Health & Wellbeing
TRINITY HEALTH
Improving Outcomes and Containing Costs by Detecting Unrecognized or Unmet Behavioral Health Needs
Andrew Philip, PhD, LP, Senior Director, Clinical & Population Health
PRIMARY CARE DEVELOPMENT CORPORATION
Mary M. Ford, Director, Evaluation and Analytics
PRIMARY CARE DEVELOPMENT CORPORATION
Managing Telehealth Benefits to Ensure Effective Care
Monica Chmielewski, JD, Partner
FOLEY & LARDNER
Til Jolly, MD, Emergency Physician
INOVA HEALTH SYSTEM
Featured Panel Discussion: Ensuring UM, Care Management and Quality Improvement Departments All Work Together More Effectively
Moderator:
Jim Milanowski, President and CEO
GENESEE HEALTH PLAN
Panelists:
Jatin Dave, MD, MPH, Chief Medical Officer
MASSHEALTH
Timothy Law, DO, MBA, Senior Medical Director
HIGHMARK
Monica Baldzikowski, RN, PHN, Senior Manager, Prior Authorizations and Quality Review
SAN FRANCISCO HEALTH PLAN
Ten Strategies for Improving Management of Patients with Complex Needs: Innovations and Best Practices
Bonnie Geld, President
THE CENTER FOR CASE MANAGEMENT
Featured Session: Optimizing Transitions of Care to Effectively Reduce Hospital Readmissions
Joann Sciandra, MHA, BSN, RN, CCM, Vice President, Care Coordination and Integration
GEISINGER HEALTH PLAN
Case Study: An Innovative MTM Program that Improves Quality and Controls Cost
Gary Melis R.Ph., Pharmacist
NETWORK HEALTH PLAN
Special Feature: Effectively Managing Gender Affirmation Services, Policies, and Criteria
Monica Baldzikowski, RN, PHN, Senior Manager, Prior Authorizations and Quality Review
SAN FRANCISCO HEALTH PLAN
Kirk McDonald, PhD, Program Manager, Clinical Operations
SAN FRANCISCO HEALTH PLAN
Case Study: Optimizing Outcomes through Improved Payer/Provider Collaboration
MJ Tran, MBA, ACO Director
HCA HEALTHCARE & EASTERN IDAHO CARE PARTNERS ACO
Feedback from Other Organizations
"Presentations are relevant to challenges across most health plans and provide valuable insight into approaches and solutions of other payers."
“Great cross section of payers and providers giving points of view we would not normally think of.”
“Many different unique and cost-effective management ideas.”
“Wonderful opportunity to network with other UM professionals. Balanced breath of talks from various sides of the business.”
“The networking and group interaction were wonderful.”
It was an open forum to discuss our concerns, challenges, barriers, hopes and goals. Greatly appreciated.”
Sponsors
Insight Exchange Network
P.O. Box 3867
Santa Cruz, CA 95062
(831) 431-6668
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