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webinars

How to Go from Transactional to Transformational Utilization Management

Dates:
Oct 5, 2023
Time:
1:00 pm EDT
Presented by Cohere Health
Register Now Registration takes place at a third-party website.

About the Webinar:

AHIP has a broad range of membership, and no two payers are alike. Payers are all at different stages in how they approach utilization management (UM). How does your strategy stack up?

There are five stages in the continuum from transactional to transformational UM:

  1. Regulatory compliance: The most basic stage of prior authorization (PA) capabilities. Payers are focused on regulatory compliance and adhering to turnaround times.
  2. Administrative efficiency: When payers want to go beyond simple regulatory compliance and implement tools to reduce administrative cost and abrasion.
  3. Utilization impact: Some of the more innovative payers adopt newer technologies like AI/ML to help drive clinical choices beyond the initial authorization request.
  4. Physician collaboration: Payers with a strong foundation of clinical intelligence in the authorization process are now looking to deploy advanced analytics to identify improvements to patient and provider experience.
  5. Quality improvement: The most advanced stage. Here, forward-thinking payers see PA as a launching point for a more longitudinal approach to helping achieve the best and fastest patient outcomes.

Attendees Will Learn About:

  • The continuum of stages and where your current strategy fits
  • How to leverage new innovations to achieve more at any stage
  • Uncovering new ways to get ahead of the competition with intelligent prior authorization

Presenters

Adrian Thomas, MD

Associate Medical Director, MSK Spine

Cohere Health

Dr. Thomas is a Board Certified Orthopaedic Spine Surgeon and a partner at New Hampshire NeuroSpine Institute in Bedford, NH. He has been in practice since 2010. He completed his undergraduate degree in Molecular Biophysics and Biochemistry from Yale University. He attended medical school at Stanford University School of Medicine. He completed his orthopaedic surgery residency at Hospital for…

Learn more about Adrian Thomas, MD

Brian Covino, MD, FAAOS

Chief Medical Officer

Cohere Health

After practicing orthopedic surgery for more than 25 years, Dr. Brian Covino joined Cohere in 2020 after having served as a consultant since 2018. During his years as a practicing surgeon, Dr. Covino was a partner at Knoxville Orthopaedic Clinic/OrthoTennessee specializing in joint replacement surgery. He holds a bachelor’s from Harvard University as well as an M.D. from Georgetown University…

Learn more about Brian Covino, MD, FAAOS

Kaleb Guion

Vice President of Product Strategy

Cohere Health

Currently, Kaleb serves as the Vice President of Product Strategy. Prior to joining Cohere, Kaleb worked for Deloitte Consulting in Washington, D.C. Previously, he held positions within the product and software department at Ob Hospitalist Group, the largest dedicated OB/GYN hospitalist employer in the nation. Kaleb holds a bachelor’s degree in biomedical engineering from Clemson…

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Justin Erickson

Vice President, UM Transformation & Operational Excellence

Highmark, Inc.

With over 15 years of experience in health plan operations, Justin has a diverse background spanning both clinical and non-clinical operations. Starting at United Healthcare in roles involving claims, audit, and consulting, Justin later transitioned to Health Management Systems (recently acquired by Cotiviti/Gainwell), where he led large-scale operations across a variety of Medicaid, Medicare,…

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Samantha Rideout, Moderator

Director of Product Marketing

Cohere Health

Learn more about Samantha Rideout, Moderator