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Health Plan Utilization Management Summit

Health Plan Utilization Management Summit

With an increasing focus on risk sharing and value based contracts, as well as high pharmacy costs, health plans must optimize resource use in order to minimize unnecessary costs and services.

The Health Plan Utilization Management Summit provides guidance and strategies for health plans to ensure their benefits are administered properly, control costs for members, promote adherence to standards of care, reduce avoidable readmissions, and enhance collaboration between hospitals and plans, all with the goal of improving quality outcomes.


Top Reasons to Attend:

  • Evaluate how Pharmacy, UM, and Case Management teams can better collaborate
  • Better allocate human and financial means to the populations that most need them, and members that utilize the greatest resources
  • Identify changes necessary to be in compliance with the CMS Mega Rule
  • Review the key aspects of UM that NCQA targets for accreditation, and ensure an emphasis on quality improvement and outcomes
  • Improve language and communication with members and physicians in denial documents
  • Explore strategies to better manage high-cost medications, particularly in specialty pharmacy
  • Pinpoint where to focus medication reconciliation efforts to make the most impact
  • Learn cost-saving medical management strategies that reduce or avoid inpatient and ED utilization and readmissions
  • Address how risk sharing with providers changes the UM landscape

COLLABORATE AND NETWORK WITH PROVIDER PEERS DURING THE CO-LOCATED 14TH ANNUAL PHYSICIAN ADVISOR SUMMIT

  • Choose 1 of 3 Pre-Summit Workshops, such as Efficiently Manage Your UM Program to Achieve Cost Savings
  • Participate in an Extended Discussion on ways to Drive Effective Collaboration between Payers and Providers
    • Examine ways to better partner with providers and reduce provider administrative burden
    • Establish a common ground for appropriate levels of care to decrease UR concerns

Confirmed Speaking Faculty


Zulma Berrios Zulma Berrios, MD, MBA, CPE
Physician Liaison
Baptist Health South Florida
Danielle Colayco Danielle Colayco, PharmD, MS
Director, Health Outcomes and Value Strategy
Komoto Healthcare
Bob Coxe Bob Coxe, MD
Senior Medical Director, GA Market
Cigna-Healthspring, Inc.
Peter Dehnel Peter Dehnel, MD
Medical Director, Integrated Health Management
Blue Cross Blue Shield of Minnesota
Karen DePasquale Karen DePasquale, LSW, ACSW
Senior Director, Health Management
UPMC Health Plan
Chandrakala Gowda Chandrakala Gowda, MD, MBA
Vice President, Executive Medical Director
Highmark Inc.
Kalyana C. Kanaparthy Kalyana C. Kanaparthy, MD, FHM
Medical Director, Physician Advisor Program, Director, MAT Unity
Rochester Regional Hospital
Jennifer McPeek Jennifer McPeek, BSN, MBOE, SSGB
Director, Care Access Management-Utilization Management
Molina HealthCare Ohio
Matt Phillips Matt Phillips, MBA
Director, Physician Advisor Program
Rochester Regional Hospital
Shelean Sweet Shelean Sweet, RN
Director, Utilization Management Pre-Service Review
United Healthcare of Nevada
Photo Not Available Latonia Walker
System Director, Care Management Operations
Advocate Healthcare System
R. June Young R. June Young, RN, BA, CCM
Director, Medical and Clinical Management
UnitedHealthcare of Nevada
Balazs Zsenits Balazs Zsenits, MD, SFHM, FACP
Associate Chief Medical Officer, Utilization and Medical Informatics
Rochester Regional Health

Sneak Preview—Featured Session:

Assess the Impact of Unplanned Care – How to Avoid Inpatient and ED Utilization With the scrutiny around admissions and readmissions, learn ways in which Utilization Management and Case Management can collaborate to focus on the right members at the right time through cost-saving medical management innovative strategies.

  • Identify strategies to reduce unplanned care through care coordination
  • Understand the value of Utilization Management and Case Management integrated processes
  • Optimize care collaboration with providers to reduce ED utilization
  • Augment Case Management activities to reduce readmissions
Karen DePasquale Karen DePasquale, LSW, ACSW
Senior Director, Health Management
UPMC Health Plan


Accreditation Provider

PACE
ACPE Credits are pending approval.
Check here for
accreditation details

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