Summary of AHIP Webinar “How to go from transactional to transformational utilization management”
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:
- Regulatory compliance: The most basic stage of prior authorization (PA) capabilities. Payers are focused on regulatory compliance and adhering to turnaround times.
- Administrative efficiency: When payers want to go beyond simple regulatory compliance and implement tools to reduce administrative cost and abrasion.
- Utilization impact: Some of the more innovative payers adopt newer technologies like AI/ML to help drive clinical choices beyond the initial authorization request.
- 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.
- 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
Speakers:
- Dr. Brian Covino, Chief Medical Officer, Cohere Health
- Dr. Adrian Thomas, Associate Medical Director, MSK Spine, Cohere Health
- Kaleb Guion, VP & GM, Intelligent Prior Authorization, Cohere Health
- Justin Erickson, VP, UM Transformation & Operational Excellence, Highmark
About Cohere Health
Cohere is a clinical intelligence company that is transforming utilization management (UM) by aligning physicians and health plans on evidence-based care paths for the patient’s entire care journey. By integrating these care paths into the prior authorization submission process, Cohere’s digital UM collaboration platform reduces denial rates and medical expenses while improving patient outcomes. The company is a winner of the TripleTree iAward and has been named to both Fierce Healthcare’s Fierce 15 and CB Insights’ Digital Health 150 lists. Cohere’s investors include Flare Capital Partners, Define Ventures, Deerfield, Polaris Partners, and Longitude Capital.
