Analyzing Trends in Utilization Management: A Focus on Regulations – Thought Leaders in Population Health Webinar Series
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We will examine the evolution of utilization management (UM) programs over the past three decades, with a detailed overview of how this managed care function is regulated. Among other issues, the webinar will highlight the impact of the Affordable Care Act and other regulatory reforms on the ways that health plans make “medical necessity” determinations and how the appeals process works when a “denial” of care occurs.
In addition, we will review the scope, licensure requirements, reviewer qualifications and the ways in which UM services are often integrated into a “care coordination” approach to managing patients.
The webinar will also offer an overview of RegQuest™, a new regulatory compliance tool created by EBG Advisors and Schooner Strategies. This resource provides health plans, regulators and others with invaluable information regarding current regulations and laws. RegQuest is the first comprehensive resource on the topic since URAC’s Utilization Management Guide was published in 2005.
During the webinar, panelists will focus on several components of UM regulations, including:
- Information on the scope, licensure information, program requirements, and reviewer qualifications
- The state surveys conducted by the RegQuest team
- Provide and overview of the appeals process
- Key trends in medical management
- How traditional UM functions are becoming integrated into population health programs.
This webinar is a must-attend event for regulators, health plan executives and others interested in the trends, regulations and laws pertaining to utilization management.
Bob Atlas, MBA, Strategic Advisor and President, EBG Advisors, Inc.
Cheri Lattimer, RN, BSN, CEO, Consulting Management Innovators (CMI)
Garry Carneal, JD, MA, President and CEO, Schooner Strategies
If you have questions regarding this event, please contact Whitney Krebs at (202) 861-0900 or [email protected].