AI and the State of Utilization Management: Lessons for Health Plans

AI and the State of Utilization Management: Lessons for Health Plans

Many current utilization management processes lack the transparency, speed and interoperability needed to meet current requirements — and the stakes for health plans are rising as CMS-0057 deadlines loom. This podcast breaks down new national research on UM practices across payer organizations, offering a clear-eyed view of what’s working, what’s not and where change is most needed. Leaders will also explore how AI-assisted technologies could help health plans get ahead of future interoperability challenges, including those tied to CMS-0057. Key insights include: * Where UM processes are breaking down across health plans and care settings * How AI-assisted tools could reduce delays and improve alignment now and in the future * Real-world takeaways to improve speed, transparency and readiness ahead of CMS-0057

The Future of Care Management: Leveraging AI and Automation

Traditional care management strategies are struggling to keep pace with rising administrative burdens, workforce shortages and increasingly complex member needs. Outdated processes — like relying on phone calls — fail to scale engagement and leave care teams overwhelmed. Health plans are turning to AI-driven technologies, such as co-pilots, to modernize care management. These tools enhance traditional care management by automating outreach, improving data-driven decision-making and expanding digital engagement across all risk levels. Join industry leaders as they share real-world insights on how AI and automation are transforming care management. Learn how your organization can: * Expand digital reach and engage more members effectively * Overcome key challenges, from data quality to adoption hurdles * Streamline workflows and reduce operational burdens * Improve member outcomes and measure the ROI of digital strategies

The Provider’s Role in Payer Care Management

As healthcare evolves, the demand for connected, data-driven, and member- and patient-centric systems is at an all-time high. By 2027, 70% of healthcare organizations are projected to adopt digital-first care management strategies, interoperable workflows, and advanced consumer data platforms to empower individuals, enhance experiences, and build trust, according to IDC. When providers are seamlessly integrated as essential contributors and collaborators in care management, organizations can unlock significant benefits, including better health outcomes and enhanced operational efficiency. Join industry leaders from IDC and Medecision for an engaging panel discussion where we will share IDC’s latest research, practical insights, and best practices. These discussions will bridge the gap between payers and providers, laying the groundwork for future-ready care management practices. Listeners will hear about: * Techniques for leveraging data interoperability and FHIR-based solutions. * Best practices for establishing data-sharing transparency. * Methods for aligning value-based care objectives. * Approaches for promoting digital tool adoption supported by AI and analytics. * Frameworks for designing comprehensive wellness and engagement programs. * Insights into the importance of closed-loop feedback for sustained, coordinated care efforts. Why Listen?  Gain valuable insights and practical strategies from leading experts to empower your organization’s digital care management initiatives. This session is essential for healthcare leaders aiming to optimize collaboration and harness the full potential of digital care management solutions.

Guiding the member’s health journey for optimal outcomes: Payer leaders’ strategies for data-driven care management

While traditional telephonic and modern digital self-service care management approaches are necessary for health plans, what both programs need now are data and insights to create deep contextual awareness of health plan members. To be effective at scale, health plans need the technology and automation to strategically leverage all their data to optimize medical costs, reduce administrative expenses, improve outcomes and personalize engagement. What’s available to empower care management teams to create that contextual awareness? Cutting-edge digital care management tools with capabilities to rapidly deliver real-time data insights that enable care management teams to build highly personalized digital outreach. During this podcast, attendees will learn: * The keys to modern digital care management * The emerging digital tools that can best support members * Lessons from efforts to deliver true personalization to the member experience Presenters:  * Katherine Schneider, MD, MPhil., FAAFP, CMO, Medecision * Mamata Majmundar, MD, Chief Medical Officer, Evry Healthcare * Jai Raisinghani, Deputy Chief Information Officer, CenCal Health * Ria Paul, MD, Chief Medical Officer, Santa Clara Family Health Plan * Howard Brill, Senior Vice President, Population Health & Quality, Monroe Health Plan for Medical Care

Introducing Aerial: The Future of Real-Time Healthcare Data

Discover * The importance of platform thinking in overcoming healthcare data challenges * Strategies for real-time and flexible data ingestion and integration (the toughest nut to crack) * Considerations for building in care intelligence * The critical role of sub-second analytics for immediate access to data * The benefits of integrating all clinical data sources * Solutions for incorporating non-clinical data sources to enhance insights * Why purpose-built healthcare data platforms are more cost-effective and efficient than custom-built solutions Featuring: The Aerial Data Platform and Clinical Intelligence Engine Discover how risk-bearing healthcare organizations are leveraging the new Aerial platform to target high-value opportunities like optimizing care management, engaging individuals like a consumer company, improving prior authorization turnaround times, reducing readmissions, boosting STARS ratings, and more. Learn how Aerial’s adaptability sets a new benchmark for data integration and intelligence in healthcare. Speakers * Pavel Grebenshikov, Chief Technology Officer, Medecision * Katherine Schneider, MD, MPhil., FAAFP, CEO, Two Canoes Health, LLC * Kenneth Young, President and CEO, Medecision