2nd Annual Utilization Management Best Practices Summit for Health Plans

Proven Strategies and Best Practices to Reduce Medical and Pharma Costs While Improving Care Quality

April 5-7, 2017
Nashville, TN

What You'll Hear

With a focus on observable outcomes and tangible results of real-world programs and initiatives, this one-of-a-kind event will provide invaluable UM tools, strategies and implementable ideas that will save your plan money and improve the health outcomes and quality of your members’ care.

You will also get best practices and critical lessons learned to boost your performance in quality improvement, case management, member services, as well as compliance monitoring. Our speaking faculty comprised of industry experts will share their experiences and keys to success for maximizing health and financial ROI on your plans’ UM investment! Also, don’t forget to register for our new, special pre-conference workshop to learn how you can meet NCQA’s rigorous standards for a strong UM program. Whether you seek accreditation or not, this workshop will provide a unique boiler plate for enhanced UM operations.

Topics at a Glance

  • Special Optional Pre-Conference Workshop: NCQA UM & Credentialing 101
  • Keys to Strengthening Your UM Clinical Policies and Decision-Making Criteria
  • Best Practices for Reducing ER Utilization and Hospital Admissions
  • Operationalizing Your Data to Drive High-Value Interventions
  • Improving UM-Pharmacy Coordination to Maximize Cost Reduction
  • Enhancing UM Data Gathering and Reporting to Capture and Demonstrate ROI
  • Molina Healthcare: Lessons Learned and ROI of Our BH Integration Initiative
  • Utilization Management Best Practices for Boosting Quality Scores
  • Minimizing Costs and Detangling Genetic Testing Utilization
  • L.A. CARE: Our Approach to UM & CM Collaboration and Transitions
  • UM Best Practices for Optimizing Costs and Health Outcomes in Post-Acute & LTSS Settings

Top Reasons To Attend

  • Hear a series of case studies featuring real-life medical management programs with a strong focus on health and financial outcomes
  • Learn strategies and tools for overcoming common (and costly) drug utilization challenges, such as detangling drugs administered under the medical benefit and avoidable utilization of expensive specialty drugs
  • Enhance your data gathering and reporting to better capture and demonstrate ROI for your program and initiatives
  • Strengthen your clinical policies and decision-making criteria to ensure programmatic effectiveness and operational compliance
  • Better operationalize your data to drive high-value interventions and avoid costly interventions that yield minimal savings
  • Gain tools and best practices to minimize ER utilization and reduce admissions and readmissions
  • Use NCQA’s UM program standards as a boilerplate to strengthen the foundations of your UM operations, with or without formal accreditation
  • Hear from Molina Healthcare who will share their experiences as they’ve worked to integrate behavioral and physical health with their vendors, plan staff, BH providers and primary care offices
  • Better evaluate your members’ usage of post-acute care services and facilities and improve continuity of care for members in LTSS settings
  • Streamline your clinical review processes by gaining actionable insights and operative strategies for health plan clinicians

Optimize the Cost-Effectiveness of Your UM Operations!

Who Should Attend

Designed for Medicare Advantage, Medicaid and Commercial plan executives and senior leaders, this program will benefit individuals with the following responsibilities:

  • Utilization Management
  • Case Management
  • Healthcare Services
  • Clinical Operations
  • Medical Services
  • Quality Improvement
  • Appeals
  • Compliance Monitoring
  • Internal & External Audit

Get Answers To These Important Questions

  • How can we reduce our members’ use of emergency services and lower the number of costly readmissions?
  • What updates or changes can we expect for NCQA’s UM programmatic standards?
  • How are other plans handling narcotic prescriptions and utilization in light of the opioid epidemic and renewed regulatory oversight?
  • What real-life programs or initiatives are other plans using to minimize medical spending while simultaneously improving health outcomes for their members?
  • What programs and initiatives can help overcome barriers related to rural and homeless populations, and other underlying issues impacting members’ health and our medical spending?
  • How can we better manage utilization of genetic testing, which tests add long-term value, and which ones have minimal to no health or financial value?
  • When planning and implementing cost-saving and health-improving programs, how do we implement an effective performance-tracking program and report on ROI?
  • What key data points should we be monitoring to evaluate the effectiveness of our medical management policies?
  • What considerations should we be making to refine our UM program structure, and improve position and programmatic written descriptions to ensure we remain fully compliant?

Improve the Quality of Your Clinical Decisions and Your Members’ Care Outcomes!

When & Where

April 5-7, 2017

Holiday Inn Express Nashville Downtown
920 Broadway
Nashville, TN 37203
Phone: (615) 244-0150

We have a limited number of hotel rooms reserved for the conference. The negotiated room rate of $229 per night will expire on March 6, 2017 although we expect the block to sell out prior to this date. To ensure you receive a room at the negotiated rate, book well before the expiration date. Upon sell out of the block, room rate and availability will be at the hotel’s discretion.


Register Now: Space is Limited!

For more information and to register, contact Kathie Eberhard at 704-341-2439 or keberhard@healthcare-conferences.com

For speaking and sponsorship opportunities, contact Jennifer Clemence at 704-341-2438 or at jclemence@healthcare-conferences.com

[+] Register Now


The 2nd Annual Utilization Management Best Practices Summit for Health Plans

April 5-7, 2017 – Nashville, TN

Proven Strategies and Best Practices to Reduce Medical and Pharma Costs While Improving Care Quality


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