Analyzing Trends in Utilization Management: A Focus on Regulations
Epstein Becker Green and EBG Advisors are pleased to announce a webinar titled Analyzing Trends in Utilization Management: A Focus on Regulations. The session 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, the presentation 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.
“As utilization management emerged and evolved over the years, payers used it to help determine what care is medically necessary and appropriate under a health insurance offering,” says Garry Carneal, JD, MA, President & CEO of Schooner Strategies. “As a result of perceived and real abuses in the 1980s, states began to regulate UM functions and URAC was formed to create national accreditation standards. This webinar will deliver an important snapshot of key UM regulatory activities 30 years after managed care took off.” This webinar will also give the first comprehensive update covering state UM regulations since 2005, when Carneal headed up the last study as President & CEO of URAC.
The webinar, scheduled for August 5, 2015, at 12:00 p.m. ET, will be led by Carneal and Cheri Lattimer, RN, BSN, Executive Director of both the Case Management Society of America (CMSA) and the National Transitions of Care Coalition (NTOCC). Bob Atlas, President of EBG Advisors, will moderate the session.
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 an overview of the appeals process
- Key trends in medical management
- How traditional UM functions are becoming integrated in to 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,” says Atlas. “Our hope is to provide a thorough review of the many business, legal, and regulatory forces directly impacting the medical management system, including the Affordable Care Act.”
Ms. Lattimer is the CEO of Consulting Management Innovators (CMI), an association management company based in Little Rock, Arkansas and Washington, D.C. Along with leading CMI, she serves as the Executive Director for two CMI clients: the Case Management Society of America and the National Transitions of Care Coalition. She participates on numerous advisory panels and non-profit boards within the health care industry and is also a member of the American Society of Association Executives (ASAE).
Mr. Carneal is the President and CEO of Schooner Strategies, a consulting firm focused on health-related organizations. He also serves as the senior policy advisor to The Kennedy Forum and as Chair to the RadSite/RadScope Advisory Board. Previously, he has served as the President and CEO of URAC. Carneal has researched, written, and published extensively on quality, medical management, information technology and regulatory trends.
Mr. Atlas is a Strategic Advisor and President of EBG Advisors, Inc. He serves as an executive consultant on strategy, policy analysis, program development, and performance improvement for health providers, payers, policymakers, product makers, investors, and others. He is highly knowledgeable about managed care and accountable care, health services management, health care finance, and the formation of value-generating partnerships.