AGENDA OVERVIEW

Reimbursement and Utilization Management: Balancing Cost and Care
Presented by: HealthLeaders
10:00 - 11:05 PM EST

About the Session:

Prior authorization, quantity limits, and step therapy are among the many utilization management (UM) tools health plans use to facilitate cost-effective care. Are they working? On balance, do members receive the care they need when they need it?

This panel will explore the current state of UM, including:

• How do you define utilization management and how have your policies and practices around UM changed since the pandemic?
• How are you leveraging technology, including AI, to execute your UM strategy and serve members?
• UM has a downside and can be seen as a way for health plans to increase profitability by constricting care.
• How can payers demonstrate that their UM goals balance cost control with care for the member?

Panelists:
Tracey Alvarez, Vice President, Medical Care Solutions, Blue Shield of California
Bill Giard, Vice President, Enterprise Architecture and Innovation, Blue Shield of California
Dr. Cathy Moffitt, Senior Vice President and Aetna Chief Medical Officer, CVS Health
Lori Beerman, Moderator, HealthLeaders