Case study: Adventist West’s success through redesigning and automating utilization management
Wednesday, November 1st, 2023 | 12:00 PM - 1:00 PM CT
Adventist West, a large health system with more than 3,000 beds and 28 acute hospitals, is well on its way to achieving its goal of exception-based utilization management (UM) by redesigning and automating their utilization review program. Leadership launched a clinically driven initiative that had a positive effect on the revenue cycle, resulting in fewer avoidable medical necessity denials, reduced length of stay and healthier financials overall. Clinical staff are now practicing at the top of their licenses, time and expertise are redirected to complex cases and discharge planning, and denials have been reduced.
Join this session to hear from UM leadership as they share how process changes paired with advanced technology, such as AI-driven medical review automation with InterQual AutoReview, continues to drive operational efficiency with a remote workforce.
At the conclusion of the presentation, attendees will be able to:
Join this session to hear from UM leadership as they share how process changes paired with advanced technology, such as AI-driven medical review automation with InterQual AutoReview, continues to drive operational efficiency with a remote workforce.
At the conclusion of the presentation, attendees will be able to:
- Summarize benefits and best practices for implementing a centralized, exception-based utilization management program.
- Transform their UM programs with workflow optimization and defensible, automated medical necessity reviews.
- Strengthen relationships with payers and optimize UM resources to fully leverage time and expertise.
- Engage revenue cycle leaders and financial officers in refining data transparency processes.
Presenter:
Regina Berman, R.N., M.A.
Value-Based Care Executive, Adventist West