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Membership Continuing Education
Reinvigorating Utilization Management

Publication Date: 5/4/2023


Length: 60 minutes 41 seconds

Content Level: 1 General CE

Abstract
Centers for Medicare and Medicaid Services outline in their Conditions of Participation the hospital requirements for a Utilization Review (UR) Plan and committee to carry out the functions of UR. Despite being highly regulatory in nature, UR is much more than determining appropriate level of care status and should include robust monitoring of key indicators and subsequent action planning for improvement. Engaging physicians and professional services in the UR Committee can be a challenge but is essential to making the work meaningful and improving outcomes. In this session, we will explore the standardization of UM metrics and processes across a large health care system. Case examples will include strategies to engage physicians and professional services. The focus will be on understanding the integration of key performance indicators and improving the collaboration of disciplines to make UM meaningful and value-added.

Learning Objectives
1. Describe key performance indicators and dashboard development for Utilization Management.
2. Connect dashboard metrics and performance indicators with action planning.
3. Identify engagement strategies to engage physicians in UM processes and committees.
4. Identify engagement strategies and metrics for including professional services in UM.

Speaker: Rebecca Severe, MD | Medical Director of Care Management, Population Health | Advocate Aurora Health Care

Dr. Rebecca Severe is a board-certified hospital medicine physician with 10 years of physician advisor experience. She led the creation of multi-site internal physician advisor programs for two Wisconsin health systems. Rebecca is currently overseeing the internal physician advisor program for Advocate Aurora Health in Wisconsin, which covers 15 hospitals. She is a current member of APLCM and served on the 2021 APLCM Care Management Physician Certification (CMPC) Exam Writing Committee.

Speaker: Lynn Sisler, BSN, MS, ACM-RN | Executive Director, Inpatient Care Management | Advocate Aurora Health Care

Lynn Sisler is the Executive Director of Inpatient Care Management at Advocate Aurora Health Care. She is a master’s prepared registered nurse with 35 years of acute care experience including clinical expertise in Emergency Department and ICU. She is responsible for strategic management and operations for inpatient care management, utilization management and care coordination for 16 Wisconsin hospitals. Lynn is a member at Large for the Wisconsin Chapter of ACMA and has served as a Board Member for ACMA Compare.

Please Note: Session was originally presented live at the 2022 ACMA National Conference on May 1-4 in Dallas, TX.

Keywords: Utilization Management, Utilization Review

Reinvigorating Utilization Management

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