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Optum and UK HealthCare: Analyzing Challenges and Achieving Results
Activity description
This session is designed to enhance the capabilities of utilization management (UM) leaders in developing and executing strategies that support revenue integrity while improving operational efficiency and accuracy and aimed to strengthen their ability to critically evaluate and determine the most effective UM approach for their organization. UK HealthCare’s journey to enhance its utilization management (UM) function in partnership with Optum will be highlighted. Participants will learn how, within just six months of implementing an AI-enabled solution, the organization began seeing measurable improvements in efficiency and financial outcomes. Key strategies, technology integration, and decision-making frameworks that supported this transformation will be explored offering practical insights for healthcare leaders considering similar approaches.
This activity is designed to meet the educational needs of nurse practitioners, nurses, PAs, case managers, physicians, psychologists, social workers, and other HCPs who have an interest in strengthening their ability to critically evaluate and determine the most effective UM approach for their organization, whether through tech-enabled in-house optimization, managed services providers, or a hybrid model that combines technology and services.
At the end of this activity, participants should be able to:
- Assess current needs, challenges, and available resources to identify gaps in utilization management performance.
- Describe how AI-enabled solutions can be implemented within UM processes and workflows to alleviate the administrative burden, provide proactive insights, and free up valuable clinical staff time to spend more time caring for patients.
- Discuss the most appropriate method for an organization, whether in-house, outsourced, or a combination to enhance the capabilities of utilization management (UM).
Provided by
This activity is provided by Optum Health Education and Optum Insight.
Commercial support
No commercial support was received for this activity.
Required hardware/software
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Presenter
Pam Ryan, RN, BSN, MHA
Director of Utilization Review
University of Kentucky
Activity planners
Rebecca Gleason
Clinical Activity Manager
Optum Health Education
Andrea Keenan
Director, Product Marketing
Optum Insight
Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.
The presenter and activity planners have no financial relationships to disclose.
Accreditation statement
In support of improving patient care, this activity has been planned and implemented by Optum Health Education and Optum Insight. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.
Credit designation statements
Nurses
The participant will be awarded up to 1.00 contact hour(s) of credit for attendance and completion of supplemental materials.
Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
Physicians
Optum Health Education designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
PAs
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
Social workers
As a Jointly Accredited Organization, Optum Health Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Optum Health Education maintains responsibility for this course. Social workers completing this course receive 1.00 live continuing education credits.
Counselors and/or marriage and family therapists
CA: The Board of Behavioral Sciences has deferred CE course approvals to APA and ASWB for its licensees. See those approvals under Psychologists and Social Workers.
Other States: If your state is not specifically listed, nearly all state Counselor and MFT boards accept either APA or ASWB approval, or are reciprocal with other state licensing board approvals. Check with your board to be sure.
AAPC-certified coders
AAPC will honor 1-for-1 CEUs for any live event offering CME credit or AMA PRA Category 1 Credit™. A certificate of attendance or completion is necessary to show participation. The certificate will give the total CMEs possible for the offering. Physicians are advised to claim only the actual hours that they were present during the education. We ask that AAPC-certified members abide by this request also. One hour of instruction is worth 1 CEU.
Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.
Available Credit
- 1.00 AMA - Physicians
- 1.00 ANCC - Nurses
- 1.00 Attendance - General Attendance
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