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Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting

Author:

Brian Dunn

Inspector General
Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

Brian Dunn

Inspector General
Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting

Author:

Brian Dunn

Inspector General
Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

Brian Dunn

Inspector General
Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

 

Samantha Werth

Executive Director
Global Enteric Methane Impact Alliance (GEMIA)

Samantha Werth

Executive Director
Global Enteric Methane Impact Alliance (GEMIA)

Samantha Werth

Executive Director
Global Enteric Methane Impact Alliance (GEMIA)

What does a health plan actually gain when it moves from random sampling DRG claims to smart triaging them? Horizon's Ron Jones and Alaffia's TJ Ademiluyi discuss the answer: shorter review cycles, a stronger case for bringing DRG review in-house, and a rigorous test of the approach against sepsis DRG, one of the more contested determinations in claims review.

In partnership with Alaffia Health

Moderator

Author:

Ryan Everist

VP Growth
Alaffia Health

Ryan Everist

VP Growth
Alaffia Health
Panelists

Author:

TJ Ademeluyi

CEO
Alaffia Health

TJ Ademeluyi

CEO
Alaffia Health

Author:

Ron Jones

Senior Director Payment Integrity
Horizon Blue Cross Blue Shield of New Jersey

Ron Jones

Senior Director Payment Integrity
Horizon Blue Cross Blue Shield of New Jersey
 

Reed Willis

Litigation Director
Align Technology

Reed Willis

Litigation Director
Align Technology

Reed Willis

Litigation Director
Align Technology

Shana Kim, Founder, Blovo

In the animal healthcare field, it is important not only to present technological innovation but also to show what meaningful impact your solution can have for pet owners, veterinarians, and the broader care ecosystem. It was helpful to prepare the application with the bigger picture in mind, explaining how our company’s product connects to and influences the overall care ecosystem. 

 

Jay Price

Chief Executive Officer
Mission Pet Health

Jay Price

Chief Executive Officer
Mission Pet Health

Jay Price

Chief Executive Officer
Mission Pet Health
 

Tommy Jackson

Chief Executive Officer
Prelude

Tommy Jackson

Chief Executive Officer
Prelude

Tommy Jackson

Chief Executive Officer
Prelude