Program Agenda  |  About the Speakers  |  Sponsors

Each year, NAIRO and its member companies stage an annual symposium discussing the latest developments and trends in independent medical review. The Symposium delivers in-depth educational content, along with networking opportunities to meet and exchange ideas with others in the industry.

The theme for this virtual one-day event was “The Use of Technology in the Review Process,” highlighting the use of and advances in technology designed to enhance the review process for all stakeholders.

Thank you to our sponsors:
Advent Health Partners and UMWare Solutions!

Virtual Symposium Agenda

Symposium Speakers

Tom McGraw

Tom McGraw is the Vice President of Business Development for SaviLinx.

Tom has over 25 years in the healthcare industry. From four years, Tom led product development for Secure Exchange Solutions (SES), which was purchased by Centauri Health Solutions in 2021, focused on developing products using Natural Language Processing (NLP) to evaluate medical records’ text against payers’ requirements. From 2012 to 2017, Tom served as CEO of Noridian Healthcare Solutions, a company that managed and reimbursed over $50 Billion in services for over 15 million Medicare beneficiaries. He led company the company into the population health and program integrity markets.

Tom previously led the government solutions group for UnitedHealth’s Optum/Ingenix health informatics subsidiary and its Integris, Inc. program integrity company. At MAXIMUS, he oversaw numerous functions including the company’s Medicare appeals, utilization review, and program integrity operations. As a Virginia government employee, Tom led the implementation of Medicaid managed care and led numerous other Medicaid operations including utilization review, long term services and support, and recipient program integrity.

Tom has a BS in Economics, Political Science and History from the US Naval Academy and an MA in Economics from Old Dominion University. He served on active duty in the submarine force and retired from the US Navy Reserves.

Tom recently moved to Conway, SC and has three grown children.

Bessie M. Tetteh

Bessie M. Tetteh, iMPROve Health's Director of Information Technology, is responsible for aligning the technology vision with business strategy by integrating processes with the appropriate technologies. Also, she is responsible for all aspects of developing and implementing technology initiatives, including maintaining existing enterprise systems while providing direction and leadership to information services members to ensure successful performance of contractual obligations.

Dr. Tetteh's experience as an executive leader and motivator includes planning and leading the execution of complex, cross-functional implementations and integrations. She has served as an efficient business transformation coach and mentor, as well as a role model on continuous improvement methodologies. She focuses on implementing methods that remove barriers to success while enabling higher operational and financial performance throughout the company.

Daniel Sierra

Danny Sierra,  Vice President of Information Technology for ProPeer, serves as CIO and CISO ensuring that technology concerns are well-balanced within the company’s vision and growth strategy.  Danny has an extensive background in IT extending 30+ years across multiple industries dating back to software development in the late 80’s.   Recently from 2010-2022 Danny served as an IT leader for HCA Healthcare directing some of HCA’s largest and most complex medical campuses and prior to which he gained deep experience in the mining industry, electric utility industry, and consulting.  Danny holds an MBA in IT Management and has acheived black belt in Six Sigma process improvement both of which compliment his mindset of “IT-as-a-customer service”; i.e., IT only exists to serve the customer need.   Danny is happiest with his wife Carla raising their two college-bound sons Anthony and Adam while enjoying the Texas hill country (with a compliment of good bourbon and a handful of guitars.)

Balu Balasubramanyam

With over 32 years of progressive experience in software development and systems engineering, Balu Balasubramanyam has wide-ranging expertise in strategy, implementation, research and operational efficiency of healthcare systems and information technology (IT). Currently, as Health solutions lead, he advises Maximus’ Federal Health portfolio executive leadership with technical solutions to fulfil commitments across its Federal Health and Human Services footprint.  

Over a 10-year career at the MITRE Corporation, Mr. Balasubramanyam served as a trusted advisor to CMS and the ONC in designing the FHIR-based certification model for reporting on clinical quality measures from EHRs.  He led the evolution of HL7’s standard for expressing eCQMs leading a public forum of stakeholders from AMA, The Joint Commission, NQF, NLM and EHR product vendors.  In 2018, he created a public private partnership for HRSA to modernize and reduce the Federal reporting burden for 1400+ Community Health Centers across the country. 

Mr. Balasubramanyam holds a master’s in computer science from West Virginia University and a bachelor’s in Electronics and Telecommunication Engineering from the National Institute of Technology, India.

Robert Coop, Ph.D.

Robert Coop, Chief AI Officer at Advent Health Partners, has over ten years of experience as a researcher, practitioner, and leader in the machine learning and artificial intelligence fields. Before coming to Advent, Robert led the machine learning line of business as General Manager for a professional services firm specializing in data engineering and machine learning services for Fortune 500 enterprises.

Robert Coop has a doctorate in Machine Learning, with a focus on neural network architectures and training algorithms from the University of Tennessee.

Sponsors
Advent Health Partners  |  UMWare Solutions

Designed for nurses/coders performing claim audits, CAVO® technology empowers organizations to achieve higher ROI across critical provider audit programs like DRG, medical necessity, utilization management, itemized bills, FWA/SIU, and more. Using deep clinical and coding expertise in conjunction with NLP and ML as the backbone of our AI-driven use case deployment, CAVO facilitates a 10X faster claim or record review, significantly improves the financial outcome per FTE, and accelerates ongoing process improvement.

CAVO: Advanced search capabilities for medical records.
CAVO Predict: Surfaces non-payables faster with machine learning.
CAVO Connect: Directly accesses EMR data.
CAVO IB Reviews: Intuitive interface to make disallowed decisions instantly.

Contact: Kurt Erickson, Director of Client Engagement
Phone: (715) 861-3606
Email Address: [email protected]

301 Plus Park BLVD Suite 500
Nashville, TN 37217

https://adventhp.com/

UMWare Solutions was born from the collective expertise of ManageWare which has offered a unique workflow platform to the workers’ compensation utilization review and peer review industry since 2014. Because Health Utilization Management and Clinical Review performed by Independent Review Organizations has its own unique challenges, requirements and nuances, UMWare was founded to address the specific challenges facing both URAC accredited and non-accredited organizations.

Given today’s business climate, organizations are facing new and unique challenges to work virtually and still maintain full production capacity. The integration and automation built into UMWare Solutions' CareWare NextGen Utilization Management / Peer Review platform was designed to support those processes using the latest technology that is critically absent in the marketplace today.

The foundational elements of CareWare NextGen were designed with functionality to address the needs of Independent Review Organizations and those entities providing independent Medical Review services in today’s world while deploying and maintaining the highest levels of data and cybersecurity required to eliminate risk for our clients.

UM, IRO & Peer Review Technology
CareWare NextGen is a web-based, proprietary system that creates a more efficient workflow for processing clinical reviews. With the ability to connect the requestor of services through a web- enabled portal, we can begin to retire the legacy workflows of emails and faxes. By enabling user access to all parties and clinical resources, we accelerate and streamline the process through expedited assignment, information flow, medical determination, creation and distribution of required correspondence. The workflow configuration capability allows CareWare to be enabled for each of a review organization’s internal resources.

• Full utilization management capabilities
• Tracking of requests, approvals and denials
• Full IRO review management capabilities
• Auto-generation of all clients and provider correspondence
• Flexible enterprise architecture for custom workflow and process configurations
• Complete document management, notes, tasks and reminders

Contact: Brian Rudiger, Vice President Business Development
Phone: (469)744-8274
Email Address: [email protected]

4135 S. Power Rd., Suite #125
Mesa, AZ 85212

https://umwaresolutions.com/