Disease Management & Nurse Triage

• Research methodologies for disease management
• Integrating nurse triage and disease management
• Disease management in state Medicaid populations
• Disease management and nurse triage accreditation
• General disease management and direction
• Nurse triage
• Provider-based versus disease management or organization-based care management delivery
• Use of disease management as a practice redesign tool/strategy
• Physician engagement strategy, including pay for performance
• Work-at-home nursing programs for disease management and triage
• Security systems for remote nursing
• Nurse call center management
• Career opportunities for nursing staff
• Integrating technology and phone- and field-based nursing staff
• Disease management nursing practice
• Telehealth nursing
• Nurse licensure in telehealth practice
• Telephone triage: history, utility, insource versus outsource, role in care management versus marketing, advantages of McKesson algorithms compared to other systems
• Importance of triage as adjunct to disease management services
• Web-based consumer health information
• Integration of nurse-delivered triage services into emergency medical services
• Health policy relating to Medicaid and Medicare disease management
• Disease management in underserved populations
• Medicaid and Medicare disease management
• Comorbid disease management

Claims Management & Adjudication

• Business process outsourcing for claims management
• Rules-based adjudication within payors' claims systems
• Improving service for members through better payor-provider relationships
• Transparency in healthcare claims processing
• Solutions, not software
• Extending claims performance
• Clinical aspects of an ASP claims management solution
• Optimizing claims performance results
• Taking the first step in improving claims quality and consistency
• Value, impact and challenge of code auditing
• Improving relationships through payor-provider transparency
• Enhancing claims management to improve performance

Business Intelligence & Reporting

• Pay for performance
• Provider profiling using financial, clinical or quality measurements
• Network management/network tiering
• Accreditation (HEDIS, NCQA, state regulations)
• Applying analytics to an enterprise-wide care management program
• Diagnosing payment policy gaps through advanced data mining
• Improving consistency and quality of claims performance

Evidence Based Medicine

• Critical success factors for evidence-based medicine use for both payors and providers
• Evidence-based benefits in consumer-directed healthcare
• Universal evidence-based medicine standards driving new provider payment models
• Physician engagement and pay for performance
• Evidence-based physician white papers in care management

Software and Architecture

• Service-oriented architecture from an industry perspective
• Software as a service-delivery model
• Business process outsourcing for claims management

Industry Issues

• Payor-provider connectivity
• Evidence-based medicine
• Predictive modeling
• Patient care management
• Business intelligence tools
• Healthcare trends: payor, provider, pharmacy, employer, benefit management
• Consumer-directed healthcare
• Electronic health records
• Emerging information technology and quality management
• The future of healthcare in the United States
• Research methodologies

Imaging & Workers' Compensation

• Care management for workers' compensation and disability
• Managing use of imaging studies