Common use of Utilization Review Meeting Clause in Contracts

Utilization Review Meeting. Description The CONTRACTOR shall meet with DEPARTMENT staff on an annual basis to report and discuss annual experience and utilization in relation to: • Disease management capabilities and effectiveness in improving the health of PARTICIPANTS and encouraging healthy behaviors, • Demonstrating support for technology and automation, • DEPARTMENT experience by disease and risk categories, • Comparisons to aggregate benchmarks and any other measures the CONTRACTOR believes will be useful to DEPARTMENT staff and the BOARD in understanding the source of cost and utilization trends, and • DEPARTMENT Initiatives, which currently include: Care Coordination, High Tech Radiology, Low Back Surgery, Shared Decision Making, Advanced Care Planning, and Low-Value Care. This information shall be presented in a format as determined by the DEPARTMENT. The DEPARTMENT will provide additional reporting criteria in advance of the meeting. (See Sections 215A and 215B.)

Utilization Review Meeting. Description The CONTRACTOR shall must meet with DEPARTMENT staff on an annual basis to report and discuss annual experience and utilization in relation toregarding: • Disease management capabilities and effectiveness in improving the health of PARTICIPANTS and encouraging healthy behaviors, : • Demonstrating support for technology and automation, ; • DEPARTMENT experience by disease and risk categories, ; • Comparisons to aggregate benchmarks and any other measures the CONTRACTOR believes will be useful to DEPARTMENT staff and the BOARD in understanding the source of cost and utilization trends, ; and • DEPARTMENT Initiatives, which currently include: Care Coordination, High Tech Radiology, Low Back Surgery, Shared Decision Making, Advanced Care Planning, and Low-Value Care. This information shall must be presented in a format as determined by the DEPARTMENT. The DEPARTMENT will provide additional reporting criteria in advance of the meeting. (See Sections 215A and 215B.)Section III.G.1

Utilization Review Meeting. Description The CONTRACTOR shall meet with DEPARTMENT staff on an annual basis to report and discuss annual experience and utilization in relation to: • Disease management capabilities and effectiveness in improving the health of PARTICIPANTS and encouraging healthy behaviors, : • Demonstrating support for technology and automation, ; • DEPARTMENT experience by disease and risk categories, ; • Comparisons to aggregate benchmarks and any other measures the CONTRACTOR believes will be useful to DEPARTMENT staff and the BOARD in understanding the source of cost and utilization trends, ; and • DEPARTMENT Initiatives, which currently include: Care Coordination, High Tech Radiology, Low Back Surgery, Shared Decision Making, Advanced Care Planning, and Low-Value Care. This information shall be presented in a format as determined by the DEPARTMENT. The DEPARTMENT will provide additional reporting criteria in advance of the meeting. (See Sections 215A and 215B.)Section III.G.1