With shifting regulations and increasing technical complexity, hospitals and health systems face constant pressure to maintain compliance. In this session, Vice President of Regulatory Affairs Angela D. Sorbelli, J.D., LL.M, CHC, MBA at CorroHealth shares how organizations can chart the course as the Centers for Medicare and Medicaid Innovation (CMMI) and healthcare ecosystem shift toward full financial accountability, demanding that hospitals and health systems actively manage cost, quality, and population health across the continuum of care.  

We’ll explore how hospitals and health systems can remain proactive in anticipation of this seismic shift, which redefines the core responsibilities of physician advisors from utilization review and denials management to strategic stewardship and clinical alignment. During the session, we will discuss current and anticipated CMMI models such as ASM (Ambulatory Specialty Model), TEAM (Transforming Episode Accountability Model), AHEAD (Achieving Healthcare Efficiency through Accountable Design), and WISeR (Wasteful and Inappropriate Service Reduction), among others. We will also analyze how these models affect utilization management (UM), care progression, clinical documentation, and post-acute care utilization.   

Attendees will learn about each model’s scope, payment mechanism, and differing strategies. Through these actionable insights, such as optimizing physician engagement, ensuring that clinical documentation integrity (CDI) accurately reflects patient complexity for risk stratification, and integrating UM efforts with population health goals to reduce avoidable variation and readmissions, physician advisors will be equipped to lead their organizations to success in the upcoming value-based payment system.