Day One – Thursday, January 28, 2027

7:15am – 8:00am
Conference Registration & Networking Breakfast

8:00am – 8:15am
Chairperson's Opening Remarks

8:15am – 9:00am

Praveen Mital, MD, MBA, FACEP
ED Adult Medical Director
UF Health Jacksonville

9:00am – 9:45am
From Discharge to Stability: Building an Integrated Care Model for Complex Patients with Medical and Social Needs
Patients with multiple chronic conditions, frequent healthcare utilization, and significant social determinants of health challenges require more than traditional transitional care interventions. This session explores how one health system developed an integrated care model that combines risk-stratified discharge planning, a Transition Clinic, Heart Failure Clinic, High Needs Medical Program, High-Risk Nurse Navigation team, chronic disease education, and a donor-supported Community Care Fund to reduce readmissions and improve outcomes. Attendees will learn how high-risk patients are identified, connected to the appropriate level of care, and supported through both medical and social barriers. The presentation will highlight program development, lessons learned, interventions that failed, and strategies that produced meaningful results while reviewing outcome data, utilization trends, and readmission reduction efforts.

Jessica Sanchez
Manager, Transition Clinic
United Regional Health Care System

9:45am – 10:15am
Networking & Refreshments Break

10:15am – 11:00am
Physician Advisors in Case Management
Length of stay is the hospital's most expensive challenge, and case management absorbs most of it. Case managers work discharge barriers relentlessly, but a case manager cannot adjudicate a clinical disagreement between services, compel an attending to make a disposition decision, or name a treatment plan that is deviating from the standard of care. The physician advisor can. The gap is not effort; it is authority. This session shows how to close it, and gives attendees two machines they can run: multidisciplinary rounds that produce a defensible discharge date, one named barrier owner per patient, and written escalation triggers; and the regulatory toolkit that converts a payer stall into a dated, appealable event, including the 2026 authorization clocks, physician standing under 42 CFR § 422.584, the appointment of representative, and the SNF, IRF, and LTCH standards. Attendees leave with a rounding script, a barrier taxonomy, a 90-day build plan, and five things to change Monday morning.

Ryan Greiner, MD, ACPA-C
System Medical Director and Physician Advisor
North Memorial Health

11:00am – 11:45am
Optimizing Your Care Team for Enhanced Throughput and Efficiency
When the normal flow of patient throughput crashes headlong into significant barriers to next care transitions, a well-organized team of savvy staff are needed to tear down these impediments. Recruiting and organizing this team should be a priority focus for any hospital.

Carissa J. Tyo, MD, FACEP
Medical Director, Clinical Decision Unit
Medical Director, Care Management and Physician Advisors
University of Illinois Hospital & Health Sciences System

11:45am – 12:30pm
Building Access: Coordinating Clinical and Operational Solutions
Transitions of care from the inpatient environment to outpatient or post-acute care can be complex, creating discharge barriers for patients and a lack of adequate access to appropriate high quality care. Novel solutions and adequate resources are needed to ensure appropriate follow up care to reduce readmissions, length of stay and comorbidities of patients.  Care management is part of a multidisciplinary team that can smooth the transition to outpatient high-quality care. 

Nicholas Mains, DO, FACP, FAAP
Associate Professor of Medicine and Pediatrics
Associate Chief Quality Officer, Medicine
Medical Director of Access
West Virginia University
West Virginia University Health System

12:30pm – 1:30pm
Luncheon

1:30pm – 2:15pm
Connecting ‘Z’ Dots: Building Sustainable Health Equity
A missed follow-up appointment. An uncontrolled chronic condition. A patient who doesn't follow the plan of care. What's really going on? The answer may lie beyond the exam room. Through innovative pilots and data-driven findings, this session explores how social drivers of health shape outcomes, how Z codes make those challenges visible, and how care teams can translate insight into action while laying the foundation for sustainable approaches to advancing health equity, one encounter at a time.

• Recognize how social drivers of health contribute to health equity, patient outcomes and healthcare utilization.
• Describe the role of screening, documenting, and communicating social drivers of health to support patient-centered care.
• Community Health Worker training and workflows for social needs intervention
• Building community resource networks and ensuring referral follow-through
• Define strategies to leverage social risk data and Z codes to support sustainable, value-based approaches for advancing health equity.

Mallory Callahan, MPAS, PA-C
Vice President, Value-Based Care
Nebraska Health Network

Kelly Mand
Population Health Coordinator
Nebraska Health Network

2:15pm – 3:15pm
Panel: Removing Barriers to Care: Aligning Clinical Authority, Access and Social Needs
Patients get stuck for different reasons: a clinical disagreement no one has authority to resolve, an access bottleneck no one owns or a social barrier no one caught in time. This panel will discuss who owns these gaps and how their organizations get clinical, operational and social teams working together to close them.

Panelists:

Sarah Reardon, MSN, RN
System Director Capacity Command Center
Bronson Healthcare 

Ryan Greiner, MD, ACPA-C
System Medical Director and Physician Advisor
North Memorial Health

Nancy C. Rush, RN, BSN, CCM
Barrow Neurovascular Care Coordinator
BNI-Advanced Practice Nursing
Barrow Neurological Institute
Dignity Health I St. Joseph's Hospital and Medical Center

3:15pm – 3:45pm
Networking & Refreshments Break

3:45pm – 4:30pm
Capacity Management and Patient Access
Care managers often find themselves managing capacity challenges when patients can't get appointments, surgeries are delayed or post-acute care placement takes days. While capacity management isn't traditionally a care management function, these delays directly impact patient outcomes and satisfaction. This session explores how care management teams are working with operations to improve patient access including facilitating urgent appointments, coordinating surgical scheduling, expediting post-acute placement and addressing capacity bottlenecks. You'll learn about effective collaboration between care management and operations, tools for tracking access delays and interventions that actually improve capacity.

Sarah Reardon, MSN, RN
System Director Capacity Command Center
Bronson Healthcare

4:30pm – 5:15pm
Beyond Discharge: The Patient Experience Advantage in Care Management and Transitional Care
What if one of the most powerful tools for reducing care gaps and improving outcomes isn't clinical at all? Patients don't remember our care plans, they remember how we made them feel. Successful care transitions require more than coordination, they require connection. This session explores how patient experience influences engagement, adherence, readmissions, and outcomes. Learn practical strategies to strengthen communication, build trust, and create seamless transitions that improve both patient outcomes and care management success.

Paul S. Kuzmickas, JD
Enterprise Director | Clinical and Operational Improvement
Cleveland Clinic

5:15pm
End of Day One