Post by Melissa Gaffney

Everyone says they want to innovate in utilization management. Everyone says they want to fix the administrative burden. Everyone says they want to align clinical and operational reality. But when it comes time to marry mandate + investment, most organizations hesitate. Or worse, want to carry legacy and disruptive innovation. But you cannot. It creates chaos. This is the chaos we are experiencing. Everyone wants this, but true transformation means thoughtful transitions. The mindset needs to be ready. And that’s okay. You can’t force readiness. But I am ready. I am looking for groups who are ready. Ready, ready. This PDF is a small snippet. I have a framework, playbook, and roadmap. This is clinical and administrative simplification, built on the original population-level insights that transformed Group Benefits years ago. I was part of the first population health platform at MetLife; I was the first strategist in HIT Payment Innovation & Value-Based Care. I started my career in marketing for the launch of managed disability, and AI 1.0 was in my roadmap. I knew I needed to refresh my knowledge of AI and spent a year doing so at Wharton. And I have spent the last 8 months grooming, listening, and ideating. Jefferson Health was the first group to introduce population health management for health systems. Mad respect. But MetLife's version was a few years before and focused on the incidence and prevalence of conditions driving the most productivity, absence, and healthcare costs. The scaffolding is ready. The right person, company, or group will see this post. Health and absence management should really be working together. This approach will eliminate the arbitrary requests for information. It will stop the proxy wars for data modes. We work with what we have. Improve without chaos. The right people will recognize exactly what this unlocks. Call to action, I’m all in. If this resonates, you’re one of them. Ping me. Let's GO! Wharton Executive Education Wharton Executive Education | Leadership Program in AI and Analytics AI 2030 Wharton AI & Analytics Initiative Jim Mayhall Julie Saslow Schroeder Julie Schilz Howard Waterman JD / MBA Jill Hummel David Nickelson, PsyD, JD, AIGP David Nicholson Stefano Puntoni Sarbjeet Johal Joshua Brooker, REBC Jennifer D'Angelo, MSHCM Marie Roker-Jones Xiaochen Zhang Rajeev Ronanki