In this episode, Dr, Sweta Singh and Jon Shreve explore how artificial intelligence is reshaping case management workflows while keeping human judgment firmly at the center of care decisions. Through real-world perspectives, the discussion examines how AI can reduce administrative burden, synthesize complex clinical information, and support more timely, informed decision-making—without replacing the expertise of case management professionals.

The conversation also dives into the evolving relationship between providers and payers, highlighting how clearer clinical summaries, improved documentation, and standardized data exchange can streamline authorizations and peer-to-peer reviews. From change management and team adoption to transparency, trust, and patient experience, this episode unpacks what it truly takes to integrate AI responsibly and effectively into healthcare operations.

This episode was sponsored by MCG Health: At MCG Health, we believe every patient deserves the right care at the right time. As part of the Hearst Health network, MCG delivers evidence-based clinical guidelines and AI-powered technology that guide case management professionals toward better outcomes for their patients. Over 3,000 hospitals, a majority of health plans, and many state and federal government agencies rely on MCG’s trusted, unbiased clinical guidance and AI to support accurate, efficient, and compassionate care decisions. With rigorous scientific processes at our core and innovation in our DNA, we help caremanagement organizations improve the patient journey while reducing unnecessary administrative burdens. MCG Health — the source of truth for clinical decisions. Learn more at mcg.com.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with Kimberly Browne and Dr. John Eanes to share their insights on pediatric cases.

The conversation explores three complex pediatric cases that highlight the challenges of managing high-risk children with medical and behavioral complexities. The first case involves a four-year-old child with sickle cell disease and multiple comorbidities admitted with fever and respiratory symptoms, raising questions about inpatient versus observation status. The second case is a 16-year-old with a chronic liver condition who overdosed on Tylenol and faced extended hospitalization while awaiting inpatient psychiatric placement. The third case discusses systemic and logistical hurdles in coordinating care for medically fragile children across state lines, including insurance limitations, care transitions, and Medicaid complexities. The panelists reflect on the unpredictability of pediatric recovery, payer negotiations, and the importance of proactive communication with insurers.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at podcast@acmaweb.org with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with Jennifer Dominow and Marla Kolovitz from Loyola Medicine to share their insights on navigating complex patient transitions.

This episode dives into three complex patient cases that reveal the real-world challenges of case management and utilization review—from surgical complications and readmission dilemmas to high-risk discharges and insurance barriers. The panel explores how legal coordination, interdisciplinary teamwork, and persistent advocacy can make all the difference.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at podcast@acmaweb.org with questions, topic requests, or other feedback.