Dr. Sam Toney and Dr. John Zelem are the principal developers of a medical platform called Utilization Management 360 (UM360). In this podcast, they will talk about why it was developed and the benefits it offers.

BIO'S

Sam Toney, M.D.

Dr. Toney is president and CEO of Toney HealthCare Consulting, a clinically-oriented consulting firm providing services in strategy, compliance, management, and clinical operations for healthcare organizations nationwide.

Dr. Toney began his private practice in general adult psychiatry in 1988 and specialized in the diagnosis and treatment of anxiety disorders and psychosomatic medicine.

Dr. Toney subsequently developed a joint venture with the Hospital Corporation of America and the USF Psychiatry Center launching a multidisciplinary outpatient behavioral health practice in the Tampa Bay Area. He then served as the national medical director of CompCare’s managed behavioral health organization from 1992 to 1995.

Dr. Toney then founded Health Integrated and pioneered Dynamic Somato-Social Theory™ (DSST) which is the clinical underpinning of the company’s care management philosophy. DSST is an interventional care management model integrating physical and behavioral medicine for high-risk populations. This proactive and comprehensive approach incorporates unique techniques to drive behavior change and has been shown to drive savings, close care gaps, and improve quality.

Dr. Toney has appeared in such publications as the Journal of Managed Care Pharmacy, Managed Healthcare Executive, and Population Health News. He is a frequent speaker at industry conferences including the Medicaid Managed Care Congress and Medicaid Health Plans of America Conference and has presented on national webinars for Health Plan Alliance, the Association for Community Affiliated Plans, and others.

Dr. Toney is certified by the American Board of Psychiatry and Neurology and is licensed to practice medicine in 35 states.

JOHN ZELEM M.D.

Dr. Zelem is a Board-Certified general surgeon with more than 25 years of clinical experience and has transitioned out of clinical practice into Healthcare Executive Leadership. As a previous Vice-President, he has over 13 years of experience in compliance, utilization management/review, federal regulations, sales, account management, and many other aspects of healthcare. He has extensive experience in quality assessment and improvement, with emphasis on case management, physician and hospital executive education for a variety of topics including Medicare and Medicaid compliance and regulations, medical necessity, Recovery Audit Contractors, utilization review, denials management, and length of stay. He has attained a passion for improving physician documentation and has extensive experience in developing new and improving existing physician advisor programs. He has recently developed a revolutionary new concept utilizing a holistic approach to “Utilization Management 360”. He is now the President and Owner of Streamline Solutions Consulting, Inc. offering services to evaluate, and improve many of the above aspects of healthcare. In addition, Dr. Zelem is a renowned industry author who has published many books and is a well-known motivational speaker and presents often to professional and public/patient audiences on health and wellness, personal development, and leadership and success.

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