Matt A. Murphy

Matt A. Murphy

Boston, Massachusetts, United States
3K followers 500+ connections

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About

Matt A. Murphy is the CEO and Co-Founder of Cascala Health, an AI-enabled care…

Articles by Matt A.

Activity

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Experience

  • Cascala Health Graphic

    Cascala Health

    Boston, Massachusetts, United States

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    Boston, Massachusetts, United States

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    Greater Boston Area

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    Boston, Massachusetts, United States

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    Atlanta, Georgia, United States

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    Greater Boston Area

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    Greater Boston Area

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    Boston, MA

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    Boston, MA

Education

Publications

  • Overhauling Prior Authorization: How to Achieve Better Outcomes at a Lower Cost

    MedCity News

    An intelligent authorization platform relies on AI and machine learning to extract patient-specific data from a number of sources including the EHR. This helps health plans better anticipate, manage and optimize member outcomes.

    See publication

  • Fixing Prior Authorization: How to Improve Outcomes Using Episodic Care Paths

    MJH Life Sciences

    As the industry becomes oriented toward value-based care and its focus on high-value outcomes, utilization management must evolve to address the entire patient care journey, often across multiple episodes of care.

    See publication

  • [Podcast] Digitization of Prior Authorizations and Utilization Management Driven by Patient-First Approach with Matt Murphy

    Empowered Patient Podcast

    Matt Murphy is the EVP of Network and Clinical Content at Cohere Health, innovators in utilization management and prior authorization for tests, services, and drugs. By taking a patient-first approach means reviewing cases on behalf of the Cohere health plan clients as well as with an eye to the health outcomes of patients.

    See publication

  • Podcast: Digitization of Prior Authorizations and Utilization Management Driven by Patient-First Approach with Matt Murphy Cohere Health

    Empowered Patient Podcast

    Matt Murphy is the EVP of Network and Clinical Content at Cohere Health, innovators in utilization management and prior authorization for tests, services, and drugs. By taking a patient-first approach means reviewing cases on behalf of the Cohere health plan clients as well as with an eye to the health outcomes of patients.

    Matt explains," Utilization management really evolved as an adversarial exercise with health plans pitted against physicians. And if you think about the key areas…

    Matt Murphy is the EVP of Network and Clinical Content at Cohere Health, innovators in utilization management and prior authorization for tests, services, and drugs. By taking a patient-first approach means reviewing cases on behalf of the Cohere health plan clients as well as with an eye to the health outcomes of patients.

    Matt explains," Utilization management really evolved as an adversarial exercise with health plans pitted against physicians. And if you think about the key areas where it's impacting patients and physicians more broadly, really it's three things. First is delays in care and access. Really there shouldn't be anything coming in between a patient and the care they need as long as it's clinically appropriate. So I'd say that's probably the first issue."

    "A few weeks ago, we reported out jointly with Humana, one of our first clients, on the impact we had in year one, and it was tremendous in terms of medical expense savings. But I think it goes back to the philosophical differences people have in utilization management."

    "On one side, you have a number of folks who think that the only way to drive down medical expense is to deny services versus our vision, which is if you truly are driving the right clinical care for patients and the highest value care, you're inherently going to have lower expense. So I think if you can kind of transition across that philosophical boundary into the focus on clinical outcomes, you inherently save money."

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  • HBR- How a Startup Accelerator at Boston Children’s Hospital Helps Doctors Launch Companies

    Harvard Business Review

    Boston Children’s Hospital designed an innovation accelerator to overcome these hurdles. While it’s still early days (we launched this accelerator in early 2016), we believe the accelerator has scored enough successes to prove that the model can work. In its first year, the accelerator successfully engaged more than 300 clinicians, researchers and administrators — touching more than 25 clinical departments at the hospital. It has accelerated nine projects and spun three of them out as start-up…

    Boston Children’s Hospital designed an innovation accelerator to overcome these hurdles. While it’s still early days (we launched this accelerator in early 2016), we believe the accelerator has scored enough successes to prove that the model can work. In its first year, the accelerator successfully engaged more than 300 clinicians, researchers and administrators — touching more than 25 clinical departments at the hospital. It has accelerated nine projects and spun three of them out as start-up companies that have secured over $2 million in venture funding.

    See publication

Patents

  • SYSTEMS AND METHODS FOR GUIDING TRAVERSAL THROUGH LOGIC SERIES FOR EVENT CHAINS

    Issued US 11,842,801 B2

    BACKGROUND: A subject can have one or more conditions. The condition can be a medical condition (e.g., knee pain, dental cavity), and various actions can be taken in response the condition. For example, one or more events (e.g., laboratory scans, procedures, therapies) can be performed in an order to alleviate or mitigate the condition.
    In many instances, approval of each event can be requested prior to performance of the event. For example, this can include providing a request for approval…

    BACKGROUND: A subject can have one or more conditions. The condition can be a medical condition (e.g., knee pain, dental cavity), and various actions can be taken in response the condition. For example, one or more events (e.g., laboratory scans, procedures, therapies) can be performed in an order to alleviate or mitigate the condition.
    In many instances, approval of each event can be requested prior to performance of the event. For example, this can include providing a request for approval of an event with an event code specifying the event to an authorizing entity for approval and receiving either an approval or rejection of the event. Such a process can be inefficient, as each event of a series of events may need to be approved prior to performance of each event, and a delay may exist between requesting approval of each event and receipt of the approval of the event.

    ABSTRACT: The present embodiments relate to generation of event chains and processing of events using the event chains. According ot certain embodiments, the embodiments relate ot generation of event chains and processing of events using the event chains. According to other embodiments, the embodiments relate to identifying a subpopulation of subjects for providing a modified request-processing technique. According to other embodiments, the embodiments relate to auto-completion of event chains for triggering auto-processing of events.

    See patent

Courses

  • Behavioral Economics, Executive Education Course

    Harvard Business School

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