Spotlight Magellan Health: Ashley Rutter

As vice president of clinical products and solutions, Ashley Rutter is focused on all things related to specialty products and specialty strategy at Magellan Healthcare – from working on projects like genetic testing and sleep solutions, to developing innovative ways to improve the provider experience. Based out of the Washington DC metro area, Rutter has been with Magellan for five years. Through innovation with developing specialty products, Rutter aims to create solutions that ensure high quality and appropriateness of care in complex specialty areas. Continue reading to learn more about the specialty products Rutter is working on, along with her thoughts on how Magellan’s culture has had a positive impact on bringing those products to fruition.

What projects are you currently working on?

Our product team is focused on developing new verticals in the specialty management space, one of which is genetic testing. Magellan is working with an organization to develop a comprehensive genetic testing solution that includes medical policies, payment integrity solutions, a preferred laboratory program and a utilization management component to cross the entire spectrum of genetic testing. This solution will ensure that the right tests are ordered at the right time and are billed appropriately.

In addition, we are also very focused on leveraging technology and artificial intelligence to drive efficiencies to maximize value for all stakeholders including members, providers, and payers. For example, we are developing solutions to automate the prior authorization process at the point-of-care to reduce the administrative burden on providers.

When we think about the future state of specialty products, we know that there is a tremendous spend across complex conditions such as oncology, musculoskeletal and cardiovascular disease. We have the clinical expertise and experience to be able to make a meaningful impact across those complex and high spend areas. Therefore, the time is right to look beyond utilization management to ensure we’re offering solutions that keep the member at the center of the treatment plan that is designed to support end-to-end management of that condition or episode.

Why is Magellan the best place to do these projects?

We have extensive capabilities and subject matter expertise across our business segments that support innovation. I also think that our clinical expertise is unparalleled, and we have tremendous support from clinical champions across the organization to drive new solutions. In addition, we have strong collaborations in place with some of the most cutting-edge companies in the industry who help to support innovation.

What are your thoughts on the culture at Magellan and how does that culture impact your projects?

The Magellan culture has supported the work that I’m doing with my team by really offering support and expertise given the diversity of experience that folks have within the organization that we can look to when developing new solutions.

The variety of business units across Magellan lends itself to a culture that supports tremendous professional development opportunities. I’ve had the opportunity to work either directly with or get exposure to all segments across Magellan, including specialty, behavioral, pharmacy, and federal and I’ve learned so much from each part of the organization. Magellan is full of mission-driven and incredibly hardworking people with expertise from all over the industry, this really supports a collaborative culture where folks are always learning from one another.

What are some exciting trends in the healthcare industry that you’ve noticed? Based on those trends, in what direction do you see the healthcare industry going in? What lessons are there to learn in other industries that could be applied to healthcare?

Every single person in this country engages with healthcare at some point in time. While the ways that folks engage continues to evolve, the opportunities to improve those experiences are plentiful.  First, digital transformation is incredibly exciting because there is so much opportunity to fundamentally improve the way that healthcare is delivered. By automating systems and processes, we can maximize value for members while driving value across the entire healthcare delivery system. Digital transformation also has the potential to empower healthcare organizations with the data to be able to best serve their members and reduce the administrative burden on providers to allow them to stay focused on treating members.

Virtual care is another trend that has gained so much momentum over the last couple of years with COVID as a catalyst. We can learn so much about member engagement in this new way that care is being delivered. As we think about more comprehensive condition management, we need to be able to leverage some of those best-in-class virtual solutions to meet numbers where they are and deliver the very best care that we possibly can.

Finally, value-based care is an important trend that we must keep front and center of any new solutions on which we are working. We know that we have a tremendous opportunity to supply providers with tools and data to understand the quality of care they are providing to those members. We’re looking forward to continuing to innovate in that space to effectively collaborate with providers on managing the highest cost and most complex conditions and services.

 

 

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