Evidence-based resources empower policy validation and clinical review
As the Chief Medical Officer of Cleveland Clinic Employee Health Plan, Dr. Bruce Rogen, MD, MPH, oversees a self-insured program serving 140,000 members at its Cleveland, OH, flagship location and across all 50 states. With a lean team of around 70 full-time employees managing a billion-dollar spend, the health plan relies heavily on trusted clinical resources to support quality, consistency, and cost-effectiveness.
“We don’t have a building full of people like the big insurers do,” Dr. Rogen explains. “I have seven pharmacists, four doctors, and about 35 to 40 nurses doing utilization management and care coordination.”
Medical directors conduct 120–150 clinical reviews daily, and as part of that process, Dr. Rogen says they consult UpToDate® evidence-based clinical decision support up to 20 times a day to validate decisions and confirm alignment with current standards. “UpToDate is so critical,” he says. “It helps us stay current with the latest research and guidelines.”
UpToDate is embedded in the health plan’s workflows, particularly to support prior authorization reviews and policy development.
“It’s amazing how quickly and quietly our specialists accept the evidence when it’s from UpToDate, because it’s the same source they use daily,” Dr. Rogen explains.
The platform also plays a key role in appeals and policy updates. Nurses and pharmacists often include UpToDate references in their appeal documentation, helping the team reassess and refine policies based on emerging evidence.
“Our policies aren’t exhaustive like those from large insurers. So, when something falls outside the scope, we turn to UpToDate to determine if a revision is needed or if the physician’s request is reasonable,” Dr. Rogen says.
