Utilization Management is Rapidly Evolving – Are You Prepared?

There may not be a more misunderstood part of the health care system than utilization management (UM). UM helps ensure that members receive health care services that are appropriate, necessary and cost-effective. 

It’s an important tool because, too often, your members aren’t getting the care they need and deserve. For example, nearly four in 10 patients receive care that doesn’t follow the latest medical evidence.[1] What’s more, costs are skyrocketing, and upwards of $340 billion is spent on low-value care in the U.S. every year, making UM more important than ever.[2] 

However, UM can lead to administrative challenges for both payers and providers, with members often stuck in the middle. Perceived flaws in UM have become political and media fodder in ways that can completely overshadow its vital role. 

To both preserve the benefits UM delivers today, and help it evolve to better meet the needs of members, providers and payers tomorrow, it’s important to understand the:

• Complexities of UM, including the role of prior authorization, which is at the center of many frustrations – and misrepresentations.
• Challenging state and federal policy environment for UM, as well as the media and public opinion landscape that drives it.
• Efforts to both right-size the use of UM and make it faster and easier through technologies like artificial intelligence (AI).
• Future state of UM, which will look at the whole person (i.e., not just the medication or medical services they require) and operate collaboratively with providers.

To get expert insights, you need to grasp the current state of UM and prepare for its evolution. Fill out the form below to receive a comprehensive guide.