What’s holding health plans’ Utilization Management (UM) programs back from improving efficiencies, reducing costs, and driving better outcomes? Legacy tools. 

Fewer than 33% of health plan leaders rate their current UM tools as “very effective” at identifying health events in time to make a positive impact, and only about 25% of the tools are “easy” to use – rendering many UM programs as fragmented and frustrating.

During our February 15, 2024 webinar, The State of Utilization Management 2024, 3 expert speakers discussed the top barriers to UM today – and how healthcare leaders can overcome those challenges to optimize UM. 

The discussion included Julie Barnes, JD, Founder and CEO, Maverick Health Policy, Kenneth Young, President and CEO, Medecision and was moderated by Stephanie Kovalick, Partner and CSO, Sage Growth Partners.

The executives examined independent market research that surveyed health plan leaders about the current state of UM and what organizations need to to transform both Utilization Management and Care Management. 

Key findings relative to UM include: 

  • More than half of survey respondents say fragmented data (57%), data that doesn’t flow into UM workflows (55%), and burdensome data integration are the top barriers to current tools 
  • 68% say inefficient workflows are their organization’s primary frustration with current tools, followed by high costs associated with data silos (49%), and provider abrasion (40%) 
  • Why? Because respondents say current tools are not easy to use and they need technologies that are “very effective” at accessing real-time data to drive down administrative and medical costs while improving health outcomes 

In addition to sharing the research, the speakers also discussed: 

  • Data types healthcare organizations should be integrating into UM workflows 
  • The power of personalization in making UM more trusted by members and providers
  • How predictive modeling for risk stratification, as well as UM workflow optimization with AI and automation, can propel UM efficiency, results, and outcomes
  • What leaders should understand about regulations relative to UM – including the newly-released ePrior Authorization rule   


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