A more collaborative, automated UM model could create a bridge between the current system, where authorizations happen after care decisions, and real-time communication between payers and providers that provides immediate decisions at the point of care.
That bridge is what we call an “exception-based utilization management model.” New technology can help payers identify which providers are getting approvals, for which care events, and how often.
Then, using that knowledge, most care events can be automatically authorized, letting the payer limit their focus to the outliers. And even then, many of those decisions can be automated.
Learn more about this new thinking and the technology innovations that make it possible in Reinventing Utilization Management to Bring Value to the Point of Care.