How AI and Automation Create Efficiencies in Utilization Management Workflows (INFOGRAPHIC)

The ultimate goal of Utilization Management (UM) is to reduce operating costs while also increasing provider and patient satisfaction. However, these two factors can be at odds when added rules and manual review processes reduce the high cost of medical services, but end up hurting provider and member experience due to significant processing time delays.

With the continuing shift toward member personalization and whole-person care, payers are taking a closer look at technology solutions that streamline the entire Utilization Management (UM) workflow process using artificial intelligence (AI) and intelligent automation.

According to a recent market guide from Gartner, the industry needs a next-generation UM solution for the following reasons:

• Current UM technology is not ready for value-based reimbursement models.
• An integrated solution that automates the utilization management process in real time would improve the care that a member receives.
• An automated prior authorization process can utilize artificial intelligence (AI)-enabled tools and clinical data integration to ultimately provide better outcomes.
• Consistent application of benefit coverages and limitations will facilitate correct payment of a claim.

The attached infographic contrasts a largely manual UM workflow process with one that is fully automated, integrating data and AI-driven rules at each step in the process. As demonstrated, the result is increased efficiency and a 50% overall reduction in processing time.

To learn more about how automation and AI can transform your UM workflow process, click here to speak with one of our UM experts.