3 Key Utilization Management Techniques in Healthcare

Effective utilization management techniques in healthcare can lead to a variety of benefits for all stakeholders. With the right objective clinical data tools, providers can transform utilization management for the better.

Objective clinical data creates process awareness and predictability, enabling providers to focus more time on the patient, not the process. And while more time may be most advantageous to the patients themselves, it’s positive for everyone involved.

A clear and consistent approach to utilization management supports effective oversight of healthcare delivery. Let’s look more closely at a few utilization review and management techniques that can support fiscal, operational, and patient processes.

1. AI to Support and Empower Staff

Artificial intelligence (AI) can make patient care more effective and efficient, addressing the diverse needs of stakeholders. Clinical staff can more accurately prioritize efforts to monitor patients when predictive analytics tools can provide valuable guidance.

Automating the review of simple cases frees providers to focus on the most complex ones. That puts clinicians in a position where their knowledge, judgment, and critical-thinking skills can provide the most value and best support patient health.

Making determinations about medical necessity shouldn’t only focus on criteria. The patient needs to be a central part of the process. AI can supply the information needed to ensure patients receive the appropriate level of attention, whether it’s a fast and efficient determination through AI-powered predictive analytics or a more involved review led by clinicians.

2. Streamlined Payer Communications

Better communication with payers can lead to better outcomes, reduced denials, and many other benefits. In the big picture, key benefits like time savings and reduced spending on administrative burdens emerge. This is an especially important utilization management technique in healthcare.

AI can again play a key role in this regard, helping to streamline authorization communications and providing a real-time view of the clinical data at the heart of each case a provider escalates.

Improving communication and offering valuable information can provide the context necessary to prevent a denial from occurring in the first place, or to more speedily address a denial that does arise.

3. Complementary Tech: Remote Patient Monitoring Solutions

Remote patient monitoring devices have substantially grown in popularity in recent years.

An American Medical Association survey finds remote patient monitoring services grew in popularity among physicians between 2016 and 2019. The COVID-19 pandemic increased adoption as well.

Electronically transmitting and capturing key patient data in these remote situations keeps your organization more informed and ready to act the next time that patient must visit a facility for an emergency or scheduled procedure.

This can be especially valuable in combination with AI-driven tools to predict patient status and guide clinicians toward the most time-sensitive and important cases.

A Partner Focused on Key Utilization Management Techniques in Healthcare

XSOLIS is committed to supplying hospitals, health systems, and payers with solutions that optimize utilization management efforts from all perspectives.

Take the next step to empower your clinicians.