UM is the first step in managing complex conditions so patients receive the right care at the right time and place. Payers are increasingly partnering with leading UM programs to guide their patients and providers along the most clinically appropriate care pathway in a rapidly evolving healthcare ecosystem.
Fremont, CA: There is a high frequency of suboptimal care among patients with complex medical conditions, despite the top healthcare expenditures. There is often a negative downstream effect for all parties (payers, providers, and patients) as a result of fragmented and siloed care journeys.
An organization's utilization management can be enhanced by outsourcing by the following means -:
Enhance the quality of patient care: As a healthcare organization, we put patients first, and their clinical outcomes are impacted by payers and providers' decisions. In partnership with a market-leading, clinically driven UM program, patients will receive clinically appropriate care and appropriate site of care decisions, resulting in optimal health outcomes.
Increased clinical guidelines: A thorough understanding of both the patient's history and clinical best practices is necessary to determine whether a procedure is medically necessary. In addition to ensuring patients receive high-quality and medically appropriate care, health plans can gain access to evidence-based criteria by outsourcing UM.
