Did you know health plans use their prior authorization list (~2,500 service codes) to manage about 22% of their spend?
Our research report compiles data from over one hundred health plans across all segments and lines of business to explore the latest utilization management benchmarks.
Here’s a preview of what we found:
- Blue Cross Blue Shield plans manage the fewest codes
- Approximately 11% of utilization and 22% of spend is managed
- Specialties with the most procedure codes managed include surgery, DME, and MSK
- Specialties with the fewest codes include pediatrics, nephrology, and endocrinology
High utilization does not always correlate with high spend (or an area of high impact).
The full report will help you kickstart your utilization management strategy.
Featured Content
News You Can Use
🏛️ RevCycleIntelligence
Regulatory burdens may take away from patient care
🤝 HealthPayer Intelligence
How can payers support providers’ workforce challenges?
Cohere Minute
Innovating prior authorization with responsible AI (First Report Managed Care)
By: Samantha Roushan
SVP, Clinical Transformation
A powerful duo: Converging AI with patient data to predict outcomes (DOTmed HealthcareBusiness News)
By: Brian Covino, MD, FACC
Chief Medical Officer
Catch up on previous newsletters here.
