How AI-Enabled Tech Can Transform Utilization Management

Across the healthcare space, AI-enabled technology is increasingly being recognized as a mechanism for meaningful change and, even more so, an operational necessity to help address enduring institutional challenges and inefficiencies. 

Within utilization management (UM), advancements have already been made to realize the value of AI and machine learning (ML) in driving change. In our latest white paper, we discuss how AI-enabled technology has the capacity to not only automate traditionally manual processes, but truly transform utilization management for health plans, providers, and patients alike. 

Below are a few key points from the paper, highlighting how AI can be implemented into UM processes to drive greater efficiency and better care: 

How AI-enabled tech can drive greater impact & value in UM

We highlight three use cases where the application of AI and ML in UM systems can effectively disrupt the status quo and drive greater value, and how Cohere’s UM platform is uniquely using this technology to drive better outcomes at lower cost. 

Delivering better experiences for providers and patients: Our technology delivers automated, evidence-based clinical suggestions to providers to ensure patients receive the care that is right for them. For example, the platform can suggest, when appropriate, moving a patient to the outpatient setting, leading to better outcomes, reduced utilization, and decreased costs.

Rewarding high performing physicians: The majority of providers’ treatment requests include adequate information to be authorized, yet all are still required to submit for prior authorization. By integrating AI and ML, providers can be tiered according to trust levels based on those delivering the highest value care; our technology can then begin to “green-light” those providers.

Case review prioritization: ML can also be applied to assist case managers at health plans during clinical review, allowing them to easily identify the cases with potential to drive utmost impact. This in turn allows them to quickly prioritize cases for review, and pass through for approval those that are less likely to impact outcomes or spend.

To learn more about the value that health plans can realize by integrating AI-enabled technology into their UM processes, we welcome you to download and read the full white paper here.