How AI-enabled technology can transform utilization management

Summary of AI-Enabled Technology White Paper:

AI-enabled technology is increasingly being recognized as an operational necessity for driving healthcare forward and delivering innovative solutions for the myriad of challenges that have inflated healthcare costs and driven sub-optimal patient outcomes. Understanding that it’s a tool both powerful and potentially problematic, there are some key considerations and use cases for applying this technology to utilization management (UM).

We discuss three key use cases where AI is being implemented in UM to help achieve greater efficiency and drive optimal patient care journeys. Beyond simply digitizing historically manual processes to reduce provider burden, we’ll discuss how the transparent application of AI and ML can also improve provider and patient experiences and outcomes, enhance programs such as physician “goldcarding” to reward high-value providers, and improve the administrative efficiency of health plan case managers.