Utilization and Cost Management
Faster decisions, better outcomes, lower costs
93%
of physicians report prior authorization delays care, and 89% say it contributes to clinician burnout. (Source: AJMC)
Why traditional utilization management and prior authorization processes slow care and increase costs.
Utilization management should enable faster, more informed decisions, but manual reviews and disconnected systems often create delays, administrative burden, provider friction, and higher MLR and overall costs.
When you rely on fragmented inputs from multiple systems without a complete view of claims, clinical, authorization, and social risk data, you cannot identify utilization risk early, control avoidable spend, or manage care proactively. Evolving regulatory requirements further increase compliance risk and operational complexity, driving up administrative costs.
“With MedeAnalytics, we’ve transformed our utilization management process. Providers feel supported instead of burdened, and our teams are able to focus more on patient care.”
Vice President of Medical Management, Regional Health Plan
How MedeAnalytics improves your utilization management and prior authorization outcomes.
With MedeAnalytics, you can move from manual, retrospective reviews to faster, more proactive utilization and cost management, enabling you to:
- Identify high-risk and high-cost utilization earlier to prevent avoidable spend
- Automate and accelerate prior authorization decisions to reduce administrative costs
- Apply consistent, evidence-based guidelines to control variation and unnecessary utilization
- Gain real-time visibility into authorization status, care activity, and cost drivers
- Align clinical decision-making with financial performance goals, including MLR improvement
Instead of retrospective reviews and manual processes, you can make faster, more informed decisions while actively managing cost of care and reducing administrative overhead.
Deliver the right care for the right person at the right time while eliminating unnecessary delays, cost, friction, and inefficiencies.
Key capabilities of MedeAnalytics quality performance solutions.
Key capabilities of the MedeAnalytics utilization management solution.
- Predict utilization risk and associated cost impact, surfacing high-value intervention opportunities
- Automate prior authorization workflows using AI-driven and rules-based decisioning to reduce processing costs
- Improve compliance with embedded, evidence-based decision support while minimizing unnecessary services
- Unify clinical, claims, and authorization data into a complete, real-time view of utilization and cost
- Reduce provider abrasion by simplifying processes and accelerating authorizations and lowering friction-related costs
- Track performance, utilization trends, and cost outcomes to continuously optimize programs and improve margins
Modernize your utilization management program to reduce costs and improve outcomes.
With MedeAnalytics, you can deliver faster decisions, reduce unnecessary utilization, and lower administrative burden—while improving provider experience, optimizing cost of care, and expanding access for members.
Learn more about how your analytics can drive action
Drive improved care quality and outcomes for your members
With today’s heightened focus on care quality, equity, affordability and member satisfaction, health plans are seeking visibility into plan and network performance to improve member care and outcomes. MedeAnalytics Quality Insights helps payers assess member risk and utilization and quality of care opportunities through HEDIS® and other quality standards. Learn more
Shaping health outcomes with social risk insights
Members/patients experience the majority of their life outside of healthcare settings. If you are collecting and analyzing data only for the time they are under your supervision, you’re missing out on any socio-economic factors that could be impactful in making decisions about care pathways. Instead, get ahead of the curve by integrating clinical, claims and SDOH data to assess social risk and improve patient care costs and quality. Learn more
How to use analytics to succeed under value-based care
Pressures and pain points have accelerated the transition from fee-for-service to value-based care. Despite the ultimate benefits, moving to a value-driven system can be challenging for healthcare organizations, so we've built a strategic guide to help payers and providers along the way. In this ebook, you'll learn the top 5 ways to leverage analytics for a successful journey to value-based care. Learn more
