Case Study

Reinventing Utilization Management (UM) to Bring Value to the Point of Care

Reinventing Utilization Management (UM) to Bring Value to the Point of Care

How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models). Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world might appear impossible; however, as providers take on greater accountability for cost, and share more risk with payers, there is a real urgency for change. The good news: the technological capabilities needed t

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