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Points of Light 2023 Case Study 5
Streamlining Utilization Review by Sharing Real-Time Clinical Data
Author
Boyd Stewart
Author
Aurene Wilford
A lack of interoperability was preventing the collaborators in this case study from being able to have a shared, comprehensive clinical view of a patient’s health status, resulting in preemptive claims denials and administrative churn. By implementing a shared utilization review platform backed by AI and predictive analytics, they were able to reduce manual work and improve efficiency for both sides. While gaining buy-in was initially a hurdle, the project’s outcomes have proven its value.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Elizabeth Pew
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.