Beyond traditional UM: Embracing the power of advanced technology

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Beyond traditional UM
Embracing the power of advanced
technology

EXL’s report outlines how advanced technology and AI solutions are reshaping <br> utilization management for improved efficiency and better patient outcomes.

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Revolutionize utilization management with AI-driven solutions

Utilization management (UM) is at a crossroads, with outdated systems struggling to meet the demands of today’s dynamic healthcare environment. The inefficiencies of traditional approaches not only burden organizations but also hinder patient care. However, cutting-edge AI-driven solutions are transforming how UM operates—streamlining processes, reducing costs, and enabling better outcomes for all stakeholders. In this report, discover how your organization can harness these innovations to drive meaningful change and stay ahead in an increasingly competitive industry.

Why Modernize UM?

The traditional approaches to utilization management are no longer meeting today’s healthcare demands.

  • Over 30% of Medicare procedures require prior authorization, creating significant administrative burden.
  • Ineffective UM practices have led to patient care delays, rising operational costs, and public dissatisfaction.
  • Recent regulations, including Medicare Advantage reforms, push for advanced, technology-driven solutions.
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Forward-thinking leaders are
adopting GenAI at scale

A recent Forrester study cited by EXL shows three-quarters of healthcare <br> leaders consider GenAI a high priority, with 68% planning increased <br> investment in the next two years.

A new approach

The Role of Advanced AI in Reimagining UM

AI and generative AI (GenAI) are transforming UM into more efficient, data-driven, and patient-centered operations. In the report, discover how AI-driven solutions can help with every step of UM, including:

Front-office support

Automated data extraction and streamlined prior authorization requests reduce bottlenecks and administrative costs.

Clinical review

AI-powered decision support ensures accuracy, consistency, and quicker determinations.

Audits & compliance

Real-time, AI-assisted audits optimize compliance standards and enhance oversight without additional costs.

Strategic Steps for Healthcare Leaders

Payers must focus on these areas to alleviate the pressures of ineffective UM systems while leveraging advanced technology.

01
<p><strong>Assess Your Baseline:</strong> Identify inefficiencies in current processes, denial rates, and provider satisfaction metrics to establish a performance baseline.</p>
02
<p><strong>Leverage Data-Driven Decision-Making:</strong> Use AI and advanced analytics to unlock insights from unstructured data and optimize decisions that align with medical necessity and cost-management goals.&nbsp;</p>
03
<p><strong>Create a Modernization Strategy:</strong> Implement CMS-aligned API strategies, automate workflows, and deploy education programs for providers to improve compliance and efficiency.&nbsp;</p>
04
<p><strong>Continuous Monitoring and Optimization:</strong> Use AI-assisted audits and regular reviews to refine UM policies, reduce friction, and deliver better patient outcomes.</p>
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EXL is helping healthcare leaders
transform UM with evidence-based
insights and cutting-edge AI solutions

Download the white paper for a closer look at how to modernize UM and align with <br> industry best practices for better results.

Read the white paper

Download white paper

Ready to transform your utilization management process?

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