Optimizing case management in a changing regulatory landscape
Building sustainable success through informed case management
Health plans face mounting demands, delivering meaningful outcomes while adapting to evolving regulations. The introduction of the One Big Beautiful Bill Act (OBBBA) in July 2025 represents just the latest in a series of significant changes, highlighting the growing administrative complexity around member eligibility and compliance.
There’s growing consensus that current approaches must evolve.
Many organizations are grappling with challenges such as:
- Disconnected data environments impeding care coordination
- Persistent staffing shortages and their impact on member support
- Intensified need for timely, compliant results amid regulatory shifts
Advancing case management for lasting impact
Industry leaders are reimagining case management, emphasizing collaboration between Licensed Clinical Social Workers and Registered Nurses. This interdisciplinary approach prioritizes proactive outreach, ensuring members—particularly those with emerging or complex needs—receive timely, person-centered care.
Beyond regulatory compliance, the focus is shifting to sustainable, measurable improvements in member health and organizational efficiency. The most resilient health plans are those that view each challenge as an opportunity to innovate and refine their processes.
As we move forward, sharing best practices and insights across the industry is essential. By fostering a culture of continuous improvement, health plans can meet regulatory demands and, more importantly, elevate outcomes for every member in their care.
Expert global clinical team support
EXL’s globally distributed clinical staff, including highly skilled US Registered Nurses, provides seamless support throughout the case management process. By handling critical tasks, this model delivers added value and significant time savings, allowing onshore case managers to focus on higher-impact interventions with members
- US registered nurses provide clinical insights for outreach and engagement
- Medication expertise assists with reconciliation and management
- Care coordination handles transportation, scheduling, and DME arrangements
- Clinical documentation delivers screening and summary notes for transitions
EXL holds NCQA accreditation for Complex Case Management and URAC accreditation for Utilization Management, supporting specialized programs including transplant, chronic condition management, behavioral health, and high-risk obstetrics.
Transform your case management operations with EXL's proven AI-enabled approach.