Transforming Utilization Management to Deliver $12.4M in Annualized Revenue

Full Case Study
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27K Admissions

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EMR EPIC

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Academic Medical Center

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86%

Accurate Patient

Status Prediction

9.2%

Reduction in
OBS rates

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9%

Increase in Monthly
Patient Upgrades

The Challenge

Facing inefficiencies in their Utilization
Management (UM) processes, this health system
embarked on a transformative journey to
streamline workflows, improve accuracy, and
maximize revenue. Historically operating under a
dyad model, where case managers also handled
utilization reviews, the team struggled with
competing priorities, complex payer
requirements, and time-consuming manual
processes. Additional more common challenges
that they were looking to overcome.

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Limited Staff & Resources

Restricted the number of case reviews possible.

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Complex Payer Requirements

Ever-changing and varied rules caused delays and denials.

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Poor Payer Communication

Resulted in incomplete patient stories and denied claims.

Inefficient Workflows

Time wasted on unnecessary reviews and difficulty compiling documentation for medical necessity.

We love Iodine- AwareUM. You have great people and great products.

Absolutely amazing! The chart summary is off-the-charts amazing. It’s almost like I had a doctor dictate the note.

Key Outcomes

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Driving Outcomes with Operational Efficiency

  • Triad Model Success: Nurses now focus 100% on utilization reviews, eliminating competing priorities.
  • Faster Reviews: AwareUM reduced review times from 15-20 minutes to just 5-7 minutes per case.
  • Lower OBS Rates: Achieved a 9.2% reduction (from 13.3% to 11.7%) since going live in May 2023.

Revenue Growth

  • Boost Status Conversions: Realized a 9% monthly increase in patient status upgrades, unlocking additional reimbursement.
  • Capture Missed IPO Revenue: Identified and corrected IPO procedures, generating an estimated $800,000 annualized revenue.
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Substantial Financial Impact

  • Achieve $12.4M in Annualized Impact: Achieved with just a 50% priority review rate, revealing substantial opportunity for scale.

The Iodine Solution

Utilization Management

AwareUM helps UM teams get reimbursed for the right level of care.

Learn More

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