Transforming Utilization Management to Deliver $12.4M in Annualized Revenue

Full Case Study
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23 Members

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EMR EPIC

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4 Hospitals

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Kansas City, KS

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86%

Prediction Accuracy on

First Prediction

9.2%

Reduction in
OBS rates

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9%

Increase in Monthly
Patient Upgrades

The Challenge

Facing ineciencies in their Utilization
Management (UM) processes, this health system
embarked on a transformative journey to
streamline workows, 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.

Inecient Workows

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

I just want to comment on how much we’ve seen the status predictions improve. They’ve come a long way from the beginning and are really pretty good.

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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Enhanced 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.

Increased Revenue Opportunities

  • More Status Conversions: 9% monthly increase in patient upgrades, directly boosting revenue.
  • Corrected Missed IPO Opportunities: Identified and corrected IPO procedures, generating an estimated $800,000 annualized revenue
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Substantial Financial Impact

  • $12.4M Annualized Impact: Achieved with just a 50% priority review rate, showcasing the potential for even greater returns.

The Iodine Solution

Utilization Management

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

Learn More

Talk with an Expert

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