Solutions / Utilization Management

Utilization Management

Utilization management (UM) is frequently a painful process for all involved. Providers, patients and payers all feel the impact of UM requirements that are designed to ensure that patients receive appropriate, necessary, and cost-effective care by reviewing and managing the use of medical services and resources but frequently create delays and frustration. Sobah Systems executives have managed UM processes from end to end, leveraging technology to provide data analysis, real-time monitoring, and automated decision support, to create a more efficient, accurate and responsive UM process. Our experience has shown that an advanced approach facilitates better communication between providers and payers, streamlines the authorization processes, and enhances overall patient satisfaction.

Healthcare

Common Challenges

  • 1

    Integrating diverse data sources and systems to provide a comprehensive view of patient care and resource utilization.

  • 2

    Navigating complex and changing regulatory & payer requirements to ensure compliance in utilization review processes.

  • 3

    Managing the administrative burden and ensuring adequate staffing to handle utilization management tasks effectively.

  • 4

    Engaging healthcare providers in the utilization management process and ensuring their adherence to guidelines and protocols.

  • 5

    Balancing cost control measures with the need to maintain high levels of patient satisfaction and quality of care.

Our Projects

Utilization Management
Home Health / Hospice
Machine Learning & Analytics
Automation

This case study shows our skill in automating UM processes, stakeholder satisfaction and efficiency.

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Our Projects

Hospitals
Value Based Organizations
Other Industries
Automation

This case study shows our skill in modernizing VISTA for smaller hospitals, enhancing user experience and efficiency

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Our Projects

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