Will Technology Change the Future of Utilization Management?

It better!  When the first Personal Digital Assistants (PDA) hit the market, the promise of greater efficiency was met by the reality of poor integration.  The same could be said about the introduction of evidence-based medicine solutions into the healthcare system.  The current method of enforcing evidence-based medicine through utilization management (UM) is generally inefficient because it does not fit well into existing workflows.  Much like the people who carried 4 devices to maintain all their PDA connectivity; now providers have to integrate UM into their practice management software and provide information in different ways for different health plans through different portals.

The good news for the PDA is that now nearly all of those useful devices have been integrated into one sleek device that can fit in a shirt pocket and synchronize with a desktop, tablet, or laptop with a push of a button or automatically for those with Apple’s iCloud.  The future of utilization management must be the same, integrated.  Well, maybe not with Apple’s iCloud, but on a cloud-based system enabling seamless access to healthcare data and bringing evidence-based medicine together with patient medical records, insurance information, and other real-time resources all available in the examination room with a patient and physician.

Utilization management of the future is fully integrated into the provider’s workflow.  The interface is a tablet or PDA that uses a camera to scan a patient’s insurance card.  This launches an app that displays the patient’s eligibility and a notification of any authorization requirements.  As the provider enters the decision-making process for a procedure requiring authorization, the app presents a focused set of questions, while pulling existing history from the patient’s EMR.  All of the provided and existing data are matched against the most up-to-date evidence-based criteria.

If the procedure is appropriate, the app instantly notifies the provider and sends an authorization to the health insurance claims system.  If the criteria are not met, the app will notify the provider that the procedure is not appropriate and offer a peer-to-peer discussion with an expert in the particular field of medicine.  This peer-to-peer conversation can take place as easily as an iPhone FaceTime or Skype chat, where a medical director will appear to discuss the case in real-time on a tablet, PDA, or other telepresence device.

Putting the tools of evidence-based medicine into the hands of the physician at the point of service with a patient, fully integrated with the medical and insurance records of the patient, is the most efficient means of providing appropriate quality care.  Moreover, integrating this tool into the physician workflow provides a feed of data, which multiplied by hundreds of thousands of interactions, begins to build a real-time means of creating and evolving evidence-based criteria.

CareCore National is poised to meet this future state with a robust cloud-based computing capability and advancements in data integration, mobile applications, and tele-presence.  This, coupled with nationally renowned evidence-based medicine, brings us closer to the reality of a fully integrated utilization management solution that provides physicians with the most comprehensive decision support and patients with the most appropriate quality care.

2 thoughts on “Will Technology Change the Future of Utilization Management?

  1. Hand held access to the latest trends in clinical care and a patient’s care history at the same time will enable the provision of a much higher level of care on the front lines.

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