The U.S. healthcare utilization management industry is projected to reach $9.5 billion by 2028, but the industry will see some developments. (Source; Market Research.com, National Association of Insurance Commissioners). These include the heightened role of data, increased emphasis on patient engagement, and a greater focus on value-based care, which has long been a focus of healthcare. It is important for healthcare providers and case management firms offering utilization management to understand these developments and how best to leverage them.
The Application of Data
As one of the largest compilers of data, healthcare institutions are in the position to use and analyze data to benefit patients, their quality of care and provide improved utilization management. Applying data analytics, providers and case managers can uncover healthcare patterns to identify the most appropriate, best quality of care and most cost-effective care for individual patients, and support population health management goals. Regarding population health management, utilization management will assume an increasingly more significant role in identifying patients and/or population groups that are at the highest risk for certain medical conditions; many of which are chronic. By identifying what groups of people are most likely to develop a chronic illness in advance, preventive healthcare measures can be implemented to mitigate this risk.
Within the context of data analytics, Artificial Intelligence (AI) will be prominent in its ability to analyze large quantities of data, as well as in identifying patterns and trends, and supporting more informed decision making related to patient care which will ultimately advance better patient outcomes.
Better Patient Engagement
Through effective utilization management, better patient engagement can be achieved. Providers and patients alike can be supported through greater access to better quality of healthcare data, more education through written information, educational videos, and online media about their specific medical condition and prescribed treatment plan. In addition, patients can be given access to patient portals where these resources can also be found and where they can access online chats and post any questions. This, in turn, can empower patients to become more proactive in their own healthcare, while supporting providers through the presence of more engaged and informed patients. Providers can also work directly with patients in the preparation of personalized treatment plans that reflect their individual needs and preferences.
Value-Based Healthcare
Over the past decade, value-based healthcare has been a primary goal of providers. Today, however, there are more advanced technologies to help them achieve that goal. Working in conjunction with utilization management providers, these technologies can deliver a real-time exchange of information between providers and patients. Additionally, hospitals and physicians can apply various technologies such as telehealth platforms and remote patient monitoring systems to keep track of how their patients are doing, and whether they are adhering to their treatment plans. Based on the information derived, they can intervene and provide the support required by their patients.
Healthcare utilization in 2024 and beyond will continue to evolve and, in doing so, become a more significant tool in our nation’s healthcare system’s quest to deliver the highest quality of patient-centered care that also supports important fiscal objectives.