The Power of Technical Alignment in Overcoming Value-Based Care Challenges

Minneapolis, MN – [November 6, 2024] – The healthcare industry is evolving rapidly, with new challenges emerging around value-based care (VBC) models, particularly when it comes to managing prior authorizations, improving patient outcomes, and reducing administrative burdens. As highlighted in the recent white paper, The Case for Technical Alignment: How Combining CM, UM & FHIR® Solves Critical Prior Authorization, Interoperability, and VBC Challenges, the integration of care management (CM) and utilization management (UM) is critical to overcoming these hurdles.

This white paper, which features insights from Itiliti Health and VirtualHealth, explores how aligning CM and UM, empowered by FHIR® interoperability, can drive efficiencies, optimize patient care, and improve provider-payer collaboration. You can read the full white paper here.

The Case for Aligning CM and UM

Aligning CM and UM programs with VBC objectives leads to significant improvements in care delivery, operational efficiencies, and healthcare outcomes. By closely integrating these programs, healthcare organizations can better coordinate care, automate prior authorizations, and reduce redundancies, ultimately ensuring patients receive the right care at the right time.

As highlighted in the white paper, inefficiencies in prior authorizations are a crucial barrier to delivering timely care. It was reported that 89% of physicians believe prior authorizations negatively impact clinical outcomes, and 30% of these authorizations are for procedures that don’t even require approval. By aligning CM and UM, organizations can streamline these processes, reduce errors, and focus on what matters most—delivering quality patient care.

The Role of FHIR® Technology in Driving Alignment

A critical element in aligning CM and UM is leveraging FHIR® (Fast Healthcare Interoperability Resources) technology. FHIR® enables seamless data exchange between CM and UM systems, allowing healthcare teams to access real-time, accurate information across platforms. Itiliti Health, in partnership with VirtualHealth, is leading the way in using FHIR® technology to optimize prior authorization processes and improve overall interoperability.


Through this integration, payers can achieve measurable outcomes, including:

  • 30% reduction in prior authorization submissions
  • Up to 93% increase in care team efficiency
  • 80% faster bi-directional data delivery

Itiliti Health’s solutions automate prior authorizations and ensure compliance with the latest CMS regulations, allowing organizations to stay ahead of evolving healthcare policies.

 

The Future of Value-Based Care

The future of healthcare lies in the integration of technology with patient-centered care. As healthcare organizations face new regulatory requirements and rising patient expectations, aligning CM and UM functions is more important than ever. The partnership between Itiliti Health and VirtualHealth offers healthcare payers an innovative and comprehensive solution that addresses these challenges head-on.

To explore how this alignment can benefit your organization, read the full white paper here.

 

Itiliti Health: Leading the Future of Healthcare Automation

At Itiliti Health, we are committed to simplifying and streamlining the prior authorization process through intelligent automation. Our advanced platform reduces administrative costs, minimizes care delays, and enhances overall patient and provider satisfaction. By automating the prior authorization process, we help healthcare organizations achieve operational efficiency and ensure that members receive the care they need without unnecessary barriers.

Our solutions are designed to address the most pressing challenges in healthcare today, including the high administrative burden and lack of interoperability that often impede clinical outcomes. By partnering with VirtualHealth and leveraging FHIR® technology, we empower healthcare payers to align their CM and UM functions more closely with VBC goals.

Learn more about how Itiliti Health’s automation solutions can help your organization streamline prior authorization processes.