Best Utilization Management Software of 2024

Many hospitals, ambulatory surgical centers (ASCs), and health systems face significant procedure documentation challenges. Many physician documentation methods, such as transcription, dictation and EMRs lack standardization, which can lead to non-compliant, inaccurate and incomplete procedure notes. Because they are made with unstructured data, the reports are difficult to search and hard to analyze. Insufficient, tedious workflows can lead to financial loss and frustrate physicians. This intuitive workflow navigation tree guides physicians to make quick documentation selections. Users can run over 100 reports and analyze structured reports to help organizations meet compliance and quality standards. It can be connected directly to endoscopy scopes in order to collect all relevant images, and then add them to procedure notes.

Our AI-driven technology transforms healthcare data from both structured and unstructured into a reliable, high-quality, standard dataset that can be used throughout your organization. It is the industry's best. Our products and services allow you to access data in near real time from disparate systems. This allows your administrative and clinical team to reclaim that time for quality and research. Our products and services can be used to collect, analyze and act on data regardless of its source, therapeutic area, organization department, or existing reporting or BI tools. Atlas combines human expertise with the power of AI to automate the time-consuming task of finding and understanding patient data for clinical registers. Cartographer analyzes, interprets, and interprets patient information across all platforms. He also standardizes the data and makes data recommendations.

Cloud-based software for quality reporting and analytics in home health can help improve organizational performance and validate OASIS information more efficiently. Home health agencies can identify opportunities to improve their star ratings, reduce readmissions and boost referrals. OASIS Intelligence will help you improve the performance of your home health agency. Our cloud-based software can handle everything from organizational performance analysis to accurate, rapid validation of OASIS information. Use the most recent data to identify performance trends, gaps, and drive faster process improvement. Ensure that you are getting the right reimbursement and quality with automated alerts. Our flexible and comprehensive reporting allows you to view everything from monthly trends, condition-specific analyses and patient-level results.

CORTEX, a new category of utilization software, offers a 360deg approach for addressing the intricacies revenue cycle and utilization management. CORTEX is powered by real-time predictive analytics, machine learning engine, and ensures that the right cases get handled at the right moment, by the right staff, or by exception. CORTEX integrates precision medicine on the basis of evidence-based medicine. Machine learning models are able to assess your patient population in real-time. Our analytics have been used in hospitals and health plans across America. CORTEX automates inpatient determinations for cases that meet your specific threshold, providing clear inpatient cases. CORTEX gives your staff the information they need to make a solid determination in difficult cases. This approach is a great value for both payers and providers.

Medius' multicloud artificial intelligence platform can unlock its full potential to provide greater than 90% accuracy and coverage for various health intelligence and risk predictions with just a few variables. Medius' multicloud artificial intelligence platform, which only requires a few health data coordinates, aggregates and mines large datasets to generate all relevant health risk or underwriting insights in seconds. This platform can assist payers and providers with their life and health needs assessments, distribution, cost optimization, and operations efficiency. Medius' UW Studio™, a complete underwriting platform, is the result of an AI revolution that has fundamentally changed the insurance landscape. Multiple science-based underwriting ensembles are used to address both business and technical requirements. They reproduce humanistic deductive reasoning with clinical accuracy.

Privacy-safe DTC segments and HCP segments with a higher audience quality that drive greater lift than conventional targeting approaches. We don't believe that traditional condition-based segments are appropriate for each therapy and brand. When designing custom audiences, we seek to understand your business goals and challenges. We can help you achieve results, whether you are a market-leader, a newcomer facing adherence issues, or planning to implement a multiproduct strategy. We maintain the highest industry standard of performance indicators, as validated by independent third parties. We will meet or surpass your Audience-Quality (AQ) benchmark if you disclose it upfront. A higher AQ leads to greater engagement, optimized conversion, and ultimately increased script lift. It also boosts therapy adherence, and therefore patient lifetime value. We guarantee 100% compliance with all policies, laws and guidelines.

InterQual AutoReview is an AI-based cloud solution for providers that want to use real-time data from their EHR to predict and provide proactive insights for patients, while also automatically completing InterQual medical reviews. InterQual AutoReview reduces administrative burdens by automating InterQual medical review using data from your EHR. InterQual AutoReview increases payer trust by providing accurate, transparent and EHR-embedded medical reviews for each objective InterQual criterion point.

A team of passionate individuals who are dedicated to helping those in recovery has created a solution for behavioral health organizations. We are fortunate to be able to work with some of best recovery and sober living coaches. We provide the digital tools that these programs need to run data driven programs that best serve their clientele. We build software that helps sober living, drug court, recovery coaches, and treatment centers deliver the best programs to clients. Our mission has been and will continue to be to support organizations that dedicate their lives to helping those in recovery. We want to automate all the manual processes involved in running a behavioral healthcare organization. We help you support clients with digital tools and make it easier for your program to run using an all-in one system developed just for your organization. Increase your referrals and revenue.

CareStat, SHP's comprehensive analytics solution for post-acute care, unites acute providers, ACOs and payers with skilled nursing facilities and home health agencies. Our goal is to advance post-acute provider partnership, patient outcomes, operations and utilization. CareStat, in addition to SHP’s proprietary readmission algorithm, uses real-time OASIS data (HHA) or MDS data (SNF) to support patient management throughout the continuum of healthcare. Reduce readmissions, and reduce length of stay. Collaboration and partnership efforts should be intensified. Improve referral patterns and patient satisfaction. Simplify the data transfer for quality and outcome metrics to save time. Your organization understands the importance of actionable insight when it comes to managing trends within a numbers-driven sector. To be successful, your initiatives need the right tools and knowledge.

CaseTrakker's comprehensive care management software is designed to provide your team with the latest information and tools to efficiently manage their members. CaseTrakker’s comprehensive care software includes a collection of tools that will meet all your health management software requirements - from utilization review to care management. Our products offer the tools you need to streamline your core business operations, increase efficiency and improve care management outcomes without compromising results. CaseTrakker Portals offer secure browser-based data access with custom branding. Portals provide a customized experience and collaboration among members, providers, clients and care management staff.

Acuity Advanced Care™ is a population health platform on-premise that supports the specific needs of programs for managing population health, utilization, diseases, and cases. The system is configurable and allows organizations to take full control of their environment. Over 90% of Acuity Advanced's clients are NCQA, URAC or both accredited. Acuity Advanced Care offers the flexibility of on-premise and full database access. On-premise installation allows you to control where your data is stored. Customers with IT teams who are experienced in the setup, security, and maintenance complex systems. Chordline Health, the leading provider of health plan software, TPAs and ACOs as well as other risk-bearing organisations, is the leader in this field. The US-based Chordline team is recognized for its best-in class managed care expertise and excellent customer service.

Our virtual therapy programs and coaching can help you reduce stress, anxiety and depression. On-demand self-care will give you the tools to build resilience and cope better with everyday challenges. You'll learn to control your emotions using tools that are based on evidence. Leading experts in mental healthcare develop customizable and protocol-driven cognitive behavior therapy programs. Predictive analytics identify people who need support and help them engage with marketing campaigns. Our tech platform helps clinicians limit costs by matching members with the treatment that is best suited to their needs. AbleTo's seamless implementation into your health plan’s existing care pathway comes with a guarantee that you will only pay for value.

Connect with people personally and powerfully using the leading digital platform. Increase annual wellness visits above the national average. Icario is an action company that focuses on health, so you pay only for results. Icario uses digital-first omnichannel paths, behavioral science, whole-person data and smart rewards and incentive to help you connect with people. We know what people want, how to connect with them, and what motivates them to act. Healthcare organizations also benefit when people take proactive measures to improve their health. Icario combines our data with yours to create a whole-person database, transforming spreadsheet lines into real, breathing people. Our proprietary behavioral data and quantitative research will help you to move from a clinical to a deeply personal understanding of people. Smart, omnichannel paths match the right messages and outreach to each individual in order to drive the correct health actions.

Specialty and Rare Diseases have undefined patient populations with individuals who may be undiagnosed or incorrectly diagnosed, healthcare providers unaware of disease states, manifestations and treatment journeys. IPM.ai is an Insights-as-a-Service (IaaS) company that empowers the world's leading life sciences brands to better understand and improve the lives of patients through the development, clinical study, and commercialization of therapeutic interventions. Forecast market size, competitive landscape and ROI potential to maximize commercialization efforts. Discover ideal patients who have been misdiagnosed or undiagnosed, and who may be suitable for disease intervention and therapeutic intervention. Model statistically the number of cases of disease present in a specific patient population at any given time. Identify physicians that diagnose and treat ideal patient and influence other healthcare providers.

The SMAF tools are now unified into a single, shareable information system. Calculation of the SMAF profile automatically. Reports that facilitate the analysis of results, and the development of an assistance plan. Simple and easy-to-use by health care professionals. Facilitates networking and service organisation. No need to install software. The iSMAF is the fifth major release of the software. It is a web-based software that automates clinical tools and processes to support the SMAF tool. The iSMAF version for Quebec includes PRISMA-7 and the SMAF Evaluation Grid, as well as the Social-SMAF, Iso-SMAF Profile Generator, and Care Table. It also has several functions that allow clinicians and managers the ability to generate different reports on individual subjects or groups of individuals. It is possible to get a picture of an establishment, the evolution or profiles or one SMAF item over time or compare the distribution of profiles among different subject groups.

We work with aid organizations and government to design open-source, human-centered health information systems. We extract insights that empower African decision-makers, healthcare workers, and patients. We specialize in digital health information systems for African low-resource settings. We concentrate on enterprise software and hardware for facilities. From design, to development, to implementation, to training, to support. In the future, the strategic management of these limited resources will be based on data analysis. We believe robust health systems and the sharing information will advance global health. Strengthening health systems in collaboration with local communities to meet their needs. Investing and developing systems within the reach of low-income nations. We help them build their capacity to support their solutions. We are a non-profit African organization that improves global health through partnerships, information systems and local capacity.

Lightbeam enables population health by transforming insights in outcomes. Close care gaps and minimize risks. Improving the quality of care and the quality of life. Lightbeam's population health management platform transforms disparate patient data into a 360-degree picture of the patient, bringing real value to value-based healthcare. In today's model of value-based healthcare, managing risk starts and ends with data analytics. Lightbeam’s population health management platform combines patient data in new and innovative ways, unlocking value from the deployment of the right data at the right place and time. Lightbeam doesn't just transform the way our clients manage value based care. It has been a game changer for our clients, saving them over 2 billion dollars in savings since 2014, and we're only just getting started. Lightbeam's approach to tech-enabled service seamlessly supports these efforts.

We improve the performance and experience of healthcare facilities around the world, both for their staff and their patients. A solution that optimizes the ambulatory care pathway to give patients peace of mind. LGI eClinibase reduces waiting time and increases patient awareness of the care pathway by disseminating data on each episode. Get data quickly on referrals, waiting lists, and appointment. Lists and summaries for all episodes of care from a clinical administrative system. Management of referrals and appointments for the entire facility. Management of patient communications, appointments and referrals for the entire facility. Automatic suggestions for corrections and duplicate matching. Management of the professional activity agenda (intake management and appointment scheduling, clinical documentation and statistics for MSSS).

Equip your team with software that supports clinical decisions and takes the guesswork out capacity management in the hospital. This evidence-based clinical-decision-support system tool helps you increase bed turnover and improve patient experience. Improve care coordination and satisfaction by leveraging the power of predictive analytics. The hospital bed management software provides care teams with visibility of the patient journey. It also allows bed demand and capacity to be managed across multiple sites in a healthcare system. Software that eliminates clinical subjectivity, standardizes data collection, and empowers your clinicians, nurses, and physicians. Medworxx uses predictive analytics to generate data that anticipates trends and provides healthcare professionals smarter data.

Envolve's valuable partnerships and expertise enable it to drive real healthcare transformation by providing affordable, value-based care solutions. Envolve MSO provides organizations with the strategies and people needed to provide affordable, value-based care and drive real transformation. As a leading provider of healthcare management services, we bring innovation and experience to drive performance for value-based and outcomes-focused reimbursement models. Our healthcare management services enable better healthcare and efficiency through the use of data, clinical excellence and operational support. Envolve has significant experience in designing innovative benefits for numerous products across the country, for both publicly funded and commercial programs.

naviHealth, through our partnerships with providers and health plans, is the future for senior-centered care. Using technology, simplify and improve care transitions. Experts provide news, insights, and analyses to improve the health care experience of seniors. naviHealth provides in-market clinical assistance with proprietary post-acute planning tools that improve patient functional recovery and reduce unnecessary medical expenses. naviHealth's unique patient care management enables our partners and customers to manage care transitions effectively and efficiently. We combine in-market clinical assistance with proprietary technology to guide individuals on their path to recovery, increase patient satisfaction and reduce unnecessary post-acute spending. naviHealth has in-market care coordinators that provide connected support to the patient, their family and their healthcare providers.

We are realizing the vision of whole-person healthcare with an innovative suite and the most interoperable collaboration network. This vision is changing expectations and revolutionizing healthcare. To enable better decision-making, we must first make a commitment to listen, collaborate, and disrupt. This is the core of our vision, and it's why we can achieve powerful results in all care settings. Real-time insights and the largest collaboration network of care in the country will help you decide on the best care options and take action with confidence. Lightweight solutions that streamline workflows to expedite patient care will help you quickly identify the best path forward. Reduce risk, lower cost and accelerate adoption of value-based healthcare with proactive intelligence previously unavailable. Whole person care can be made a reality by incorporating both physical and behavioral experiences.

We offer a wide range of products and solutions created by computer doctors, who elevate the data and tools available online. System that optimizes patient flow while improving productivity, performance and patient experience. Spend more time with your patients and less time on your computer. Reduce absenteeism and presenteeism in your business. Our system allows you make a difference, improve monitoring and promotion of services and to make a real impact. Let us help you care for your older adults. We provide you with the tools necessary to improve your processes' effectiveness and efficiency. We develop and analyze to meet your needs. We are health computer specialists who speak and understand the language of health. It is a platform that allows you to spend less time administering, and more time caring for your patients. Any technological advancement that improves the lives of humans must be shared.

Our integrated platform of end-to-end health plan solutions simplifies healthcare for employers, payers, members, and providers. Valenz combines member-centric services and data-driven insights to provide personalized service and guidance that improves outcomes and ensures high-quality care. We engage early and frequently with results-driven support, education, and services in order to avoid more serious, costly health events. Valenz can help you achieve a healthier population of members while also saving money on the plan and for your members, year after year. Let's get started on your path to better, more efficient healthcare by gaining the tools and transparency that you need to make quality-first, cost-effective decisions. Valenz's healthcare ecosystem optimization platform integrates a range of configurable solutions into a single ecosystem strategy. This allows for extensive visualization of cost and quality opportunities.

A complete hospital management is a one-stop solution for all the workstations in the hospital. We are working towards a paperless system, and we are also focusing on reducing the management effort to maintain all of its work. We have committed to allowing access from any device, keeping in mind the technology trend. The software was designed to reduce the effort of the client, increase their productivity, and provide them with faster, easier and correct results. You only need a browser and internet connection to access the hospital application software. SaaS is accessible from anywhere and on a wide range of devices, making it more accessible than traditional software installations.