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Utilization Management

ChallengeA priority of every case management intervention is to support the patient, making sure they are getting the best care and support over a continuum of time to achieve positive clinical out-comes. UM interventions help ensure patients receive the “right care at the right time” to improve clinical outcomes and lower costs. However, this effort comes at a high cost to Payers forced to balance the cost of UM and the best ap-proach to staffing and/or outsourcing.

These costs are broken down into sever-al factors:• Costs of UM staff including Review-

ers, Physician Advisors and UM Pro-gram Managers

• Costs associated with prioritization of discharge planning, pre-certifi-cation and clinical case appeals

• Managing processes such as De-mand Management, Utilization Review, Case Management and Dis-ease Management

SolutionThe key to reducing operational costs associated with UM personnel organi-zations, is identifying and improving the efficiency of potential bottlenecks and work activities.

WorkiQ provides the detailed opera-tional intelligence and workforce ana-lytics needed to improve productivity.

WorkiQ Workforce Analytics identifies the following in real-time:• Average units of work and average

time to complete specific process-es. This helps to identify poten-tial bottlenecks and productivity drains.

• Processes and work steps that can be eliminated or automated to im-prove throughput and accuracy.

• Categories of work and utilization management staff productivity. This enables UM managers to per-form “in the moment coaching” and balanced work allocation.

BenefitsThe WorkiQ solution provides event-based intelligence to quickly lower the overall costs of operations.

Benefits include:• Compare “true” employee produc-

tivity by taking into account the mix and complexity of the work they handle

• View most frequently utilized ap-plications and websites in real-time

• Identify productive activities and time spent by associates in these activities

• Compare all UM staff on multiple types of productivity and work items

• Evaluate UM staff utilization• Improve your employee engage-

ment and accountability• Automate desktop activities or

augment the user as they perform their job function

WorkiQ® makes it easy to understand and visualize employee performance. It enables the organization to go beyond simple statistics and self-reporting, cre-ating actionable insights that drive real improvements within your business.

AboutThe WorkiQ® solutions drive produc-tivity improvements throughout your workforce. WorkiQ® Workforce Analyt-ics provides visibility across the organi-zation of what, how much, and how ef-

fective employees complete their work. Only WorkiQ® provides the visibility to know exactly what work is being done, how it is actually being done, and the quantitative measures required to im-prove workforce productivity.

Solution Brief - Health Plans

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