Patients with complex medical conditions often face top healthcare expenditures yet experience the highest frequencies of suboptimal care. Due to fragmented and siloed care journeys, patients are not improving as efficiently and effectively as they could which often leads to negative downstream effects for all parties—payers, providers, and patients.

Utilization management (UM) is the first step in managing complex conditions, so patients receive the care they deserve at the right time and place in their care journey. With a rapidly evolving healthcare ecosystem, more and more payers are partnering with leading UM programs to guide their patients and providers along the most clinically appropriate care path. Here’s what outsourcing your UM can do for your organization.

Improve Patient Outcomes

Patients are at the center of what we do, and their clinical outcomes are impacted the decisions made by payers and providers. By partnering with a market-leading, clinically driven UM program, patients will receive clinically appropriate care and appropriate site of care determinations that drive optimal health outcomes.

Heightened Clinical Guidelines

Determining whether a procedure is medically necessary requires thorough insight into both the patient’s history and knowledge of clinical best practices. By outsourcing UM, health plans unlock access to a new level of evidence-based criteria which ensures patients experience high-quality and medically appropriate care.

TurningPoint’s difference starts with our clinical leadership team that guides the quality and effectiveness of patient care. Our market-leading clinical experts include former presidents of the American Academy of Orthopedic Surgeons (AAOS), former presidents of the American Board of Orthopedic Surgery, former presidents of the American College of Cardiology (ACC), and more. Our clinical experts are world-renowned clinicians who will work with your networks to promote clinical best practices. Outsourcing UM to a clinically established and trusted UM partner is a crucial step in providing patients with the care they deserve.

Guaranteed Cost Savings

Integrating UM into your workflow is a key driver in cost savings. With deeper clinical knowledge, offered by reputable and trusted clinical guidelines, payers can reduce low-value care, promote value-based care, and save money. But what if your UM partner not only offers cost savings as a potential benefit but can guarantee cost savings.

TurningPoint, as a fully-integrated complex condition management platform, has a proven track record of significantly reducing PMPM costs for health plans. TurningPoint bears financial risk and guarantees cost savings across a diverse set of clinical categories, including musculoskeletal (MSK) care. With clear line items, the allocated savings can be assigned to other items and investments.

Top-Notch Provider Support

Provider education and support are essential to promoting value-based care. When providers have a clear understanding of clinical guidelines and best practices, they’re able to connect patients to the right clinical pathway without fear of denial.

TurningPoint provides clinical guideline education, ongoing clinical webinars, access to our team of clinicians for surgical consultation, ad hoc support, and more. If providers want to connect with our team, they will always speak with a specialist in their field, opposed to a generalist, which allows for a clinically effective conversation and a high level of respect. This is proven through our high provider satisfaction scores.

Reduced Administrative Burden

Leaning on UM support from an outside vendor can be a scary thought. But outsourcing UM can dramatically lower the administrative burden and organizational complexity in-house. With fewer administrative complications and tasks, plans can reduce costs, increase employee satisfaction, and focus on new and inventive ways to support their members.

To learn more about TurningPoint’s suite of services, contact us today.

‍