Most patients never see utilization management (UM) in action. It is how health plans and providers work together to confirm that care is safe, necessary, covered, and based on clinical evidence. It also helps patients receive the right care at the right time while also reducing unnecessary costs. Often in UM, the challenge in making timely decisions is a lack of connected data.
This is one area in healthcare where there is broad agreement on what improvement should look like: secure, real-time exchange of accurate clinical information between providers and payers. When that happens, decisions can be made faster and with continued rates of high confidence and accuracy.
We are seeing this firsthand through Elevance Health’s Health OS interoperability platform and its integration with health systems through electronic health record connections such as Epic Payer Platform.
The results are meaningful.
Two common examples are inpatient concurrent review (IPCR), which takes place while a patient is in the hospital, and electronic prior authorization for medical services, which happens before certain treatments begin.
With ICPR, among the health systems connected through Health OS, prior authorization denials caused by missing information have dropped by 61%. Cases delayed because additional information was needed have fallen by nearly 60%. Follow-up reviews that interrupt clinicians’ workdays, including appeals and peer-to-peer discussions, have declined by as much as 51%.
These improvements also save time. Health systems are gaining an average of 15 minutes per case because fewer reviews require a second round of work.
A similar pattern is showing up in electronic prior authorization for medical services through this Health OS connection.
During the first four months of 2026, this collaborative approach processed more than 250,000 electronic prior authorization requests for medical services. Of these, a large proportion of decisions were completed in one minute or less. That means clinicians and patients avoid unnecessary waiting before the process even begins.
The lesson from both IPCR and electronic prior authorizations is clear: when the right information is available at the start, decisions happen faster and with less friction.
In many cases, the issue is not the decision itself. It is the work required to gather and exchange information before the decision can be made. When that work is built into connected infrastructure that organizations already use, delays begin to disappear.
Providers experience these changes in practical ways every day. Case managers no longer need to rebuild information that already exists in the electronic health record. Clinicians can spend less time checking authorization status and more time caring for patients.
These may seem like small improvements in isolation, but across a hospital unit or an entire health system, they add up quickly. More importantly, they return one of healthcare’s most valuable resources: clinical attention.
Patients and families feel the difference as well. Care transitions move faster. Appropriate treatment decisions arrive sooner.
UM will always involve difficult questions about what care is medically necessary, safe, and covered. Those are important discussions, and they deserve thoughtful answers. But the administrative friction surrounding those decisions does not have to remain.
Every minute removed from the back-and-forth between health plans and providers is a minute returned to patient care.
Ashok Chennuru serves as chief data & digital transformation officer at Elevance Health
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