Utilization Analytics Dashboards

Care Requests

This dashboards helps utilization managers deliver timely care by identifying care requests that are close to breaching an SLA. Isolate requests that are closest to falling out of bounds, and act to make sure that patients get what they need, when they need it. Dashboard key performance indicators (KPIs) include the current total of care requests, their average age, and the percent that breached SLA. Also get a breakdown by clinical case type of care requests that are close to breaching an SLA. The table at the bottom of the dashboard shows details of each care request. Details include a request’s age, clinical case type, status, and whether it’s breached its SLA.

Care Requests Segmentation

This dashboard visualizes care requests by type. Learn the reasons why requests are denied, and then assign the right resources for timely adjudication of care requests. You can also identify areas with high denial rates to find out why they’re high and then act to remedy the issue.

Learn demand and usage patterns by viewing care request numbers accepted, rejected, and reopened, as well as average days for resolution. Also view a breakdown of requests by type and rejected requests by the reason they were rejected. Scroll down to see details about each care request, including request type, clinical case type, decision reason, status, and days since creation.

Denied Care Requests

Drill into the care request denial and reopen process. You can learn if care requests are denied or reopened at a high rate, which implies members aren’t receiving timely care. Identify process bottlenecks so you can understand the underlying causes of high rates of case denials or reopenings. Then, make process changes to speed up adjudication of care requests so you can render timely care to members.

Analyze care request denials in a single place. You can see the total number of denials versus requests and the number and percent of denied requests that have been reopened. Open Denials, which shows the breakdown of denials by reason, type (newborn, elective, urgent, and so on), and clinical case type. To see the same breakdown for reopened request, click Reopened. The table at the bottom provides details for each request denial. Details include request type, clinical case type, the reason for denial or reopening, date request was opened, and date it was denied or reopened.

Open Care Requests

View care requests by type and clinical case types by age. Also see the average age of all care requests and their minimum and maximum age. Scroll down to see details for each care request, including its type, status, and the date it was opened. Then, prioritize care requests that have been open the longest to ensure that members receive timely care.

Top Care Requests

This dashboard provides key insights into benefits usage, shows the most requested services, and highlights where to assign care resources to high-demand areas. Use the dashboard’s visualizations to analyze benefit usage by viewing care requests by admission category, such as elective, emergency, and newborn, and clinical subtypes. This dashboard opens to a view of requests for admission. Click the other tabs to see service requests and concurrent reviews. KPIs include the number of care requests of the selected type, the number of clinical subtypes, and average age (in days) to resolve. Scroll down to see details about each care request, including its type, admission type, diagnosis, status, date opened, and due date.

Care Request by Provider

View care request volume by provider, including the top providers submitting care requests. You can see the total number of care requests by type, open care requests, denied care requests, and reopened care requests.