The Power of Utilization Management and RPM

To deliver high-quality, accessible healthcare to all, efficient resource management is essential. Healthcare Utilization Management (UM) has become a strategic framework to ensure the smart use of medical services, control costs, and improve patient outcomes. When paired with Remote Patient Monitoring (RPM), UM becomes even more powerful, enabling healthcare organizations to balance resource optimization, cost containment, and patient-centered care.

As the healthcare industry continues to evolve in 2025, understanding and implementing UM strategies, enhanced by RPM, is critical for organizations aiming to unlock efficiency and achieve better outcomes. At HealthSnap, we’ve seen how this combination transforms care delivery for over 150 partners, including health systems like Prisma Health and UnityPoint Health. Let’s explore the key strategies of UM, the role of RPM, and unique insights to help you stay ahead.

What Is Healthcare Utilization Management?

Healthcare Utilization Management (UM) is a systematic approach to evaluating the necessity, appropriateness, and efficiency of medical services. It ensures resources like hospital beds, tests, and procedures are used wisely, balancing cost control with quality care. UM strategies include preauthorization, pre-certification, case management, and utilization review—each playing a vital role in optimizing healthcare delivery.

Key Strategies in Healthcare Utilization Management

1. Preauthorization: Ensuring Necessity Before Care

What Is Preauthorization?

Preauthorization, or prior authorization, requires healthcare providers to get approval from payers before performing certain services or procedures. It’s a checkpoint to confirm that the proposed care is medically necessary, appropriate, and cost-effective.

Why It Matters

Preauthorization prevents unnecessary treatments, acting as a gatekeeper to control costs. For example, by verifying the need for an expensive imaging test, preauthorization ensures resources are allocated where they’re truly needed, reducing wasteful spending.

HealthSnap Insight

Unlike competitors who focus solely on cost control, we’ve seen preauthorization also improve care coordination when paired with RPM. Real-time data from RPM can provide payers with evidence of medical necessity, streamlining approvals and reducing delays—something niche vendors don’t emphasize.

2. Pre-certification: Strategic Resource Allocation

What Is Pre-certification?

Similar to preauthorization, pre-certification involves obtaining verification from insurers before delivering specific services. It ensures that proposed interventions meet established criteria.

Why It Matters

Pre-certification controls unnecessary utilization, preventing overuse of resources like hospital beds or surgical facilities. This strategic allocation reduces strain on the healthcare system, ensuring capacity for patients who need it most.

HealthSnap Insight

At HealthSnap, we’ve found that pre-certification paired with RPM data can predict resource needs more accurately. For instance, our AI-guided analytics can forecast potential hospital stays, allowing providers to allocate resources proactively.

3. Case Management: Coordinating Complex Care

What Is Case Management?

Case management is a patient-focused approach that involves assessing, planning, coordinating, and evaluating care to meet individual health needs, especially for complex cases with multiple conditions.

Why It Matters

• Holistic Planning: Case managers assess medical, social, and psychological needs to create tailored care plans.
• Better Collaboration: It improves communication among care teams, reducing fragmented care.
• Patient Engagement: Patients are empowered to participate in their care, improving adherence.
• Cost Efficiency: It avoids unnecessary tests or hospitalizations, optimizing resources.

HealthSnap Insight

While some vendors focus on CCM without RPM, HealthSnap integrates case management with RPM for real-time insights. For example, our platform’s 80+ EHR integrations ensure seamless data sharing across specialties, enhancing coordination for complex cases.

4. Utilization Review: Ensuring Quality and Efficiency

What Is Utilization Review?

Utilization Review (UR) evaluates the necessity and appropriateness of healthcare services, ensuring they align with standards and patient needs. It includes two main processes:

Concurrent Utilization Review

This real-time assessment happens during a patient’s treatment or hospital stay. It ensures care aligns with evidence-based guidelines, allowing immediate intervention if issues arise.

Retrospective Utilization Review

Conducted after care is complete, this review examines medical records to assess appropriateness and efficiency, identifying areas for improvement in future care delivery.

Why It Matters

UR ensures quality care while avoiding unnecessary interventions, and maintaining a balance between comprehensive care and cost control.

HealthSnap Insight

HealthSnap’s RPM enhances concurrent UR with cellular-enabled devices that work out of the box. This ensures continuous data flow, enabling real-time adjustments that competitors with BYOD models (like Vivify Health) can’t match as seamlessly.

The Role of Remote Patient Monitoring in Utilization Management

What Is RPM?

Remote Patient Monitoring (RPM) uses digital devices to track patients’ health metrics—like blood pressure, glucose levels, or heart rate—outside traditional clinical settings. It provides near real-time data to healthcare providers, enabling proactive care.

How RPM Enhances UM

RPM and UM work hand in hand to optimize care delivery. Here’s how:

1. Proactive Patient Care - RPM enables continuous monitoring, catching issues early. For example, a patient with heart failure might show subtle weight gain—a sign of fluid retention. RPM alerts providers to intervene before an emergency room visit is needed, reducing utilization.
2. Optimized Resource Use - By preventing ER visits and readmissions, RPM frees up resources. HealthSnap’s data shows a $5,400 annual cost saving per patient for conditions like diabetes and heart failure, a metric competitors like Cadence (rural-focused) don’t emphasize as strongly.
3. Customized Care Plans - RPM provides data for tailored care plans. At HealthSnap, we’ve seen patients with hypertension achieve a 14.4 mmHg average blood pressure drop, thanks to personalized interventions—outcomes that niche players like Rimidi (cardiometabolic-focused) don’t match across broader conditions.
4. Improved Adherence and Outcomes - RPM engages patients with real-time data, boosting adherence. HealthSnap’s programs have achieved 68% blood pressure control rates, a result competitors like 100Plus (smartwatch-focused) don’t highlight as prominently.
5. Advanced Data Analytics - RPM supports predictive analytics for risk stratification. HealthSnap’s AI-driven platform identifies high-risk patients, enabling targeted interventions—something competitors like AccuHealth (lacking CCM) don’t offer as comprehensively.
6. Addressing Health Equity - RPM can reduce disparities by providing care to underserved populations. However, challenges like digital literacy and internet access persist. HealthSnap tackles this with cellular devices (no WiFi needed) and full-service support, ensuring equitable access—unlike competitors like Current Health, which focuses on high-acuity care without the same equity emphasis.

Unique HealthSnap Insight: Scalability for Enterprise Systems

While competitors like CoachCare focus on niche areas (e.g., weight loss), HealthSnap excels in enterprise scalability. Our 80+ EHR integrations (outpacing CareSimple’s 40+) and HITRUST certification make us a trusted partner for large health systems. For example, our work with Tampa General Hospital shows how RPM can scale across 12 hospitals and 200+ outpatient centers, a level of enterprise impact other vendors can’t match.

Achieve Excellence with HealthSnap’s RPM Programs

HealthSnap’s Virtual Care Management Programs elevate UM by combining RPM with CCM and PCM solutions. With 150+ partners, we’ve helped organizations reduce costs, improve outcomes, and generate up to $1.2 million in annual revenue per 1,000 patients. Our platform’s AI-guided insights, cellular devices, and seamless integrations ensure you can deliver proactive, equitable care at scale.

Ready to optimize your UM strategy? Schedule a consultation with HealthSnap to see how we can help. Click here to schedule a consultation.