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.
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.
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.
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.
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.
Similar to preauthorization, pre-certification involves obtaining verification from insurers before delivering specific services. It ensures that proposed interventions meet established criteria.
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.
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.
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.
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.
Utilization Review (UR) evaluates the necessity and appropriateness of healthcare services, ensuring they align with standards and patient needs. It includes two main processes:
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.
Conducted after care is complete, this review examines medical records to assess appropriateness and efficiency, identifying areas for improvement in future care delivery.
UR ensures quality care while avoiding unnecessary interventions, and maintaining a balance between comprehensive care and cost control.
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.
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.
RPM and UM work hand in hand to optimize care delivery. Here’s how:
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.
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.
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