Otter Health provides real-time visibility into provider performance against the standard of care, helping to eliminate prior auth while controlling risk and restoring the payer-provider-patient relationship.
Explore Partnership
Monitor real-time provider performance to safely enable PA relief, protecting against utilization spikes.
Manage medical spend beyond the limited scope of PA to address a broader set of low-value activities.
Gain visibility into complete utilization and quality patterns to support network tiering and contract negotiations.
Automate the real-time surveillance of utilization, allowing Medical Directors to redirect effort to higher-impact and more collaborative clinical interventions.
Identify and prevent upstream inappropriate decisions that lead to a costly cascade of additional, low-value services.
Work with Payers to eliminate frictions by participating in PA relief models that re-create the joy of practice and enhance patient satisfaction.
Gain decision-level insight into appropriate specialist and facility utilization for episodic and other advanced payment models, before they become costly patterns.
Automate and reduce payment denials for high-friction areas like Admission status, Level of Care, Length of Stay extensions, and discharge decisions.
Alleviate the heavy administrative workload on UM teams and case managers, allowing resources to focus on patient flow rather than paperwork.
Monitor real-time provider performance to safely enable PA relief, protecting against utilization spikes.
Manage medical spend beyond the limited scope of PA to address a broader set of low-value activities.
Gain visibility into complete utilization and quality patterns to support network tiering and contract negotiations.
Automate the real-time surveillance of utilization, allowing Medical Directors to redirect effort to higher-impact and more collaborative clinical interventions.
Identify and prevent upstream inappropriate decisions that lead to a costly cascade of additional, low-value services.
Work with Payers to eliminate frictions by participating in PA relief models that re-create the joy of practice and enhance patient satisfaction.
Gain decision-level insight into appropriate specialist and facility utilization for episodic and other advanced payment models, before they become costly patterns.
Automate and reduce payment denials for high-friction areas like Admission status, Level of Care, Length of Stay extensions, and discharge decisions.
Alleviate the heavy administrative workload on UM teams and case managers, allowing resources to focus on patient flow rather than paperwork.
Effectively manage the network without hard UM models like prior auth, keeping clinical decision-making between providers and patients
Otter's platform is designed to impactfully engage providers on clinical improvement and higher value care, not inundate them with paperwork
Moving away from hard UM tactics, like prior auth, introduce opacity in actual performance. Medical Directors and providers can’t see how they are performing or why, undermining trust and muting the behavioral incentives that make collaborative models work. The result: uncertainty, anxiety, and inconsistent access to salient data.
Otter Health creates real-time, full visibility into concordance logic, evidence references, and aggregate performance—building confidence in the delivery of appropriate care across clinicians and UM teams.
The heavy economics and general burden of Prior Auth have traditionally limited the scope of assessed performance to only those low volume, high cost services that have the highest acute impact on cost. Meanwhile, 60% of low value spend is typically not subject to Prior Auth.
Otter Health expands the lens of utilization management across all low-value care. This not only impacts higher volume and lower unit cost services, but also limits the costly care cascades that inevitably result from those services and can be >100x the cost of the original action.
Fear of utilization spikes often leads payers to over-constrain or retract prior auth relief or provider-led programs. This ultimately stems from lack of discrete and comprehensive evaluation of services against the evidentiary standard, done in a timely manner to allow for a more dynamic program that applies cost guard rails
Otter Health combines real-time monitoring and evidence-based controls that immediately quantify utilization impacts, giving those exposed to financial risk the confidence to sustain and expand successful collaborative UM programs and shift away from prior auth.
Moving away from hard UM tactics, like prior auth, introduce opacity in actual performance. Medical Directors and providers can’t see how they are performing or why, undermining trust and muting the behavioral incentives that make collaborative models work. The result: uncertainty, anxiety, and inconsistent access to salient data.
The heavy economics and general burden of Prior Auth have traditionally limited the scope of assessed performance to only those low volume, high cost services that have the highest acute impact on cost. Meanwhile, 60% of low value spend is typically not subject to Prior Auth.
Fear of utilization spikes often leads payers to over-constrain or retract prior auth relief or provider-led programs. This ultimately stems from lack of discrete and comprehensive evaluation of services against the evidentiary standard, done in a timely manner to allow for a more dynamic program that applies cost guard rails
Otter Health creates real-time, full visibility into concordance logic, evidence references, and aggregate performance—building confidence in the delivery of appropriate care across clinicians and UM teams.
Otter Health expands the lens of utilization management across all low-value care. This not only impacts higher volume and lower unit cost services, but also limits the costly care cascades that inevitably result from those services and can be >100x the cost of the original action.
Otter Health combines real-time monitoring and evidence-based controls that immediately quantify utilization impacts, giving those exposed to financial risk the confidence to sustain and expand successful collaborative UM programs and shift away from prior auth.