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.
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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.
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.