Smart Utilization Management: Beyond The Friction—What's Next

50 health plan executives reveal why legacy UM is failing—and their roadmap for transformation

Utilization management was meant to ensure medically necessary, cost-effective care. Instead, it's become a source of friction, regulatory scrutiny, and public backlash.

In this report, health plan leaders reveal:

• Why over half believe legacy UM policies are among the leading causes of member and provider abrasion
• How AI agents can automate 70% of cases and slash administrative costs 
• Why the shift from "sick care" to proactive risk management is finally possible
• 5 barriers holding back UM transformation today
• The technology roadmap that turns UM from liability into strategic advantage

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