Take Control of UM with Data-Driven Insights

Control unlocks agility and agility is the new currency of UM 

Delegated UM models once offered scale, but today they often slow down operational adaptation. Payers lack direct influence over decision logic, policy interpretation, and workflow tuning. 

Insourcing, or a well-structured hybrid model, allows payers to:

• Adjust routing and criteria in near real-time

• Respond faster to regulatory feedback and audits 

• Maintain oversight of medical policy, analytics, and governance 

• Improve consistency and transparency across decisions 

A delegated vendor can support capacity but control must live inside the plan to achieve speed and accuracy without added risk. 

The right metrics aren’t individual KPIs, they’re KPI constellations 

Health plans typically track time, cost, and quality separately. Lydia cautions that this creates tradeoffs and tunnel vision.

Modern UM requires evaluating performance as a balanced system, not isolated targets: 

• Faster TAT cannot come at the expense of quality 

• Reduced cost cannot degrade provider experience 

• Higher accuracy must not create operational bottlenecks 

With AI now enabling automation, the longstanding “pick two” dilemma is fading, but only if plans monitor all three domains in coordination. 

Abrasion isn’t caused by turnaround time, it’s caused by effort 

This is one of the most important insights in the interview. 

Providers feel friction through: 

• Repeated handoffs 

• Inconsistent requirements 

• Back-and-forth documentation cycles 

• Multiple portals and system navigation 

• Poor visibility into status 

Reducing the number of clicks, steps, and exceptions matters more than shaving a day off TAT. Effort reduction is the new abrasion metric and one that payers can meaningfully influence. 

One portal, intelligent routing, and clear visibility reduce multi-portal chaos 

With delegated vendors, plans often force providers to navigate multiple submission systems. Lydia stresses that payers must hide the complexity behind the scenes. 

Provider centric UM design includes: 

• A single front door (one portal) 

• Intelligent routing behind the scenes 

• Consistent submission requirements 

• Realtime or near real-time status visibility 

• Integration where possible (EHR, APIs, single sign-on) 

The result: fewer delays, fewer errors, and a measurable reduction in provider frustration. 

Stay tuned for Part 2 and Part 3, where Lydia Turner dives deeper into how clinical expertise, technology, and modern medical policy design are reshaping the future of UM.