Case Study: Regional One Health reduces observation rate and boosts utilization review efficiency with Optum Case Advisor

Regional One amplifies utilization review effectiveness with Optum Case Advisor

Regional One Health, a 337‑bed teaching hospital in Memphis, turned to Optum and its Optum Case Advisor after its utilization review (UR) team was overwhelmed—staff routinely worked 10‑hour days digging through multiple documents, relying on subjective first‑level criteria, and losing revenue on inconsistent patient‑status decisions. They needed an objective, efficient way to prioritize reviews, reduce manual work and improve payer conversations.

Optum implemented Case Advisor’s AI‑driven case stratification, continuous scoring, NLP data extraction and access to physician‑advisor support, which let UR staff prioritize gray cases, make status decisions earlier and reduce manual review time. Within six months Regional One saw a 14% decrease in observation rate, improved overturns on inpatient denial peer‑to‑peer reviews (winning the first three cases for one payer), faster turnaround with Optum remote PAs, and the ability to manage workload without adding staff.

Regional One Health

Sandra McClairen

Director of Inpatient Access Services