Case Study: a large national payer improves UM efficiency with Tegria's new care management platform

New Care Management Platform Increases Efficiency, Reduces Cost of UM

A large national payer based in the Midwestern U.S. faced a challenge with its costly and inefficient utilization management (UM) systems. Its legacy platforms and manual processes were difficult to maintain and scale for its 50 million members, leading to long turnaround times. The organization engaged Tegria to overhaul its UM support systems to reduce costs and increase efficiency.

Tegria implemented a multi-pronged solution, which included customizing a CRM platform, developing a new care management application, and integrating a clinical decision support tool. Tegria also led a transition to Agile development methodologies. The results included the successful deployment of the new application to new business units, improved visibility into KPIs, and increased operational efficiency.