Your Simplified Outsourced Utilization Management Solution
ClearPath Benefits
Proven ROI Results 1.5:1 – 3:1
The Smarter Way to Optimize Utilization Management
Comprehensive Clinical Expertise
Leverage MRIoA’s expert clinical panel, including 35+ MDs, 100+ nurses, and 100+ pharmacists across all 50 states, plus 700+ MDs in 150+ specialties on our panel
Scalable and Flexible Clinical Outsourcing
ClearPath’s robust network of clinical resources is designed to handle all procedure categories
Expanded and Flexible Service Offerings
Tailor the solution to your needs with flexible, modular services that can seamlessly integrate into your current operations, maximizing value and efficiency
Proven ROI – Achieve a 1.5:1 – 3:1 Return on Investment
Streamlined Prior Authorization (PA) Management
ClearPath reduces the average PA list up to 20%, ensuring a leaner
and more efficient process while eliminating unnecessary PAs
Improved Operational Efficiency
By eliminating inefficiencies and redundancies, ClearPath
helps health plans and at-risk providers reduce administrative
overhead while ensuring compliance with clinical standards
Optimized Healthcare Utilization
ClearPath ensures appropriate care delivery through precise,
rules-based clinical guidelines, helping to manage costs
effectively while maintaining high-quality standards
How We Do It – MRIoA Capabilities
1. Intake from
provider (Client UM Platform)
2.Transfer PA into MRIoA platform or work in client UM platform
3. Clinical Review
High Cost Specialty RX
Gold Card
PA Optimization
Virtual Second Opinion
4. MRIoA Clinical Platform
- MRIoA Clinician places clinical decision back in client UM platform
- MRIoA utilizes client letter templates to communicate determination digitally to member/provider, and client sends hard copy
Case Study – Our Results from a Regional Blues Plan
A leading Blues Plan partnered with MRIoA to address compliance issues and TAT challenges caused by clinical resource shortages and inefficient utilization management processes. These issues led to increased auto-approvals, unnecessary medical expenses, and jeopardized URAC accreditation.
- Case volume of 700/day
- MRIoA’s clinical staff combined with reporting and quality audits demonstrate a more consistent application of guidelines resulting in ~$2M lower medical costs
- Optimized the PA list and generated $4 million in annual medical expense savings by removing procedures that did not benefit from PA and adding procedures that could significantly impact overall medical expenses
- MRIoA supplied nurses and medical director clinical reviewers with appropriate licensure and specialties to meet complex multi-state and multi-line of business requirements
- By implementing appropriate staffing, MRIoA increased TAT compliance from 17% to 95%. Additionally, administrative approvals were reduced from 32% to 7%, ensuring appropriate care and delivering $32M in savings for the plan. This allowed to obtain URAC accreditation status once again
- MedEx and Administrative savings combined to lower the payors medical claims by ~$38M annually, resulting in an ROI of 2.4:1
Resources
Why Delay?
Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.
