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When it comes to utilization management (UM) and utilization review (UR), complexity reigns supreme. Hospitals face rapidly changing clinical data, payor requirements, and the need to justify every admission status decision. Pieces Technologies has stepped in with an innovative Utilization Management Assistant—a solution designed to streamline case reviews, reduce administrative strain, and optimize financial outcomes. 

A New Era 

Instead of juggling multiple EMR screens, manual checklists, and repetitive documentation, the Pieces Utilization Management Assistant brings everything together in one intuitive interface. By embedding seamlessly into existing EMR workflows, our suite offers a consolidated view of each patient’s labs, vitals, consult notes, and more, empowering reviewers to make accurate Observation vs. Inpatient determinations in a fraction of the time. Orchestrate more accurate, efficient reviews that are intelligently tuned with the health system’s financial engine and quality of care teams.

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Key Highlights

• Centralized Data
  With critical patient information unified in a single location. Utilization Management teams spend less time looking for the relevant data that is tucked away in multiple areas of the EMR. Less clicks and a single place means less friction and more time to make the medical necessity determination.
• Built for Accuracy and Speed
  The solution aligns patient-specific data with inpatient medical necessity criteria, aiding teams to make fast and accurate determinations. Our approach aims to minimize avoidable denials and shorten the time required to make medical necessity determinations, this provides benefits that extend to both care teams and patients.
• Seamless Integration and Intelligent Orchestration
  Reviewers never have to leave their EMR workflows to access the Pieces Utilization Management Summary. The backend of the Pieces system is able to bring the patient context and all the data points (structured and unstructured) to the forefront. The product complements legacy third party, UM/UR software systems that do not unify and contextualize the thousands of pages and flow sheets that a single patient record contains. 

Why Pieces

Relevant data in one place

Side-by-side comparison of medical necessity guidelines

Faster level of care determination

Minimize appeals and denials

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‍The Results

Early data from a pilot at a large Academic Medical Center demonstrates an opportunity to convert 24% of Observation cases to Inpatient level of care, in approximately 2,000 cases.  Moreover, Pieces Utilization Management Assistant flagged these cases an average of 5 hours (median of 3) after the patient was admitted to Observation, which is significant for the downstream care and authorization process. The product creates an actionable report for the reviewer at the earliest entry point – right when a bed request is made in the Emergency Department. That’s a meaningful demonstration of how comprehensive, real-time insights help the Utilization Management reviewers ensure the right status from day one, improving care coordination and cost management.

Envisioning the Future of Patient Care

Imagine a world where decisions about level-of-care assignment happens swiftly—no frantic rummaging through scattered imaging, vital flow sheets, no missed details on labs or consult requests, and fewer back-and-forths with payors. With the Pieces Utilization Management Assistant, hospitals easily transition patients from observation to inpatient, when warranted, manage concurrent or extension requests, address denials, and support challenging peer-to-peer appeals.

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Better utilization management leads to tighter collaboration among clinical, financial, and administrative teams. As hospitals navigate heightened regulatory challenges and tighter margins, implementing a robust Utilization Management solution can make all the difference in patient outcomes and financial stability.

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Ready to Learn More?

If you’re curious about how Pieces Technologies’ Utilization Management Assistant can transform your hospital’s workflows, contact us. Embrace the power of consolidated data, accurate decision-making, and streamlined processes in healthcare technology—and see what’s possible when your teams have the clarity they need from the start.