Executive Summary
Effective utilization management is essential for maintaining quality of care while ensuring cost efficiency and compliance. PPi’s Utilization Management module redefines this process by fully integrating with other core components of the PPi platform—Care Planning, Clinical Management, Transportation, and DME (Durable Medical Equipment) to create a seamless, automated workflow.
This comprehensive and configurable solution allows care teams to authorize services, manage resources, and ensure that every participant receives the right care at the right time—without administrative bottlenecks.
Introduction
Healthcare organizations often rely on disjointed systems to manage utilization, authorizations, and provider coordination. This fragmentation creates unnecessary delays, increases the potential for errors, and makes it harder for teams to track performance across services.
PPi’s Utilization Management module solves these challenges by centralizing all UM processes within a single, unified platform. Designed for Program of All-Inclusive Care for the Elderly (PACE) and other care models, it combines automation, integration, and flexibility to deliver a truly end-to-end solution.
Core Capabilities
1. Integrated Care Management
PPi’s UM module works hand-in-hand with the Care Management module, allowing users to assess, review, manage, and authorize services all in one place. This integration ensures that clinical support and utilization oversight occur seamlessly across the care continuum.
2. Transportation Integration
Transportation is often a hidden driver of care costs and participant satisfaction. PPi’s module integrates directly with its custom Transportation system, authorizing services whether they are provided by internal fleets, external providers, or contracted services—ensuring accurate billing and resource allocation.
3. DME Integration
Managing Durable Medical Equipment (DME) can be complex. PPi simplifies this process by integrating UM with its DME module, enabling flexible options such as rent-to-own, short-term rentals, and inventory tracking—all tied directly to participant authorizations.
4. MD Order Integration
Primary Care Providers (PCPs) can create and manage MD Orders directly within PPi, ensuring correct propagation of services and authorizations to both internal and external providers. This reduces communication gaps and improves clinical accuracy.
5. Flexible Utilization Recurrence
PPi offers unmatched flexibility in scheduling and recurrence management. The system supports multi-shift, split-shift, one-time, alternating-week, and monthly service patterns—adapting to the real-world variability of participant needs.
6. Automated Management
Manual intervention is minimized through automation. PPi automatically handles suspensions, restarts, one-time changes, and service stops based on participant events such as hospitalizations or status changes—reducing administrative workload and potential errors.
7. Clinical Interface Integration
PPi’s UM module integrates seamlessly with InterQual, a leading clinical decision support tool. This ensures evidence-based utilization review and enhances compliance with regulatory standards while supporting better clinical outcomes.
Comprehensive Reporting and Insights
All utilization data flows into PPi’s reporting suite, giving leaders full visibility into authorization trends, service usage, and provider performance. These insights empower proactive decision-making and help organizations stay ahead of compliance audits.
Conclusion
PPi’s Utilization Management module is more than a tool—it’s a strategic advantage. By connecting every component of care authorization and management into one platform, PPi eliminates silos, reduces manual effort, and strengthens operational efficiency.
With integrated workflows, intelligent automation, and comprehensive analytics, organizations can focus less on administration and more on what matters most: delivering high-quality, person-centered care.
