Reclaiming Utilization Management: Intelligent Insourcing in the Era of CMS Reform

Health plans have long faced challenges in achieving full transparency within delegated utilization management (UM) arrangements. Poor communication, operational complexities, and limited data access have created gaps in understanding and confidence. To meet rising regulatory expectations while preserving clinical integrity and provider trust, plans must move beyond incremental automation and toward intelligent insourcing: operating models that combine technology-enabled workflows, scalable operational oversight, clinical rigor, and clear accountability.

In this webinar, UM leaders from Sagility and Availity will share how forward-looking health plans are modernizing prior authorization by redesigning UM systems for better decisions, seamless interoperability, and regulatory resilience.

Participants will learn how to translate modernization from a strategic aspiration into an operational reality — aligning people, process, and technology to reduce friction, minimize manual review, and strengthen clinical governance under evolving CMS requirements.

You’ll Gain Practical Guidance to:

• Assess current UM operating models and identify gaps and requirements to insource robust UM programs that address care quality while reducing medical costs and operational costs
• Segment authorization work intelligently, aligning automation, clinical review, and escalation paths to decision complexity
• Design scalable governance and oversight structures that support compliance, audit readiness, and consistent clinical judgment
• Strengthen provider trust while improving turnaround times and decision transparency