Health Plans

Cut costs and improve experiences by going all-in on prior authorization transformation

By Vimbai Mudimu, Kara Chung, and Andrew Borenstein

Nov. 7, 2023 | Interactive | 10-minute read


In the high-stakes game of healthcare, advanced analytics are the ace payers need to transform their utilization management (UM) programs. Data-led insights inform efforts to optimize prior authorization (PA) programs, helping maintain appropriate medical spend and minimize administrative spend. Without making a significant and concerted effort to advance their use of data, health plans risk playing a losing hand. Perpetually inefficient and ineffective PA rules significantly limit their medical loss ratio opportunities.


UM is poised for transformation:

  • Approximately 80% of PA volume has no return on investment for payers.
  • Nearly 40% of procedure codes are approved 100% of the time.
  • PA processing cost payers $305 million in 2019, $202 million of which was related to manual processes.

This interactive infographic can help you gauge your PA program’s maturity to build a winning hand.

For more information on ZS’s advanced analytics-based recommendation engine, download our brochure here. To learn more about the impact of a transformed prior authorization program and how ZS can help, reach out to our experts to book a meeting.

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