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In our recent guide, Outsourcing Utilization Management Reviews, we identified provider and member experience as a defining reason why payers choose and benefit from outsourcing. While scalability and compliance drive operational success, it’s satisfaction and trust that determine long-term retention. 

This deep dive explores how the right utilization management (UM) partner helps payers improve relationships with providers, enhance member satisfaction, and strengthen clinical outcomes. Let’s look at the three experience drivers that most impact performance: provider friction, member delays, and strategic refocus.

Key Takeaways

  • Provider friction erodes network trust. Lengthy or inconsistent UM decisions increase grievances, strain relationships, and threaten provider participation. Outsourcing brings predictable turnaround times and transparent communication.
  • Member delays lower satisfaction and STAR ratings. Faster, evidence-based determinations improve care continuity and reduce complaints.
  • Strategic refocus improves outcomes. By offloading routine reviews, internal clinicians can concentrate on care management, appeals prevention, and quality initiatives.
  • BHM Healthcare Solutions delivers measurable experience gains. Our clinically led model accelerates review cycles, reduces appeals, and supports payers in improving CAHPS and STAR performance.

Provider Friction

Reducing Authorization Pain Points Before They Escalate

Every day of delay in a prior authorization creates tension between payers and providers. Grievances, appeals, and dissatisfaction often stem not from medical necessity disagreements, but from administrative friction.
 
According to the AMA’s 2024 Prior Authorization Survey, 93% of physicians report care delays due to authorization requirements, and 36% say these delays have led to adverse clinical outcomes. These frustrations directly affect payer–provider relationships and increase network instability.
 
The Risk
 
  • Increased grievances and appeals that drive administrative overhead and regulatory scrutiny.
  • Provider attrition or reluctance to join payer networks due to perceived inefficiency.
  • Lower STAR and satisfaction scores tied to provider-reported delays.

Outsourcing advantage

Partnering with a clinically driven UM vendor like BHM Healthcare Solutions reduces friction by streamlining decision timelines and communication. BHM’s board-certified physician reviewers complete determinations quickly, providing clear, evidence-based rationales that reinforce provider confidence and minimize disputes.

Provider Friction FAQs

Q1: How do lengthy utilization management reviews affect provider satisfaction?
Delays in authorization create frustration, disrupt scheduling, and increase the likelihood of grievances or appeals. Consistent turnaround times and transparent communication are key to maintaining provider trust and network stability.
 
Q2: How does BHM Healthcare Solutions help payers strengthen provider relationships through UM outsourcing?
BHM delivers consistent, fast, and clinically defensible determinations. Our transparent processes and dedicated client communication teams help reduce provider friction, improve satisfaction, and protect network integrity.



Member Delays

Turning Timely Determinations Into Trust and Retention

For members, time to care is a direct measure of plan value. Each delay, whether in specialty referrals, behavioral health services, or post-acute care, risks dissatisfaction and poorer outcomes.
 
CMS ties multiple quality metrics and STAR ratings directly to timeliness and access to care. The NCQA 2025 HEDIS Updates continue emphasizing rapid authorization processes and seamless care transitions.
 
The Risk
 
  • Lower CAHPS and STAR ratings reduce bonus eligibility and competitive positioning.  
  • Higher appeal and complaint rates trigger additional compliance oversight.
  • Member churn caused by dissatisfied individuals switching plans due to access frustrations.

Outsourcing advantage

A quality outsourcing partner integrates speed and clinical rigor. BHM’s review teams provide rapid turnaround on authorizations – without sacrificing quality – helping payers reduce complaints, improve STAR performance, and increase member retention.

Member Delays FAQs

Q1: How do faster utilization management decisions improve member satisfaction?
Prompt, evidence-based determinations prevent care delays and reduce member anxiety. Faster authorizations lead to higher satisfaction, better CAHPS scores, and improved plan loyalty.
 
Q2: How does BHM Healthcare Solutions help payers improve CAHPS and STAR ratings through utilization management?
BHM’s efficient, clinically guided workflows reduce member delays and ensure determinations align with quality-of-care standards. This approach supports payers in achieving higher satisfaction scores and maintaining compliance with CMS and NCQA benchmarks.

Strategic Refocus

Empowering Clinical Teams to Deliver Higher-Value Care

Internal clinicians bring immense value but too often that value is spent on repetitive utilization reviews rather than proactive care coordination. Offloading day-to-day UM activity allows teams to redirect expertise toward quality initiatives that directly improve outcomes and member loyalty.
 
Research published in Health Affairs highlights that payers reallocating clinical resources from administrative to care-management roles report up to a 20% increase in quality-of-care metrics and a 15% reduction in avoidable readmissions.
 
The Risk
 
  • Burnout among internal staff from administrative overload.
  • Underutilized expertise that could be improving member outcomes.
  • Stalled innovation in care management and quality improvement.

Outsourcing advantage

By managing the review workload, BHM empowers payer teams to focus on additional high-value administrative functions such as quality measures, predictive analytics, and population health initiatives. This shift strengthens plan performance while enhancing both provider and member satisfaction.

Strategic Refocus FAQs

Q1: Why should payer organizations redirect internal clinicians away from utilization management reviews?
Administrative review tasks limit clinicians’ ability to focus on member engagement and care quality. Redirecting these resources supports population health management, preventive care, and measurable outcomes.
 
Q2: How does partnering with BHM Healthcare Solutions help payers refocus their internal teams?
BHM handles complex, day-to-day UM reviews through an experienced, NCQA-accredited network—freeing payer clinicians to concentrate on strategic initiatives that improve care coordination and member outcomes.



Implementation Blueprint: A Practical Path Forward

A strong provider and member experience is a quality strategy. Payers can strengthen satisfaction and retention with this approach:
 
  • Baseline Measurement: Assess grievance, appeal, and CAHPS data to identify friction points.
  • Process Alignment: Select a UM partner with proven expertise in communication, turnaround, and documentation.
  • Integrated Workflows: Define SLAs around satisfaction KPIs (timeliness, transparency, dispute resolution).
  • Feedback Loops: Conduct joint reviews of provider and member feedback to drive continuous improvement.
  • Expand & Optimize: Scale across lines of business and integrate satisfaction metrics into performance reporting.

 

At BHM Healthcare Solutions, every review is more than a compliance task—it’s an opportunity to strengthen relationships, reduce friction, and improve care experiences. Our UM-accredited, clinically-led UM services help payers maintain operational excellence while building trust that drives lasting member loyalty.

Learn more about outsourcing utilization management & download a free 12 point UM vendor evaluation checklist.

>> Outsourcing Utilization Management Reviews Hub
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Leveraged Expertise You Can Count On

CLIENT SATISFACTION IS OUR TOP PRIORITY

"BHM plays a key role in ensuring that we meet our turnaround time requirements."
Corporate Medical Director
"The medical director services provided seamless transitions and maintained operational stability while meeting our URAC and NCQA quality requirements."
Compliance Director
"BHM made our accreditation process so much easier and saved us a ton of time."
Executive Director
"Working with BHM streamlines our utilization process and keeps us compliant without the stress."
UM Manager
Our increasing reliance on BHM is driven by the exceptional quality of their review services. Their attention to detail, reliability, and consistency help support our operational efficiency. This high standard of service has made BHM a valued partner.
Procurement Leadership
When evaluating our ROI with BHM, we look beyond just the financial impact. Their flexibility in licensure, reliable coverage during gap periods, adept handling of volume surges, quick turnaround times, and reduction of auto-approved cases have all been critical to our success.
Medical Affairs Leadership

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Sources

  1. American Medical Association. 2024 AMA Prior Authorization Survey Results.
    https://www.ama-assn.org/delivering-care/administrative-burden/ama-prior-authorization-survey
  2. Centers for Medicare & Medicaid Services (CMS). CAHPS and STAR Ratings Methodology Overview.
    https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/medicarequalityinitiativesgeninfo/star-ratings
  3. National Committee for Quality Assurance (NCQA). 2025 HEDIS Measurement Year Updates.
    https://www.ncqa.org/hedis/
  4. Health Affairs. Administrative Simplification and Its Impact on Quality Outcomes.
    https://www.healthaffairs.org/

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