Physician-led utilization management powered by evidence-first clinical intelligence

Otter Health provides rapid, decision-level analysis of physician adherence to Standard of Care. This enables no-touch utilization monitoring for risk-bearing entities and powers hard UM relief models for providers and patients. A win win win.

The Standard of Care (SoC) Engine:

Every physician decision is automatically analyzed against gold-standard evidence.

01

Standard of Care Concordance classification for every clinical decision

02

Transparent explanations with targeted clinical references

03

Missing data detection to identify gaps in clinical records

Standard of Care Concordance Classification

Services are deemed concordant with gold-standard evidence or not and documentation missing crucial data is flagged.

Transparent clinical rationales

Clear explanations provide the basis of evidence concordance decisions supported by targeted references

Automated missing data flagging

Missing data detection to identify gaps in clinical records

Payer/Provider Performance Dashboard

Visibility that drives accountability

For Payers

Hospital, group, physician, and code-level performance visibility.

Identify patterns of low-value care as soon as they appear, both within and beyond the scope of traditional UM controls.

For Providers

Crystal-clear view of SoC performance and feedback.

Analysis rationale and transparency

Appeal and feedback mechanisms for bi-directional accountability

Intelligent Notification System

Timely, Actionable Engagement

The right message, to the right place, at the right time.

Multi-channel alerts keep providers and payers informed when performance slips or action is needed.

Performance Improvement Tools

Evidence-Based Behavior Change

Accountability without support doesn't work. Deliver targeted, panel-specific continuing medical education and motivate improvement with validated behavioral science strategies

Targeted evidence and clinical references

Panel-specific CME modules

Peer comparison analytics