Clinical intelligence to re-imagine how performance is measured and managed

Otter Health provides real-time visibility into provider performance against the standard of care, helping to rethink UM, while controlling risk and restoring the payer-provider-patient relationship.

For Risk-Bearing Provider Groups

Manage Real Time, Clinical Standard of Care:

Instead of risk-adjusted, claims-based outlier analyses, manage providers on clinically-precise and real-time performance on evidentiary standards.

Enhance UM efficiency:

Relieve coarse and friction-laden UM approaches that add inefficient admin, allowing teams to redirect effort to higher-impact and more collaborative clinical interventions.

Stop the "Cascade of Care":

Identify and prevent upstream inappropriate services and referrals that lead to a costly cascade of costly, low-value care.

For Health Systems

Standardize Quality and Clinical Variation:

Use evidence-based pathway adherence to drive quality improvement and clinician development tied to clinical and financial performance

Succeed Across VBC Models:

Precision management of inappropriate utilization across the continuum for lower cost outcomes in commercial risk and CMS models

Collaborate with Payers on UM Relief:

Alleviate the heavy administrative workload on UM teams and case managers, allowing resources to focus on patient flow rather than paperwork.

For Payers

PA relief through collaborative UM:

Monitor real-time performance to safely transition to provider-led UM, while protecting against utilization spikes.

Expand UM impact without abrasion:

Manage medical spend beyond the current limited scope to address the broadest set of low-value activities.

Enhance network strategy:

Gain visibility into complete utilization and quality patterns to support network tiering and contract negotiations.

The Problem

Managing low-value healthcare utilization relies on inefficient and misaligned systems.

But simply removing controls leads to unmanaged spend...

Otter Health empowers a collaborative UM approach that controls risk:

Real-time visibility into evidence-based practice

Accountability through behavioral design

Custom Learning and Feedback Opportunities

Solutions for a UM approach that is more comprehensive, effective, and removes today's frictions

The Opacity Problem

Moving away from hard UM tactics introduces opacity in actual performance. Medical Directors and providers can’t see how they are performing or why, undermining trust and muting the behavioral incentives that make collaborative models work. The result: uncertainty, anxiety, and inconsistent access to salient data.

Our Transparency Solution

Otter Health creates real-time, full visibility into concordance logic, evidence references, and aggregate performance—building confidence in the delivery of appropriate care across clinicians and UM teams.

The Narrow Scope Problem

The heavy economics and general burden of current UM models have traditionally limited the scope of assessed performance to only those low volume, high cost services that have the highest acute impact on cost. Meanwhile, 60% of low value spend is typically not subject to those hard controls.

Our scope expansion solution

Otter Health expands the lens of utilization management across all low-value care. This not only impacts higher volume and lower unit cost services, but also limits the costly care cascades that inevitably result from those services and can be >100x the cost of the original action.

The Cost Anxiety Problem

Fear of utilization spikes often leads payers to over-constrain or retract UM relief or provider-led programs. This ultimately stems from lack of discrete and comprehensive evaluation of services against the evidentiary standard, done in a timely manner to allow for a more dynamic program that applies cost guard rails

Our cost confidence solution

Otter Health combines real-time monitoring and evidence-based controls that immediately quantify utilization impacts, giving those exposed to financial risk the confidence to sustain and expand successful collaborative UM programs and shift away from high friction models.