Articles
Concurrent Review Bottlenecks: How Administrative Burdens Hurt Outcomes
For health plans navigating value-based care, the concurrent review process is essential to utilization management - making sure members receive appropriate care during their stays in skilled nursing facilities (SNFs) and other post-acute settings. Yet, for all its importance, concurrent review often falls victim to administrative bottlenecks, slowing down care, draining staff resources, and ultimately harming both outcomes and member satisfaction. This article examines the roots and impact of these bottlenecks, and explores how the new generation of care coordination technologies are modernizing workflows, streamlining communication, and helping health plans reclaim efficiency and quality.
August 20, 2025
The Role and Challenge of Concurrent Review
Concurrent review is a real-time process that requires health plans to:
- Ensure care is medically necessary at the right level of care
- Communicate effectively with providers
- Authorize continued stay or transition of care without delays
But, as regulatory requirements multiply and the healthcare ecosystem grows more complex, concurrent review too often devolves into a paperwork-heavy operation. Health plan nurses and utilization management staff are swamped by:
- Chasing incomplete or inconsistent documentation
- Parsing lengthy, unstructured provider records
- Filling gaps via phone, fax, or email - often with multiple providers at once
- Tracking deadlines to avoid compliance risk and ensure proper reimbursements
Administrative Burdens: Where Bottlenecks Happen
Fragmented Workflows and Documentation Silos
Health plans receive clinical updates and documentation from multiple facilities, each with its own record-keeping systems. There’s rarely a clear, consistent path for sharing information, so documentation must be compiled, extracted, and reformatted before a review can even begin. Any missing data can stall the entire process, causing delays in authorizations and discharge planning.
Manual Communications and Missed Opportunities
Much of the communication between SNFs and health plans still happens via email, fax, or even phone calls. This manual “ping-pong” drains staff time, increases the risk of missed details, and creates unhealthy inertia when quick action is needed for a change in status, escalation of care, or safe discharge.
Staff Burnout and Resource Drain
These administrative tasks leave less time for health plan employees to focus on clinically meaningful work. The mounting documentation requirements heighten stress, lead to staff burnout, and limit the bandwidth needed for proactive care management or complex case escalation.
How Bottlenecks Impact Outcomes
Administrative bottlenecks don’t just slow things down; they can directly harm:
- Length of Stay and Cost: Delays in concurrent reviews mean members might stay longer in higher-acuity settings than medically necessary, increasing costs and exposure to complications. Payers may be financially liable for payment for untimely reviews.
- Readmission Risk: Inconsistent or late documentation can disrupt coordinated discharge planning, increasing the likelihood of preventable hospital returns.
- Compliance and Denials: Gaps in communication increase the risk of denied days/payments or regulatory non-compliance, putting additional strain on health plans and providers.
- Member Satisfaction: Slow transitions, uncertainty about coverage, and inconsistent care experiences lead to dissatisfied members and downstream retention challenges.
The Solution for Concurrent Review Bottlenecks
Forward-thinking health plans are discovering that streamlining the concurrent review process is not just about protecting the bottom line - it’s about driving better health outcomes. Modern care coordination platforms unite all stakeholders - health plans, SNFs, home health, hospitals, and more - into a centralized, secure environment. Health plans can:
- Centralized Documentation: Providers upload patient information in a standardized way, making it instantly visible and actionable for health plan reviewers.
- Enable Real-Time Coordination: Secure messaging, alerts, and updates replace phone tag and fax delays, ensuring everyone has immediate access to the latest status and needs.
- Create a Repeatable Review Process: Structured workflows guide both providers and health plans, ensuring nothing falls through the cracks, compliance risk is reduced, and timelines are met.
- Foster Proactive Care Management: By tracking cases across the care continuum, health plans gain the actionable insights needed to properly intervene, put transitions in motion, and prevent avoidable readmissions.
Looking Ahead: How AI Will Shape the Future of Concurrent Review
The challenges of post-acute care and concurrent review are only intensifying as healthcare evolves and regulatory demands increase. Health plans are seeking smarter approaches to manage documentation, communication, and decision-making—setting the stage for transformative change.
By leveraging AI-powered document summarization to extract and condense key information from complex clinical records, it can:
- Streamline workflows and reduce manual administrative burdens.
- Accelerate authorizations and care transitions, ensuring timely member support.
- Enhance accuracy and consistency, helping to avoid compliance risks and missed details.
- Increase capacity through operational efficiencies
As these powerful capabilities become more integrated into care coordination, health plans and providers can expect greater efficiency and improved health outcomes—making seamless, reliable concurrent review the new standard for the entire care ecosystem.
Contact Olio today to learn more about how we are revolutionizing the concurrent review process.
