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Analysis of utilization management data

At Devoted Health, we’re committed to driving excellent health outcomes for all our members, regardless of social risk factors such as low income.

To this end, we have conducted an analysis examining key utilization management metrics for calendar year 2024, comparing groups of Devoted Health members based on 2 proxy measures for low income:

  • Members enrolled in a Dual-Eligible Special Needs Plan (DSNP) versus those enrolled in a non-DSNP
  • Members with Low-Income Subsidy (LIS) versus those who do not have LIS

This analysis found no notable differences between these groups of members based on the social risk factors of DSNP enrollment and LIS status. 

For transparency, a summary of the data is included below and a machine-readable file is available for download. 

Standard approvals

  • DSNP standard approval rate is 1.1 percentage points higher than the non-DSNP rate (DSNP 74.0%; non-DSNP 72.9%)
  • LIS standard approval rate is 0.3 percentage points higher than the non-LIS rate (LIS 73.3%; non-LIS 73.0%)

Expedited approvals

  • DSNP expedited approval rate is 1.5 percentage points lower than the non-DSNP rate (DSNP 7.0%; non-DSNP 8.5%) 
  • LIS expedited approval rate is 0.2 percentage points lower than the non-LIS rate (LIS 8.1%; non-LIS 8.3%)

Standard denials

  • DSNP standard denial rate is 0.4 percentage points higher than the non-DSNP rate (DSNP 18.2%; non-DSNP 17.8%)
  • LIS standard denial rate is 0.3 percentage points higher than the non-LIS rate (LIS 18.0%; non-LIS 17.7%)

Expedited denials

  • DSNP expedited denial rate is 0.07 percentage points higher than the non-DSNP rate (DSNP 0.84%; non-DSNP 0.77%)
  • LIS expedited denial rate is 0.12 percentage points higher than the non-LIS rate (LIS 0.86%; non-LIS 0.74%)

Requests approved after appeal 

  • DSNP post-appeal approval rate is 0.02 percentage points higher than the non-DSNP rate (DSNP 0.41%; non-DSNP 0.39%)
  • LIS post-appeal approval rate is 0.03 percentage points higher than the non-LIS rate (LIS 0.41%; non-LIS 0.38%)

Standard turnaround times

  • DSNP average standard turnaround time is 0.7 days longer than the non-DSNP time (DSNP 3.5 days; non-DSNP 2.8 days)
  • LIS average standard turnaround time is 0.4 days longer than the non-LIS time (LIS 3.2 days; non-LIS 2.8 days)

Expedited turnaround times

  • DSNP average expedited turnaround time is 0.7 days longer than the non-DSNP time (DSNP 0.3 days; non-DSNP 0.3 days)
  • LIS average expedited turnaround time is 0.1 days longer than the non-LIS time (LIS 0.4 days; non-LIS 0.3 days)

Extension requests
We received a total of 4 extension requests. We approved:

  • 0 out of 1 requests for DSNP members and 1 out of 3 requests for non-DSNP members
  • 1 out of 2 requests for LIS members and 0 out of 2 requests for non-LIS members