In a year marked by Medicaid policy reform, redetermination waves, and increasing demand for accountability, WNS-HealthHelp continues to deliver strong results for Medicaid health plans. Our clinically rigorous and AI-powered programs ensure members receive the right care at the right time while containing costs and easing provider burden.

This report outlines our impact across Medicaid plans in 2025 showcasing the measurable value of tiered, flexible utilization management.

Key Outcomes YTD

• Average Utilization Reduction across all clients: 21.2%, demonstrating substantial influence in guiding more appropriate care decisions.
• Total Volume Managed: Over 300,000 requests annually validating our ability to handle scale without compromising quality.
• High Auto Resolution Rates: Proactive decisions minimize delays with intelligent workflows are resolving most cases early and keeping costs and denials down.
• Average Escalation Rate: ~27% kept low through early clarity and automation focusing on complex or medically unnecessary requests
• Practicing MD Consultations: Thousands of consultation done annually by leading practicing MDs
• Broad clinical coverage: Medical Oncology, Radiation Oncology, Genetic Testing, Diagnostic Imaging, Musculoskeletal, Pain Management, Physical Medicine, Sleep Management, Cardiology

Health Plan Value

Cost Avoidance at Scale

• Clinical reviews prevent downstream waste while keeping members engaged in appropriate care
• Tiered impact rates ensure each case is matched with the right level of review

Provider-Focused

• Minimal delays thanks to real-time decisions and T1 prioritization
• Transparent documentation and evidence-based guidance reduce abrasion
• True consultation model driving lower denials and appeals while ensuring appropriate treatment for patients

Policy-Aligned Performance

• In sync with CMS goals: fewer denials, fewer delays, more transparency

Summary

Medicaid plans are facing a new era of scrutiny, staffing gaps, and reform. HealthHelp stands ready to support plans with scalable, smart UM solutions that uphold compliance, improve patient care, and reduce total cost of care.