R1 Launches Phare UM to Enhance Real-Time Payer Risk Management

CHICAGO, Sept. 16, 2026 /CourierPR/ -- R1, the leader in healthcare revenue management, has expanded its Phare Operating System (Phare OS) with the launch of Phare Utilization Management (Phare UM). This new AI-powered solution aims to transform utilization management from a retrospective review process to a proactive, real-time clinical and financial decision-making function.

Phare UM is designed to help health systems make faster, more consistent, and more defensible decisions throughout the patient stay. Unlike traditional utilization management processes, which focus limited resources on a small subset of admissions, Phare UM continuously evaluates every patient encounter from admission through discharge. This helps teams apply clinical judgment while identifying payer risk, thereby preventing medical necessity denials.

The solution is built on Phare OS and integrates AI-driven clinical intelligence, predictive payer-risk insights, and intelligent workflows. It continuously reviews 100% of cases from admission through discharge, surfacing payer-specific risk and documentation gaps within a utilization management team’s existing workflow. This reduces the need for manual chart review and allows teams to focus their expertise where it can have the greatest impact.

According to Joe Flanagan, CEO of R1, "Healthcare organizations have too many critical decisions occurring in disconnected workflows across the patient and financial journey. Our vision for Phare OS is to create the industry's most intelligent and integrated pre-bill architecture, connecting the revenue cycle through a shared foundation of clinical, financial, and operational intelligence. Phare UM brings that vision to life in utilization management by helping organizations reduce friction, spot risk sooner, close documentation gaps earlier, and reduce avoidable medical necessity denials."

Phare UM extends the Phare OS pre-bill architecture by grounding its evaluations in clinical judgment, informed by reimbursement risk. It layers payer-specific risk through Payer Atlas and calibrates recommendations to each health system's clinical policies, payer mix, and denial tolerance. This enables utilization management teams to see which cases need attention first, rather than working through a queue in admission order. By combining clinical and denial-likelihood signals, Phare UM surfaces risk that clinical criteria alone may not catch.

The solution connects the utilization management process across the patient stay, ensuring relevant context carries forward across review, escalation, care team input, and downstream denials. This reduces disconnected workflows and uses outcomes to inform future decisions, helping teams build a stronger payer-facing rationale while reducing the cost-to-collect.

Phare UM pairs AI-enabled signals and insights with clinical human expertise to surface cases where escalation or intervention may be needed. Utilization management teams receive prioritized worklists and evidence-based recommendations, gaining visibility into cases most likely to warrant escalation. This keeps human judgment at the center of every decision.

The Guthrie Clinic is among the first health systems adopting Phare UM to align utilization decisions with clinical necessity, strengthening utilization management and proactively reducing avoidable denials. In a sample assessment for one customer, Phare UM found that approximately 65% of observation encounters should have been billed as inpatient status, demonstrating opportunities to reduce revenue leakage, improve status accuracy, and reimbursement performance.

Drs. Jennifer Weinberg, Vice President of Physician Advisory Solutions at R1, stated, "Our physician advisors are already using Phare UM in active case reviews and peer-to-peer workflows, and the early feedback is positive. By surfacing the right clinical and payer insights at the right time, Phare UM helps clinicians spend less time gathering information and more time making complex statusing decisions."