At the Evive 2026 Conference, the panel discussion eventually turned to one of the most fraught topics in behavioral health: utilization management. The question was straightforward: How should treatment centers rethink UR to reduce denials and improve length of stay stability without compromising ethics?
Greg Keilin from Prosperity Behavioral Health’s response revealed a philosophy that goes against what many treatment centers practice: radical realism with payers.
The Credibility Currency
Greg laid out a principle that might make some treatment center operators uncomfortable: You don’t actually want to fight for every single day for every single patient.
“We have a lot of people who come to us and say we want every day that you can possibly get for every patient, we want to take everything to peer review, we want max, max, max, max,” he explained. The Prosperity feedback to that approach? You’ll actually get way farther over time by being strategic and thinking about the business for the long term.
Here’s why: The same case managers review your requests over and over again. These aren’t faceless bureaucrats – they’re human beings who recognize patterns and people. They detect credibility. And credibility matters.
The Long Game
The Prosperity approach is to build a foundation of realism. When someone is genuinely ready to step down to a lower level of care, step them down. Don’t fight it. Don’t take it to peer review just to squeeze out another day or two.
This creates something valuable: trust. When you really need those extra days – when it’s genuinely clinically justified, when your team has real passion behind the need for continued care – that’s when you can lean on the relationship.
“I don’t BS you, I’m real with you,” is the message this approach sends to case managers. “When someone’s ready to step down, I’m ready to step them down with you. But this guy? I’m telling you, our team is really committed to this.”
That’s when case managers, being human beings who appreciate working with reasonable people, are more likely to approve those extensions.
The Foundation: Better Documentation
Of course, none of this relationship strategy matters if your clinical documentation doesn’t support the level of care you’re requesting. Prosperity’s approach starts with the unglamorous work of chart audits and feedback on charting quality.
They’ve even implemented technology that audits charts and identifies deficiencies in real-time. This serves two purposes: It gives the UR team the information they need to make the strongest case for each level of care and extension request. And critically, it means claims won’t get denied on the back end because the chart didn’t meet required criteria.
“The best way to have strong payer relationships, including utilization management, is to provide good care and to document that care appropriately,” Greg emphasized. It’s the bedrock of everything else.
Data Powers Payer Conversations
Ryan, the panelist with private equity and investment banking experience, reinforced how crucial this data becomes in payer negotiations. “That data when it comes to payer negotiations… is so valuable when either going to approach a payer for a commercial in-network contract.”
He explained that it’s no longer the days of going to an insurance company and simply saying you have good data. “You have to show over a period of time what you’ve done, how it’s improved, and most importantly, how that is going to save the insurers money.”
This data is also critical on the clinical side for utilization review and getting extended authorizations. “If you’re able to take that patient data, go to the insurance company and say, hey, we need another week… we show that if we stay 35 days on average, we have better outcomes than programs that have 25 day stays.”
The Ethics Question
The original question specifically mentioned “without compromising ethics.” It’s worth noting that the panel’s approach doesn’t compromise ethics – it actually elevates them.
Fighting for every day regardless of clinical necessity isn’t ethical. It’s not good for patients. It’s not good for the industry’s reputation. And as the panelists pointed out, it’s not even good for your business in the long run.
The ethical approach is the strategic approach: Honest assessment of what each patient needs, realistic communication with payers, and fierce advocacy when it’s truly warranted.
The Uncomfortable Truth
Here’s what makes this approach uncomfortable for some operators: It requires leaving money on the table in the short term. There will be patients you could have potentially kept another few days. There will be peer reviews you could have requested. There will be authorizations you could have fought harder for.
But by not doing those things when they’re not clinically necessary, you’re making a deposit in the credibility bank. And when you really need to make a withdrawal – when you have a patient who genuinely needs extended care – that credibility will be there.
The treatment centers that play games with UR might win individual battles. But they’re losing the war. Case managers compare notes. Payers track patterns. Reputations get established.
What This Means Practically
For treatment center operators, the panel’s insights suggest some concrete steps:
Invest in clinical documentation. Not just for compliance, but for building the evidentiary foundation that supports your UR requests.
Train your team on realistic assessment. Clinical staff need to understand that good UR isn’t about maximizing days – it’s about matching patients to the appropriate level of care.
Build relationships with case managers. Remember you’re dealing with human beings who appreciate honesty and directness.
Be willing to step patients down when appropriate. This isn’t leaving money on the table – it’s building credibility for when you really need it.
Track your patterns. Are you taking too many cases to peer review? Are your authorization rates low? These might signal that your approach needs recalibration.
The Bottom Line
When panelists talk about having “soul” in your business – about making decisions based on mission and connection rather than short-term optimization – this is exactly what they mean.
The utilization management game isn’t about maximizing today. It’s about building sustainable relationships with payers that allow you to advocate effectively for patients who genuinely need care, while maintaining the financial stability that allows you to continue operating.
That’s not just good ethics. It’s good business.
