From Check-the-Box Guidelines to Advanced Intelligence: Kettering Health’s $6.7 Million UM Transformation

The Challenge: When Rigid Screening Guidelines Meet Complex Patient Realities

Barbara Long, RN, Director of Utilization Review at Kettering Health System Services, started her career as an ER nurse providing direct patient care. Seeking to expand her impact on patient advocacy beyond the bedside, she transitioned into utilization management (UM) and case management. When she joined Kettering in late 2016, a non-profit, faith-based system dedicated to serving the Dayton, Ohio region with patient-focused healthcare, the health system was just beginning its transition to a triad case management model with a centralized UM structure.

After eventually assuming responsibility for oversight of UM operations and leadership of the UM staff, Barbara and her team faced the typical UM challenges. The health system uses Epic as its EMR, and before working with Xsolis, her team relied on traditional screening guidelines for utilization review.

However, these guidelines fell short because they don’t account for individual patient complexity. Guidelines operate on a “check-the-box” system that doesn’t allow for nuance or adapt to the reality that every patient is unique. According to Barbara, her team struggled with prioritization: “They essentially relied on luck of the draw when it came to identifying which patients needed immediate attention, as there wasn’t a systematicway to surface the highest-risk cases.”

A Strategic Approach to UM Transformation

To address these challenges, Kettering implemented Xsolis’ AI-driven Dragonfly™ platform across its 8 facilities in June 2024. Xsolis deployed a training team on-site to support Barbara’s team through the initial transition. Following the training, Barbara noted that her team adapted quickly, embracing the standardized workflows much faster than expected.

The strategic goals for partnering with Xsolis included: 

• • Appropriate Inpatient Revenue Capture:
    Optimize observation rate and appropriately convert cases from observation to inpatient status.​
  • Physician Advisor (PA) Engagement:
    Leverage Xsolis reporting to drive PA performance improvements and operational efficiencies.​
  • Staff Efficiency:
    Use Dragonfly to increase productivity and improve prioritization through Xsolis’ real-time analytics and Care Level Score™ (CLS™).
  • Payer Engagement:
    Identify and influence payer behavior through data-driven reporting while adding value through strategic payer connections.

Operational Excellence Through Advanced Intelligence: Dashboard and Reporting Capabilities

Two of the most impactful components of Dragonfly for Kettering’s UM team include the Facilities Dashboard and robust reporting capabilities. The dashboard serves as the team’s daily command center, allowing staff to quickly identify which patients need immediate attention and access comprehensive patient lists in one centralized location, eliminating the need to hunt through multiple systems. 
For UM leaders, the dashboard provides real-time visibility into team capacity and workload distribution at a glance, enabling them to proactively balance assignments and prevent staff burnout. The intuitive design means the team spends less time navigating the system and more time on patient care, significantly improving productivity and daily workflow. The Facilities Dashboard has transformed how Kettering’s UM team operates, becoming essential to their daily function.

Dragonfly’s robust reporting capabilities provide data-driven insights that drive continuous improvement. The most impactful reports for Barbara’s UM team include:

Xsolis reporting also transforms how Kettering manages payer relationships. The UM team can now track and analyze denial patterns across all payers to identify behaviors and trends, entering discussions with concrete metrics rather than anecdotes. This objective data strengthens their position during contract negotiations and renewals. According to Barbara, “Xsolis reporting shifts payer conversations from subjective disputes to objective, data-driven discussions, enabling strategic payer management.”

Dragonfly’s UM improvements have impacted Kettering’s staff, operations, and most importantly, their patients. The UM team can now prioritize urgent cases and ensure patients receive appropriate, timely care. Accurate status determinations prevent billing issues and denials. With increased efficiency, Barbara’s UM staff now handle additional responsibilities including discharge summaries and 72-hour clinical updates.