Overcoming Fragmentation: HonorHealth’s Pursuit of Centralized UM
As one of Arizona’s largest non-profit health systems, HonorHealth serves over 5 million people across the greater Phoenix metropolitan area. It was vital for HonorHealth to have a centralized, streamlined utilization management (UM) process and workflows to ensure that patients requiring clinical review were prioritized appropriately.
However, prior to 2019, HonorHealth’s UM and case management workflows were inefficient. They relied on time-consuming manual processes, such as daily faxing, and lacked a structured process for prioritizing reviews. Nurses often had to sift through 20 or more patient charts before identifying one that required clinical review. Additionally, HonorHealth had minimal collaboration with their health plans.
The lack of centralization and reliance on manual processes prompted HonorHealth to partner with Xsolis and implement their AI-driven platform, Dragonfly, in April 2019 across six of their facilities. Going into the implementation, HonorHealth set some ambitious goals to transform their UM processes. Pamela Foster, MBA, MSW, Vice President of Care Coordination at HonorHealth, identified centralization of the UM function as the top priority. She wanted her team to utilize a shared framework to ensure all teams were focusing on the right cases at the right time with the appropriate resources.
Additionally, Pam aimed to decrease the administrative burden of UM and reduce the overall number of case touches to increase staff efficiency. Finally, HonorHealth sought to optimize collaboration with their health plan, improve communication between the two parties, and support a more streamlined and proactive denial management process.
Partnering with Xsolis to Increase Efficiency & Capacity Through Streamlined UM Processes
In alignment with their established goals, HonorHealth worked closely with Xsolis to overhaul their UM processes and workflows. They successfully transitioned to a centralized UM structure, replacing their previous facility-based approach. This included automating key processes and workflows, reducing the administrative burden, and minimizing the constant back-and-forth with their health plan partners. Samantha Longenbaugh, RN, BAS, ACM, Senior Network Director of Utilization Management at HonorHealth, noted the impact of these changes:
– Samantha Longenbaugh, RN, BAS, ACM
Senior Network Director of Utilization Management at HonorHealth
“Xsolis has helped us standardize our internal workflows and work standards on a daily basis. My previous EMR system didn’t provide a way to prioritize my cases. With Xsolis, I suddenly had a powerful prioritization tool. And my team loved it. That’s what really sold it to my team — knowing they could come in, find those priority cases, and address them right away.”
The ability to standardize processes and prioritize patients is driven by Xsolis’ Care Level Score™ (CLS™). The CLS provides a numerical calculation that gauges the likelihood of appropriate patient status. This analysis is powered by Xsolis’ real-time predictive analytics and machine learning.
“The Xsolis platform and the CLS enable our nurses to focus on cases requiring their clinical expertise, while automating cases that don’t need an in-depth review. This allows our nurses to practice at the top of their license and apply their valuable clinical knowledge more effectively.”
– Pamela Foster, MBA, MSW
Vice President of Care Coordination at HonorHealth
By implementing a streamlined process for priority reviews, from 2022 to 2023, HonorHealth’s nurses increased the average number of monthly reviews by 31% with 97.6% of initial reviews completed within 24 hours. This has allowed HonorHealth to reallocate their nurse resources to higher-value projects and more clinically focused efforts.
Enhancing Productivity & Alignment with Health Plans Using Precision UM
The efficiencies gained by working with Xsolis also extended to HonorHealth’s health plan collaborations. In 2021, HonorHealth connected with a large national health plan on the Xsolis platform, enabling streamlined access to clinical data and faster medical necessity determinations. Xsolis’ real-time insights and predictive analytics allow HonorHealth and health plan teams to align on appropriate decisions more quickly.
A time study found a full clinical review and assignment can now be completed in just over 5 minutes, down from the previous manual process of bundling, faxing, and confirming receipt of authorization requests. Even for health plans not on the Xsolis platform, HonorHealth can share insights to facilitate more efficient collaboration, as Pam notes: “We can still share valuable insights and data from the platform and have collaborative conversations that help us work more efficiently together.”
In 2023, HonorHealth expanded their health plan connection to include Precision UM, enabling the proactive alignment of case reviews with historical inpatient and observation determinations. Implementing Precision UM with a large national health plan has resulted in improved relations and shared efficiencies, elimination of traditional manual processes — including eliminating unnecessary review of 23% of their patient case volume when automating appropriate cases —and the reduction of downstream denial work and appeal volume.
Looking Ahead: Expanding Impact with Xsolis
From April 2019 to December 2024, HonorHealth experienced more than $203 million in savings, due to their use of Xsolis’ solutions. Looking ahead, Pam’s goals include broader access to the Xsolis platform across their health plan partners. They want to replicate the success they’ve had with one of their large national health plans and work collaboratively with all of their health plans. Pam also aims to further expand Precision UM and automate as many appropriate cases as possible, ensuring optimized efficiency across their teams.
To discover how you can empower your organization to optimize UM workflows and enhance your team’s efficiency to achieve optimal outcomes, contact Xsolis today.
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