Seeking to Overcome UM Obstacles & Foster Payer Alignment
AnMed, a not-for-profit health system serving Upstate South Carolina and northeast Georgia with 370 physicians and more than 3,600 employees, was seeking to address various utilization management (UM) and case management challenges, while improving access to care and patient outcomes. Suzanne Wilson, the Assistant Vice President of Population Health at AnMed whose responsibilities include UM, case management, payer relationships, and more, evaluated UM platforms to address the following obstacles:
- Significant staffing challenges
- Increasing shift to value-based care
- Misalignment between AnMed and their payer partners
These obstacles, coupled with heightened demands on efficiency and productivity as well as the importance of ensuring each patient receives the appropriate care in the right setting, led AnMed to partner with Xsolis.
Key Results
Transformative Impact: AnMed’s Optimization of UM, Case Management, & Payer Relationships
In January 2023, AnMed implemented Xsolis’ AI-powered platform, Dragonfly, to streamline UM and case management workflows, enhance staff productivity and efficiency, and increase collaboration with health plans. AnMed added Xsolis’ award-winning Physician Advisory Services in August 2024 to supplement its internal PA model.
Since partnering with Xsolis, the results have been exceptional, including a 14.6X return on investment (ROI), driven by increased UM and PA efficiency, accurate and timely patient status determinations, and improved alignment with health plans. Utilizing Dragonfly and streamlined workflows, Suzanne’s teams can now easily prioritize patients for review, enabling them to focus on high-acuity cases. AI and predictive analytics allow UM and case management teams to accurately identify the appropriate level of care, seamlessly aligning with health plans on patient status.
According to Suzanne, “Xsolis’ AI platform won’t replace your teams, but it will empower them to be more productive and streamline their work.”
The efficiencies achieved are driven by Xsolis’ Care Level Score™ (CLS™), a numerical calculation that gauges the likelihood of appropriate patient status based on a comprehensive analysis of patient data, powered by Xsolis’ real-time predictive analytics and machine learning. Using the CLS allows the AnMed teams to gain objectivity and confidence with patient status determinations and focus resources on the patients who require further review.
“Xsolis’ objective CLS enables earlier, more accurate status determinations, improving efficiency and cost-effectiveness. It also helps our UM staff prioritize patients, focusing on those who need attention and cases requiring physician advisor review.”
The ability to better prioritize cases has had a significant impact on the productivity and satisfaction of AnMed’s UM and PA teams. “It’s about rightsizing the work – ensuring that each patient receives the right care at the right time and in the right setting. Xsolis helps our teams feel more confident in ensuring patient status determinations are accurate and reached more quickly,” Suzanne notes.
Since June 2024, AnMed and a large national health plan have leveraged Xsolis’ Precision UM to proactively align case reviews with historical inpatient and observation determinations, automating appropriate cases. Xsolis’ shared AI insights have fundamentally changed the conversation, Suzanne said, making tough discussions easier to navigate and enabling more collaborative problem-solving to reach shared goals.
Working together on the platform allows AnMed and the health plan to focus on cases requiring human intervention, improving alignment between the parties and improving the overall relationship. This ultimately ensures optimal outcomes for patients and health plan members. Utilizing Precision UM with their health plan partner has resulted in front-end review time savings of 1,221 hours from June 2024 to June 2025.
"Xsolis has delivered on our key objectives, including the ROI and more. This is an ongoing journey, and we're excited about the opportunities to further optimize our operations and enhance patient care through the power of their AI capabilities."
Embracing the Future: AnMed’s Commitment to AI-Drive Optimization
AnMed is looking forward to continued success with Xsolis’ AI technology, which has empowered its teams to work more efficiently and effectively.
“Xsolis has delivered on the key objectives we set out to achieve, including the promised return on investment and even more,” said Suzanne. “This is an ongoing journey, and we’re excited about the opportunities ahead as we continue to collaborate with Xsolis. We look forward to further optimizing our operations and enhancing patient care through the power of their AI capabilities.”
Shelley expressed excitement about exploring innovative ways to leverage Xsolis’ AI technology even more broadly across AnMed’s operations. “We’re exploring innovative ways to utilize Xsolis’ AI technology for patient status in the ED. Our goal is to initiate patient reviews as soon as they enter the ED, as the faster we can start that process, the better. And we would also like to further leverage Xsolis’ AI capabilities in our case management work, specifically to help predict the appropriate post-acute care setting.”
To learn more about how to start your AI-powered journey to streamlined UM, improved efficiency, and payer alignment, contact Xsolis today.
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