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:

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.