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.    
 

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.