4 Ways CORTEX Helps Payers & Providers Connect & Collaborate

by XSOLIS Insights, on Jan 26, 2021 7:00:00 AM

In 2021, the healthcare industry continues to strive for improved relationships between payers and providers. We need to increase collaboration and communication for two important reasons: to ease the cost to the industry (billions of dollars), and to improve efficiency on both sides. By doing so payers and providers can finally get back to their common goal: improving outcomes by providing value-based care for patients and members.  

So, where do we stand today?  In 2020, COVID-19 sped up the adoption of technology-based solutionsthat weren’t available before when it comes to solutions based on the importance of shared data, instant communication, and patient-centered care. The push to adapt and move into a new future faster through shared data allows these payer-provider networks to connect, adapt, and expand.   

XSOLIS helps usher in this new future centered on technology, focused on the member, and collaborative across the continuum of care, acting as the bridge between payer and provider. Here are four ways XSOLIS’ CORTEX platform is improving the connection and expanding the network.

 

1. Real-Time Analytics 

One of the biggest obstacles to a collaborative relationship between payers and providers has been shared data. XSOLIS’ platform, CORTEX solves this by extracting data from the electronic medical record and applying natural language and machine learning to provide real-time updates of the patient’s clinical picture that can be accessed by both payers and providers.  

 

2. Access to the Same Data  

CORTEX goes beyond simple EMR access to offer a shared framework for accessing and assessing cases for review.  

“If everyone is looking at holding onto their data as a competitive piece or advantage, that won’t work anymore,” says George Renaudin, Sr. Vice President at Humana. “Instead, it should be about how we can improve everything for everyone.”    

CORTEX allows this to happen, providing the same data at the same time to be shared automatically and in real time.   

3. Objective Clinical Picture  

When providers and payers don’t have AI or machine learning technology to help build the patient’s clinical picture, the information can become subjective, thus creating conflict between the two sides. It is that subjective data which leads to the frustrating back and forth nature of the relationship.     

CORTEX removes the back and forth, providing both sides with an objective clinical picture through the Care Level Score. Rather than give a blanket “inpatient” or “observation” status for each patient, the Care Level Score, or CLS, is XSOLIS’ proprietary artificial intelligence model which predicts numerically where each patient falls on the medical necessity spectrum – clear inpatient, likely inpatient, likely observation, and clear observation – through proprietary artificial intelligence.  This allows clinical staff members to assess and prioritize patients accurately and more efficiently quickly.   

4. Reduced Administrative Burden   

BY sharing real-time data and an objective clinical picture, CORTEX reduces administrative burdens and creates efficiencies for both payers and providers.   

“Having them [payers] be able to work within CORTEX has not only increased our efficiency, but I do believe it has increased theirs too,” says Renee Dunagan, Case Management Supervisor at Citizens Medical Center.  

Those efficiencies include eliminating faxes, phone tag, and EMR diving, which has resulted in reduced denials, faster decisions, and substantial financial savings for many XSOLIS clients including Citizens Medical Center.  

If you are looking to create a better payer-provider connection, XSOLIS can help you start on the right path.    

Schedule a demo today and see how CORTEX could be the solution you need for 2021.   

Topics:Products & Solutions