Artificial Intelligence is Connecting Payers and Providers

In a webinar hosted by Becker’s Hospital Review, Joan Butters and Heather Bassett shared how Xsolis connects payers and providers through artificial intelligence. They spoke on where the organization has been, where it is currently, and most importantly how Xsolis plays into where the industry is headed. 

From the earliest days of Xsolis, there was focus on leveraging the power of data and analytics to help find needles in the haystack or, in other words, understand how to deliver practical value and efficiencies from mountains of digital information. Xsolis journey began in 2013 with a focus on Utilization Review. As a historically underserved space, UR uniquely intersects with clinical, operational, and financial healthcare ecosystems. UR nurses are tasked with making critical clinical and financially impactful decisions on a minute-to-minute basis yet the tools available to them have not been up to the challenge. Historically, UR tools are outdated, incompatible and ineffective. UR teams battle ever-mounting paperwork, phone calls and faxing consuming their days. The flood of digital data was meant to increase insights. Instead, it has in effect created inefficiency. 

Data, without insight or practical application, means that decisions are made by staff only able to see part of the patient/member’s medical story. This limited, subjective perspective cannot leverage the vast but valuable patient dataset that is available. 

Xsolis challenged itself to bring realtime data from the electronic medical record to life, which allows the case manager or utilization review nurse to make informed determinations while the patient is receiving care in the hospital. The UR team can then direct decisions on the front end to improve outcomes versus reacting to past behavior.  

This journey ultimately led Xsolis to create a communication and an analytic bridge between providers and payers. This technology platform, Dragonfly, formerly known as CORTEX, interfaces directly with the electronic medical record, ingesting data feeds in real-time from their provider clients. Dragonfly harnesses that data and then feeds it into proprietary analytic algorithms, generating output in the form of actionable insights that users can then operationalize. Dragonfly interfaces with all major EMR vendors from coast to coast and is live in approximately 250 provider facilities. 

Dragonfly offers three significant innovations for payer and provider clients  

  1. Real-time access with a normalized and concise view of the clinical picture of each patient, resulting in a datadriven patient story that is told neutrally between both the payer and the provider.  
  2. Superior visibility into clinical meritthe ability to collaborate concurrently with staffinstant communication between parties and ultimately reduces manual processes through a streamlined, prioritized workflow.
  3. Analytics that can be used to create a threshold for automating status decisions: cases with a high degree of certainty can be informed and confirmed by highly accurate AI. These cases no longer need to be debated, no longer need to go back and forth, typically resulting in a 20% decrease in case touches.

With their success serving the provider market and now integrating and creating a different framework for interoperability between payers and providers, Xsolis leaders believe that they are just at the beginning of the journey improving relationships between providers and payers. 

Considering the longitudinal and comprehensive data that Xsolis consumes, Joan, Heather, and Product Leaders constantly seek new ways to innovate the information gap through AI and technology.