In the fast-paced world of healthcare, where headlines often reflect challenges and uncertainties, a different narrative emerges from the heart of Xsolis CONNECT events held across the United States in 2023. Far from the gloom suggested by recent news, these gatherings revealed a palpable sense of optimism and a shared commitment among providers and health plans to tackle industry challenges collaboratively.
The Birth of CONNECT
The brainchild of Xsolis, the CONNECT event concept debuted in 2022 in Knoxville, Tenn., with Sherri Ernst, Revenue Integrity and Utilization Management Officer with Covenant Health, taking the stage as the keynote speaker. Attracting a diverse audience, including case management and revenue cycle leaders, as well as health plan executives, CONNECT events provide a platform to explore advancements in utilization review processes, reimbursement accuracy, and enhanced health plan-provider relations, all facilitated by Xsolis’ innovative technology and services.
These events culminate in engaging panel discussions and Q&A sessions, fostering collective efforts to identify and address challenges hindering health plan-provider partnerships. Sherri’s insights from the inaugural CONNECT were so well-received that they were later shared in a compelling article for Healthcare Innovation.
A Nationwide Expansion
Building on the success of the inaugural event, 2023 witnessed the expansion of CONNECT to five different metro areas, including Phoenix, Seattle, Chicago, Dallas, and a virtual gathering that brought together participants from the Northeastern U.S. In the face of ongoing revenue challenges and staffing deficits, attendees delved into region-specific obstacles, collaboratively brainstorming strategies to strengthen collaborations amid growing health plan-provider friction.
Insights from the Field
Dr. Heather Bassett, Xsolis’ Chief Medical Officer, set the stage at the November event, highlighting a noticeable shift in the relationship between health plans and providers, opening up avenues for strategic alliances as both parties recognize the high cost of the zero-sum game.
- Enhanced Provider-Health Plan Relationships:
- Director of Care Coordination (Health System):
“The biggest success of our payer connection is transparency of information. We are now having real discussions around correct status.” - Lead Provider Engagement Administrator (Health Plan):
“Xsolis has definitely helped our relationship (with providers). I can’t say that enough. We want doctors to be able to doctor and not have to deal with administrative burden. They didn’t go to school to learn how to be a biller … and we’re getting out of the way as much as we can administratively.”
- UM Nurse (Health Plan):
“We absolutely love (Dragonfly). It has decreased our provider abrasion, allowing us to work very closely with our providers and have a positive relationship.”
- Director of Care Coordination (Health System):
- Organization-Wide Collaboration and Shared Information:
- Director of Utilization Management and Clinical Denials (Health System):
“I’m excited to say that our teams across the organization are in one system with shared information.”
- Director of Utilization Management and Clinical Denials (Health System):
- Expansion of Conversations Beyond Utilization Review (UR):
- Director of Care Coordination (Health System):
“Denial rate is not a marker for a high-performing utilization review team. We leverage (Dragonfly) and reporting to help us find the happy medium between the money, the patient, and overall what is the right thing to do.” - Director of Utilization Review and Case Management (Health System):
“The Care Level Score used to be just a UR conversation, now that conversation is happening at the finance level, across our nursing administration and in conversations around length of stay.”
- Director of Care Coordination (Health System):
- Empowerment and Change in Nursing Practices:
- Director of Case Management (Health System):
“Dump the criteria. Our nurses are now empowered to care for patients the way they were trained to do.” - UM Nurse Manager (Health Plan):
“From the UM standpoint, everything is at the nurse’s fingertips with Xsolis. Not having to go into the EMR and having the information we need in one view is just amazing from an efficiency standpoint.”
- Director of Case Management (Health System):
- Anticipating a Nationwide Wave of Change:
- Director of Health Services (Health Plan):
“Bringing information together is just awesome. We can’t say enough about how Xsolis helps us do this.” - Case Management Manager (Health System):
“Xsolis not only changes the way we see and think about utilization management, but it also increases our awareness of our clinical environment.” - AVP, Revenue Cycle and Utilization Management (Health System):
“I think there’s a lot to be said for this being a wave. (Undisclosed health plan) is a national company, but somebody took the first step, and look how successful it’s been. This is going to be a wave across the country.”
- Director of Health Services (Health Plan):
These testimonials collectively underscore the transformative impact Xsolis is having on utilization management and provider-health plan dynamics, breaking down barriers, fostering transparency, and driving systemic change within the healthcare industry.
Looking to the Future
As healthcare charts its course into 2024, a year poised to witness prioritized investment in technology solutions, the focus will be on promoting interoperable data views, reducing health plan-provider friction, and preserving precious clinical resources.
In the words of Dr. Heather Bassett, Chief Medical Officer at Xsolis, “AI is designed to help us. This is what brings me joy as a clinician, and why I enjoy what we’re doing at Xsolis, which is making a difference in simplifying the administrative side to help clinicians focus more on care.”
The story of Xsolis CONNECT events paints a compelling picture — one of hope, collaboration, and a shared vision for a healthcare ecosystem where administrative burdens are eased. Xsolis and its customers stand ready to lead the industry in simplifying complexities and empowering clinicians to concentrate on what matters most — patient and member care.