Earlier this week, XSOLIS CEO Joan Butters spoke with Becker’s Healthcare Editor-in-Chief Laura Dyrda about the evolving healthcare landscape and what it means for payer-provider relations. The conversation centered on how COVID-19 exposed flaws of administrative excess within healthcare and why a reset makes sense now more than ever.
Joan stressed the importance of technology to bridge the silos that have historically caused friction. However, leading health plans and providers are taking the lead to change this dynamic. Joan shared the example of Covenant Health, a regional health system based in Knoxville, TN, which identified shared administrative burden that could be eliminated through payer collaboration. Through an early partnership with Humana, Covenant Health used XSOLIS’ CORTEX platform to conduct concurrent utilization and medical necessity reviews: Humana nurses had access to member information throughout the encounter and were able to align on appropriate status determinations out of the gate. Humana and Covenant Health’s partnership has also expanded to include Precision Utilization Management: using XSOLIS analytics to identify a subset of patients that both parties would agree are medically necessary inpatients and using technology to strip away the administrative burden of review on those patients.
But that’s only the tip of the iceberg. Hear the entire conversation below: