From Adversary to Ally: How CORTEX Connects Payers & Providers
by XSOLIS Insights, on Dec 10, 2020 6:00:00 AM
The disconnect between payers and providers has grown over the years, creating more work and frustrations on both sides. This strained relationship is also costing the healthcare industry billions of dollars, but it doesn’t have to continue this way.
XSOLIS dedicates itself to helping payers and providers collaborate and achieve their common goal; to improve patients' outcomes when it comes to utilization review. XSOLIS’ CORTEX platform allows for this collaboration through objective, real-time technology, and artificial intelligence that enables providers and payers to work from the same data.
“We can’t collaborate about how to improve the health outcomes for our members and our providers’ patients if we’re not being collaborative with the data,” says George Renaudin, Sr. Vice President at Humana.
How Collaborative Data Works
Forget sending faxes, playing phone tag, and pouring through every electronic medical record. CORTEX automatically extracts the data from the EMR and applies natural language processing and machine learning, which allows each party to see the same patient picture in real-time.
“What I loved about XSOLIS is the fact that it would create the patient's story and really hone in on what the payers want to see, which is: why does this patient need to be in the hospital,” says Pam Foster, AVP of Care Coordination at HonorHealth in Scottsdale, Arizona.
XSOLIS’ clients have experienced many benefits from using CORTEX to collaborate, including:
- No paperwork
- Faster decisions
- Huge financial savings
- Increased efficiencies
“We’ve gone live with Humana and having them work within CORTEX has not only increased our efficiency but theirs too,” says Renee Dunagan, Case Management Supervisor at Citizens Medical Center in Victoria, Texas. “This has been one of the best outcomes.”
Right now, CORTEX is connecting more and more hospitals and health plans across the nation. The platform is not only helping to build relationships but expand them as well.
“We're going to arrive at a state where we have partnered joint status management of our patients and our members,” says Samantha Longenbaugh, Network Director UM at HonorHealth. “That's what we want to achieve. Not this constant inpatient versus outpatient battle. Instead, let's all come together and agree on managing the status of the patients.”
And according to George Renaudin at Humana, it all starts with communication. “I think that the communication layer and the ability to communicate real-time is going to open the door to all sorts of ways that we can collaborate better as payers and providers.”
If you’re looking for a better way to approach utilization management, take the first step by scheduling a free, no-hassle, obligation-free CORTEX demo here.