5 Ways CORTEX Improves the Utilization Review Process

by XSOLIS Insights, on Dec 22, 2020 10:53:06 AM

How can CORTEX® help my organization?  

CORTEX helps clients in so many ways. From increasing efficiencies and workflows to reducing denials to lower observation rates to increased revenue, XSOLIS’ clients have changed the way they work.

Our return on investment has been excellent.

“We've been delighted by our outcomes,” says Rita Regan, VP of Quality and Care Management at Mount Sinai South Nassau in Oceanside, New York. Our return on investment has been excellent. 

Here are five ways CORTEX may help your organization.


1. Increased Efficiency 

When asked how CORTEX has changed their work, the number one response from clients is increased efficiencies.    

“It has helped our efficiency tremendously,” says Jan Trevillian, Director of Care Management at Chesapeake Regional Healthcare in Virginia. “We aren't hunting and pecking and trying to find a box in the chart. Instead, information from the EMR flows over directly from the chart into the platform automatically, in real-time.”  

CORTEX consolidates key information and displays data intuitively for staff, allowing them to quickly review cases and make more accurate status determinations. Those accurate status determinations help prioritize which patients need to be seen first, saving nurses the time of going through charts manually, one at a time. 

2. Right-sized Observation Rates 

Very quickly, we've seen our observation rate go down.

Another outcome clients experience is an appropriately lowered observation rate. Samantha Longenbaugh, Network Director UM at HonorHealth in Scottsdale, Arizona, saw a drop within the first six months after implementation.  

“We've been live for six months, and very quickly, we've seen our observation rate go down,” she says. “Before CORTEX, there were some months we were pushing an observation rate of 40%! We knew we could not sustain that. Now, CORTEX helped us lower that observation rate 8 to 10 points.”  

 HonorHealth has now been live for nearly two years and that right-sizing has stayed true to form. 

3. Increased Conversions 

HonorHealth and many other XSOLIS clients have also experienced an increase in appropriate conversions within the first few months of using CORTEX.  

CORTEXs real-time notifications have been tremendously helpful for us,” says Jan. “As patients approach the second midnight, we can see who we can appropriately flip to inpatient thanks to those notifications, and that’s allowed us to increase our revenue.  

4. Maximum Financial Impact 

“We know as an organization, prior to CORTEX, that we left over a million dollars on the table by doing inpatient procedures only as outpatient,” says Jan. “It's been unbelievable how much money we have had as a return on investment by using CORTEX.” 

Chesapeake Regional Healthcare isn’t the only XSOLIS client experience this kind of positive financial impact. In Portland, Oregon, Legacy Health experienced an eight-figure positive impact due to a 43% increase in appropriate conversions. 

This kind of return on investment has amazed organizations, especially when health systems and hospitals are experiencing financial challenges and hardships 

5. Seamless Payer-Provider Communication 

Because of the evidence-based, real-time analytics CORTEX provides, many healthcare clients experience a reduction in denials due to the increased accuracy of status determinations up frontCitizens Medical Center in Victoria, Texas, reduced their denials by 36%. 

That increased accuracy also creates a more efficient process between providers and payers when it comes to escalating cases. 

“We recently have gone live with Humana,” says Renee Dunagan, Case Management Supervisor at Citizens Medical Center. “Humana is within CORTEX so we are able to escalate cases back and forth easily. This has been one of the best outcomes.”  

Humana’s national agreement with XSOLIS provides a seamless communication portal for hospitals to escalate member cases directly. Currently, HonorHealth, Citizens Medical Center, Chesapeake Regional, and other provider clients across the country are using this approach and recentering their payer relations. 

What Else Can CORTEX Do? 

It’s such a high-power tool

These are not the only benefits providers and payers experience using CORTEX. In fact, clients are always sharing new opportunities for the tool. 

“It's such a high-power tool,” says Samantha. And if anyone asks me how I’m using CORTEX, I say we're squeezing every ounce of juice we can out of it.   

Learn more about how CORTEX can help you. Schedule a demo to see firsthand all the ways the platform can benefit your organization.