Enabling Real Payer and Provider Collaboration


Matt Royalty is a director of payer partnerships at Xsolis. He recently sat down to discuss the rapid growth of our payer-provider connections, specifically those with Humana which will number more than 100 provider site connections by the end of 2021. 

Since the earliest days of Xsolis in 2013, a key focus has been to streamline payer-provider communication and effectively, to reduce abrasion. Historically, health plans have received manual clinical submissions from providers via fax, phone calls and emails, causing frustration and wasted time on all sides. The Xsolis Utilization Review platform, CORTEX, now known as Dragonfly, acts as a shared framework for case review between payer and provider – backed by AI and analytics focused on the true clinical merit of the case. 

From a payer’s perspective, the ability to have access in real-time to clinical records – and predictive analytics – from providers has been a true paradigm shift. This change in patient clinical visibility creates a collaborative dynamic that is producing remarkable results. In some instances, time to status determinations has been reduced by more than half a day. Additionally, we see a significant reduction in denials due to timeliness and completeness of clinical submissions, as well as a shared understanding of medical necessity that decreases the need for appeals.  

Through connecting payers to providers through Dragonfly, Xsolis is enabling meaningful and valuable collaboration between payers and providers with each new payer-provider connection. These connections are sprouting up across the country in a groundswell of provider partners who are reaching out directly to payers in their key markets. Once payers and providers have jointly experienced the efficiency, value and reduced friction of Dragonfly, it is very difficult to imagine using any other approach to Utilization Management.  

Learn more about our payer-provider partnerships here