“This is only the beginning.” That’s how Rikki Moye, Vice President of Case Management at Hillcrest HealthCare System in Tulsa, Oklahoma, describes the current state of her organization’s improved communication and relationship with payers.
Transforming the relationship from bad to good took time, and the work towards better communication continues. But Rikki says it could’ve never happened without XSOLIS technology to bridge the gap.
How it Began
For Rikki, like many provider UM leaders, payer relations were often challenging.
“It was pretty confrontational, and that was due to the number of denials we were getting,” she explains. “We couldn’t win an appeal in cases we felt strongly about, and no amount of negotiations was changing that.”
As someone who never throws her arms up in defeat, she decided to try a different approach: XSOLIS’s CORTEX platform. She figured having a third-party’s objective data may help move the relationship forward and it worked.
The Relationship Now
CORTEX and its Care Level Score removed the stress from the payer–provider conversation.
“That’s what has changed that entire relationship — the language we’re all speaking is the same,” she says. “And it wouldn’t be possible without XSOLIS.”
That is because CORTEX acts as agnostic tool with no motive except to look at evidence-based medicine, analyze the data and create a Care Level Score that removes that stress that initially impacted the relationship.
“When we can look at this third–party data from XSOLIS that we have all already agreed is accurate, then there’s nothing to argue about.”
Getting to the Next Level
Rikki is taking the success she found through XSOLIS with one payer and using those results to bring more insurance companies to the platform.
“We all have to line up together to expand this into the next realm,” she says. “This is just the beginning. There are multiple payers out there. All of us want this to be right. And removing the stress and the expense and the wasted time around appeals and denials management gives everyone more time to get back to the work that matters.”
Rikki is on a path with her organization to a better relationship with payers so we asked her about where she sees the healthcare industry as a whole evolving into an improved payer–provider network.
“The industry is changing, and COVID kick-started those changes last year,” she says. “These manual–labor intensive processes and personal opinions just can’t fly anymore in the 21st century.”
She explains that artificial intelligence and machine learning technology, like the CORTEX platform, is key to that essential change.
“The benefit of agnostic artificial intelligence is it constantly pushes you forward,” she explains. “As it gets better, you get better, and you gain more control. When you have control, change is just not that scary.”
Join Rikki’s Live Webinar
Creating a better payer–provider relationship isn’t the only change Rikki helped develop and implement at Hillcrest HealthCare. View her recent on-demand webinar to hear how one simple act inspired a successful, new case management model.