As part of the American Case Management’s Care Transitions Today podcast, Hillcrest HealthCare System VP of Case Management Rikki Moye sat down with host Deb McElroy to discuss how ideas and technology help power innovation at her organization.
When she joined Hillcrest HealthCare System (the Oklahoma division of Ardent Health Services) in 2016, Rikki knew she could bring about positive change. According to her, “there was not a lot of case management structure at the division or the corporate level at that time. Each hospital did its own work, as it felt that needed to do. I was brought in to bring it to bridge operations, strategy, structure, and provide a gap analysis for where we could go in the future.” For Rikki, that future presented itself in a bolt of lightning: “I literally put my head down on my desk and frustration and said why with all of my typical tricks of the trade and pretty standardized process improvements are we not turning the corner? And when I put my head on my desk in frustration, I realized that the triad model of case management that we were using was so siloed off that you had people that literally were not talking to each other and they were in their own work streams: utilization management didn’t feel like it needed to be talking to care coordination and care coordination did not feel like they needed to know what utilization management was doing because that wasn’t their job and social work and discharge planning were just trying to keep up. That’s when it hit me that those silos more than anything else were causing the problem. And how do you break down those silos?”
The Right Care Case Management Model
The siloed nature of the triad model required a change in perspective. The Right Care Case Management Model inverts these traditional silos and places the patient at the center of the conversation, with communication and care facilitated by a resource manager following that person throughout their encounter and beyond. Those silos became an hourglass.
Powered by Artificial Intelligence
While clear in theory, one major barrier to change has always been the availability of technology to make the process doable at a large scale (especially for a multi-hospital system like Hillcrest). Recognizing this, Rikki partnered with XSOLIS to offer her staff a new path forward. “I worked with the Hillcrest leadership and the company to arrange to have this artificial intelligence technology [XSOLIS CORTEX] brought in and support this right care model because the manual labor to keep up with all of this on one resource manager was going to be impossible to maintain,” said Rikki. “What really turned the corner was XSOLIS and getting the CORTEX platform, the artificial intelligence, the machine learning, it is literally at the click of a finger. You have tremendous amounts of information, and it’s laid out in such a way that a very short glance you know everything you need to know and you’re not digging through a medical record trying to figure something out. And that’s where the Right Care Model really kicked into high gear. And that is why we are so successful today.”
Adopting Precision Utilization Management
Hillcrest has also been at the cutting edge of payer relations, recently adopting another new framework that has reduced case review burden: Precision Utilization Management. Centered in XSOLIS analytics, Precision UM allows Hillcrest and participating payer partners to create automated thresholds for inpatient determinations, reducing time and effort spent on a large subset of cases. With several partners alongside, Hillcrest has seen a dramatic change in their workflow as well as positive change in payer-providercollaboration.
Hillcrest continues to build upon and refine the process in the service of their patients and utilize a winning formula for success: people + process + technology. And they’ll continue to do so because according to Rikki, “if nothing else, we are pioneers.”
Listen to the full conversation with Rikki below or check out our full client success story here.