Quick Summary: PeaceHealth, a not-for-profit health system across Washington, Oregon, and Alaska, standardized its utilization review (UR) function after the pandemic, but the model left UR siloed from clinical operations. Following a multidisciplinary evaluation of four AI-enabled platforms, PeaceHealth selected Xsolis and its Dragonfly platform because the offering most closely matched their requirements for aligning UR with clinical decision-making and physician advisor (PA) workflows. This article describes how PeaceHealth identified clinical gap, established evaluation criteria, and selected a technology and services arrangement intended to better align UR with clinical operations.
Like many health systems emerging from the COVID-19 pandemic, PeaceHealth faced two pressures at once: mounting workforce shortages in UR and growing variation in clinical practice across its sites. PeaceHealth operates medical centers, critical access hospitals, and medical clinics across Washington, Oregon, and Alaska.
The system responded by standardizing its approach. PeaceHealth adopted traditional criteria and engaged a third-party vendor to provide remote UR services to support the transition.
The partnership improved consistency in how criteria were applied. It also introduced an unintended consequence. The UR function became increasingly siloed, disconnected from the day-to-day realities of clinical operations. UR assessments were no longer synchronized with care management workflows, real-time patient status changes, or the natural progression of care. Standardization had come at the cost of integration.
Kim Sinclair, System VP of Integrated Care Management at PeaceHealth, recognized this as a critical inflection point.
“We understood the importance of reintegrating UR into care management and clinical operations in a way that added value for clinicians, how capacity was managed across the system, and most importantly, for patients”
The challenge was rethinking how UR could actively support clinical decision-making rather than run parallel to it. Solving it would require outside expertise, and Kim was deliberate about how PeaceHealth approached vendor selection.
The team conducted a broad review of the growing AI-enabled solutions landscape before narrowing its in-depth analysis to four platforms. PeaceHealth then used a multidisciplinary evaluation involving leaders and frontline experts from revenue cycle, care management, physician advisors (PAs), nursing, contracting, informatics, and IT. Each group assessed the options against PeaceHealth’s clinical, operational, technical, contracting, and implementation requirements.
Based on PeaceHealth’s evaluation, Xsolis and its Dragonfly platform most closely matched the system’s stated requirements for connecting UR and PA workflows with timely clinical information. PeaceHealth selected the offering for its fit with the system’s intended operating model, subject to contracting, implementation, performance monitoring, and ongoing oversight.
The distinction came down to whether the work itself would change. Kim shared:
“We were looking for an approach that could support a different workflow, not only improve the efficiency of the existing one. In our evaluation, the Xsolis offering aligned most closely with the operating model our PA and UR teams were working to establish.”
In PeaceHealth’s planned use, the platform is intended to support information-sharing across utilization management, case management, PA activity, reimbursement, and payer collaboration. Its functions include surfacing AI-supported information for review, helping teams prioritize cases, documenting medical-necessity assessments, supporting concurrent authorization workflows, and escalating cases. Clinical and operational decisions remain subject to professional judgment, PeaceHealth policies, contractual requirements, and ongoing review.
PeaceHealth’s selection followed its multidisciplinary evaluation and due-diligence process. As one input, the team spoke with health systems already using Xsolis to better understand implementation considerations, workflow changes, and potential risks. Those conversations informed PeaceHealth’s assessment but did not replace its own contracting, technical, privacy, security, compliance, and operational reviews.
PeaceHealth then moved into implementation while also onboarding a new team and transitioning from its previous physician advisor vendor.
“The initial implementation proceeded as planned despite the added complexity of onboarding a new team and transitioning from our previous physician advisor vendor. Input from other health systems helped us anticipate parts of that process,” Kim said.
For PeaceHealth, the selection was one step in a broader effort to reconnect UR with clinical operations and align workflows with how UR and PA teams work. PeaceHealth will continue to assess implementation, performance, and outcomes against its own requirements.
PeaceHealth’s experience points to a lesson that applies well beyond one health system. Standardization and integration are not the same goal. A UR function can be consistent and still be disconnected from clinical reality.
For leaders evaluating AI-enabled UR solutions, three principles stand out:
PeaceHealth’s experience underscores the value of a documented, multidisciplinary process tied to organization-specific requirements. Selection of Xsolis reflects PeaceHealth’s circumstances and evaluation at the time; it should not be interpreted as an endorsement or recommendation for other organizations.
Disclaimer: PeaceHealth’s selection of Xsolis does not constitute an endorsement.