Transforming the Utilization Management and Physician Advisor Processes

Streamlining Processes with Xsolis Amidst Challenges 

Although Karen chose to implement the Xsolis platform, the onset of COVID-19 compelled her team to postpone the launch. Throughout the pandemic, the hospital grappled with patient surges and staffing shortages, exacerbating the strain on utilization management (UM) staff handling 60 to 80 observations daily. 
 
Once the Xsolis platform, CORTEX (now Dragonfly), was deployed, Karen’s team recognized the imperative to revamp their entire UM process, necessitating additional staffing. Insights gleaned from CORTEX facilitated departmental expansion by pinpointing areas for improvement. Moreover, Karen’s team developed concise UM workflows for the first time, enhancing staff training. Since embracing CORTEX, Karen’s team has achieved an 8.5% enhancement in review efficiency² compared to pre-platform implementation. The hospital has not only seen improved internal efficiencies including ensuring appropriate patient statusing but also experienced improvements in its processes with MLKCH’s payer partners. Karen stated, “The use of the Xsolis platform has strengthened our collaboration with payer partners. We can now analyze trends and patterns more effectively, enabling us to address issues promptly and with the necessary documentation.” 

Leveraging the Xsolis Care Level Score™ (CLS™) for Informed Care

Incorporating the Xsolis platform, MLKCH now utilizes the Care Level Score™ (CLS™) to guide patient level care decisions. Drawing from EMR data, the CLS provides a numerical representation likelihood of appropriate status for each patient, leveraging real-time predictive analytics and machine learning. Daily CLS utilization enables Karen’s team to prioritize cases effectively, expediting reviews and bolstering their productivity. While clinical decisions remain vital, the CLS offers a valuable starting point. Karen appreciates that, “the CLS dynamically updates as Xsolis’ artificial intelligence (AI) undergoes quarterly retraining.” 

“We serve a unique need in the community, providing care to underserved populations while regulatory requirements are constantly evolving. Xsolis helps us ensure appropriate reimbursement for the services provided and also puts us in a more defensible position to navigate future challenges. Their partnership has proven invaluable, as they consistently collaborate with us to meet our changing needs.”

– Karen Taylor
Senior Director of Care Management,
Social Work & Post-Acute Services

Innovating the Physician Advisor Workflow  

Dr. Sarah Kim commenced her role as a Physician Advisor at MLKCH concurrent with the Xsolis implementation, incorporating the Best in KLAS Xsolis Physician Advisor Services to supplement existing coverage. The Xsolis PA Team seamlessly supports Dr. Kim, intervening in cases as needed. A smooth implementation process, coupled with ongoing education sessions and collaborative rounds with the Xsolis PA team, enabled Dr. Kim to establish a protocol for concurrent denials, accelerating reimbursement capture. Dr. Kim highlights the contribution of this supplementary coverage to the hospital’s financial health, facilitating denial reversals. She emphasizes, “Xsolis is indispensable for efficient PA operations. It’s hard to imagine how other PAs do their jobs without this additional coverage.” 

Optimizing Reimbursement and Operational Efficiency 

MLKCH has leveraged the Xsolis platform to streamline its processes, boost operational efficiency, and ensure they can navigate future reimbursement-related challenges. “We serve a unique need in the community, providing care to underserved populations while regulatory requirements are constantly evolving,” said Karen. “Xsolis helps us ensure appropriate reimbursement for the services provided and also puts us in a more defensible position to navigate future challenges. Their partnership has proven invaluable, as they consistently collaborate with us to meet our changing needs.”