Chesapeake Regional Healthcare
Seven years ago, Chesapeake Regional’s utilization review (UR) and case management processes were extremely manual. With the reduction of paper charts through EMR utilization, skilled nursing staff were required to sift through piles of data and multiple systems to access critical patient information. Furthermore, these systems didn’t provide a continual stream of data that would allow staff to consistently analyze each patient’s condition in real-time — nor did her staff receive notifications as patient conditions changed. This manual review process created inconsistencies so Jan Trevillian, Director of Care Management at Chesapeake Regional, sought to address these issues proactively.
Searching for a solution that would help streamline Chesapeake Regional’s UR processes, Jan discovered that Xsolis offered a platform that analyzes and scores clinical, administrative, and financial data together in real-time to provide automated decision support for level of care decisions, reimbursement accuracy, and denial management. Realizing her opportunity to capitalize on the discrete data in Chesapeake’s EMR while providing her team with a power tool for case review, the Xsolis core platform, Physician Advisory services, and Denial Management services were implemented in 2016.
Gaining Efficiencies to Focus on Patient-Centered Activities
Jan’s team can now complete more timely reviews and in 2022, 99.4% of reviews were completed within 24 hours from the status order. Thanks to the Xsolis Care Level Score™ (CLS™), Jan’s team no longer has to hunt and peck through EMRs to determine medical necessity. The CLS also ensures more efficient and accurate depictions of each patient’s clinical condition. These updates have given Jan’s team two hours back in their day, allowing clinical resources to be reallocated. Some of her team was moved to discharge planning, a more patient-centered activity, which has been key for Chesapeake Regional especially because of nursing shortages widely being experienced across the U.S.
Getting the Patient Status Right from the Beginning
Based on Jan’s evaluation, because of Chesapeake failing to get the right patient status within the first 24 hours, they left $1.2 million on the table in just one year. Nurses were leaving inpatient-only procedures as outpatient because her staff couldn’t code in real time.
Xsolis was the only vendor that delivered on her need to get status right earlier on, in real-time, with an alert if a patient isn’t in the correct status. In their first week of training on the Xsolis platform, Jan and her team caught three procedures in the incorrect status. According to Jan:
“It’s a tremendous cost savings for the facility to get it right from the beginning.”
– Jan Trevillian, Director of Care Management
Ensuring the Right-Sized Observation Rate
Since the implementation of the Xsolis platform in 2016, Chesapeake has experienced a 5.6% improvement in their observation rate, resulting in more than $1.1 million in savings. And although 2021 was a turbulent year, especially in healthcare due to the global pandemic, Jan says that “Xsolis helped the hospital to stay in a positive margin.”
Improving the Payer-Provider Dynamic: Collaboration Between Chesapeake Regional and Humana
The Xsolis platform has been used by Chesapeake Regional and Humana as a shared framework for real-time, concurrent case reviews to determine the appropriate level of care since the platform went live in the first quarter of 2021. Due to this collaboration, communication between Chesapeake Regional and Humana and timely authorizations have both improved. Phase two of this collaboration will involve Precision Utilization Management (PUM) which entails utilizing the Care Level Score™ (CLS™) and artificial intelligence (AI) to automate the authorization process for inpatient cases.
“Hospital and health plan leaders are all struggling with the same things – to create more efficiencies, improve the bottom line, improve the payer-provider dynamic, and we have achieved all of these with Xsolis and more.”
– Jan Trevillian, Director of Care Management
ROI projections are estimates based on similar system information and averages over the first 2 years of utilization. Such ROI projections do not guarantee future results. Actual ROI will vary based on various conditions and factors for each customer, including, but not limited to, client baseline information, best practice utilization of the products, etc.