Elevating and Connecting the Utilization Review Process

Springhill Medical Center l Mobile, Alabama

Springhill_HospitalProfile

XSOLIS recenters Utilization Review around the patient, not the payment."

-Michelle D. Allen, former Director of Case Management

As a full-service, acute care facility servicing southwest Alabama, Springhill Medical Center (SMC) provides crucial care to communities in and around Mobile and the Gulf Coast area. SMC’s mission to be the foremost provider in the city is bolstered by its talented team of clinicians, nurses, and staff – each of whom share a passion for providing the best care to their patients and improving the health of their community.

Guiding Care throughout the Gulf Coast

Michelle D. Allen, SMC’s former Director of Case Management [who now works at XSOLIS client Hillcrest HealthCare System], frequently collaborates with her peers across the country and is an active attendee at national and regional case management conferences. At one of these conferences, she and her colleagues were discussing the common challenges case management teams face – workflow shortcomings, day-to-day frustrations, payer relations and fluctuating guidelines – when she was introduced to XSOLIS and its ability to support her team in mitigating these challenges. Michelle immediately saw the value in technology that would allow her team to focus on patients, not guidelines and payment outcomes. As the case management department at SMC reports directly to the CFO, Michelle found her executive team receptive and willing to support her on her quest to find a tool that not only empowered her team but would have a measurable impact on financial and operational metrics. SMC was also searching for external physician advisor services to supplement their second level review process.

A Partnership

After several meetings with the XSOLIS team, SMC’s leadership team knew they had found a partner that would positively impact multiple facets of their organization: technology for case management and utilization review, and physician advisor services for compliance support. After implementing and fully utilizing XSOLIS technology, key metrics at SMC – denials rate, length of stay, observation rate, number of physician advisor referrals – saw a noticeable reduction. XSOLIS “empowers the case manager to make better decisions on status” which “saves them so much time, and allows them to focus on the patient,” said Michelle. As an Allscripts facility, Michelle was at first hesitant about making her staff take additional steps to utilize the XSOLIS platform on top of their workload using the native EMR. XSOLIS’ team stepped in to overcome
this workflow hurdle by interfacing directly with Allscripts, automatically transferring all documentation and reviews from XSOLIS back into the Allscripts system.

“After the usual validation and comparison process, the onboarding [with XSOLIS] was fairly easy,” continued Michelle. “The support we received was great and we introduced [XSOLIS] at the right time. Now, my top nurses save at least an hour and half out of their day by using the XSOLIS platform for case review, enabling them to use that extra
time for conversations with payers and patients.”

Reframing Utilization

Michelle is firm on her stance: “Healthcare is patient care.” While other systems seemed to be working against effective patient-centered utilization management, XSOLIS “is so intuitive to case management, it gives us the time to work around a patient.” Michelle and her team were a part of the testing and refining process for XSOLIS’ predictive DRG (Diagnostic Related Group) capabilities: at Springhill, “our coders do concurrent coding, so in about 48 hours into the patient stay, we know what we’re working with. As we integrate the predictive DRG, we’re looking to correlate the DRG and associated length of stay with XSOLIS’ Care Level Score (a prediction on medical necessity) to not only better capture the clinical merit of each case but identify approaching discharge opportunities – focusing our process squarely around the patient.”

By “offering my staff a tool that helps them be more patient-centered and focused, [XSOLIS] is worth everything to us.”

To hear from Michelle Allen in an on-demand webinar, fill out the form below:

webinar springhill Transforming Payer Provider Relations

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