Partnering with Xsolis to Innovate UM & Improve Outcomes

In the search for a more sustainable approach to case management and UM, UMC Health partnered with Xsolis to help them reach their goals and improve outcomes. By partnering with Xsolis, UMC Health aimed to:

• Enhance the accuracy and timeliness of patient status determinations
• Strengthen alignment with health plan partners on the appropriate level of care
• Improve utilization review efficiency, enhance length of stay management, and optimize staff allocation
• Proactively identify and address potential inpatient-only conversions prior to discharge
• Optimize denial management processes

Enhancing Utilization of the Xsolis Platform

Although UMC Health implemented the Xsolis CORTEX (now Dragonfly) AI-driven platform in October 2020, they realized they weren’t utilizing it to its full potential to drive sustainable, impactful change. According to Kayla Long, Director of Case Management, “We re-engaged our staff to use the Xsolis platform to its full potential – leveraging the decision matrix, developing workflows with staff input, and holding weekly meetings.”
 

“We re-engaged our staff to use the Xsolis platform to its full potential – leveraging the decision matrix, developing workflows with staff input, and holding weekly meetings.”

– Kayla Long
Director of Case Management
 
 

Optimizing the Xsolis platform also involved integrating the Care Level Score™ (CLS™) as a prominent feature in UMC’s EMR. The CLS is a numerical calculation that represents the likelihood of a patient’s appropriate status, powered by Xsolis’ real-time predictive analytics and machine learning.

Improving Collaboration & Streamlining UM with Health Plan Partners 

Realizing the need to improve collaboration and alignment with their health plan partners, UMC Health utilized the Xsolis platform to connect with several health plans, allowing them to access the same clinical data. The health system also now directly escalates clinicals to these health plans using Dragonfly.

The next phase involved implementing Precision UM with a large national health plan to ease the administrative burden and streamline review processes. Precision UM automates inpatient determinations agreed upon by both parties (UMC Health and the health plan), eliminating the need for unnecessary back-and-forth communication via faxes, emails, or phone calls. According to Dr. Amy Sikes, Physician/Physician Advisor of Utilization Review and Case Management at UMC Health System, utilizing Xsolis’ Precision UM allows their staff to focus on the cases that need a closer review and coordinate care with the multidisciplinary team to improve patient flow and length of stay. 

Leveraging AI to Manage Length of Stay

In September 2023, UMC Health implemented CM Analytics (now Navigate AI) to help manage length of stay. This included placing the target discharge date and the likelihood to discharge in the EMR banner bar, which has provided the following benefits:

• Enables real-time conversations about patients still in the hospital
• Connects care teams and creates transparency with patients, nursing, and medical staff
• Aligns resources to the analytics to create efficiency 
• Embeds the insights directly into the clinical workflow, creating awareness

Experiencing Operational Improvements & Financial Impact

“The results (with Xsolis) are simpler workflows and processes as well as significantly improved collaboration between our internal teams and payer partners,” according to Dr. Sikes. The successful partnership has yielded:

• 5.3% improvement in reviews completed within 24 hours from December 2022 to November 2023
• 3.8% decrease in observation rate from December 2022 to November 2023
• Increased efficiency and reduced administrative burden by automating inpatient and observation cases
• Accurate patient status determinations using the Care Level Score™ (CLS™) to match reimbursement
• Ability to prioritize cases needing attention, reviewing the right cases at the right time with the right resources

Streamlining workflows with Xsolis has improved revenue capture by over $800,000 through appropriately identifying real-time patient status changes resulting in IP conversion opportunities. This also enabled the UMC Health Case Management department to be more efficient, allowing them to work with more patients directly. The Case Management staff can now focus more on care coordination, including expediting plans of care, leading to a 20% reduction in length of stay and a 21% improvement in patient flow. According to Dr. Sikes, “With Xsolis, we are doing way fewer reviews which has allowed me to focus on important initiatives like length of stay management and discharge planning improvements.”