Maximize Your  Health System's Utilization Management Impact

For many healthcare systems, Utilization Management has shifted from a patient-centered service to an administratively frustrating body of work.

CORTEX® changes all of that.  CORTEX starts with real-time EMR data, centers on predictive analytics, and ends in a technology platform that gives hospital staff a clear view of medical necessity for each patient. CORTEX also acts as a conduit with your payer partners, enabling a new level of collaboration and communication.

Schedule Demo
XSolis2-01[3]

Improved Efficiency 

Traditionally nurses start at the top of their daily census and work their way down treating the daily census as an all-or-nothing approach, giving all cases an equal priority. CORTEX uses artificial intelligence and machine learning to identify cases that are mostly like at risk to help nurses spend more time on the cases that actually need the most support. 

  • Nurses can start on high priority, high-risk cases to best utilize their time 
  • Helps standardize workflows
  • Patient data flows from the EMR directly into the platform.   

The average CORTEX client sees a 30% efficiency gain.

Improved Efficiency

 

 

Better Payer Communications

CORTEX makes payer relations seamless and collaborative.  With CORTEX, payers and providers see all of the patient’s data per encounter in real-time without the need for faxes, emails, or phone calls.  CORTEX acts as the source of truth for medical necessity on each case, offering a shared framework of analytics and insight. 

  • Gets payers and providers on the same page using the same tool 
  • Significant reduction in case touches, administrative work, and appeals burden 
  • Cases are statused upfront, expediting the review process 

Up to 40% of inpatient cases can be automated with 99% accuracy 

Payer Communication

 

 

Inpatient Conversions

CORTEX uses XSOLIS Analytics to give recommendations on the appropriate status of a patient based on the patient's labs, vitals, medical history, orders, meds, and procedures.  If the recommended status is different from the assigned status, the UR team will be notified of the conflict and empowered to take action.

  • 24/7 monitoring of all patient information 
  • Find inpatient opportunities as soon as the patient demonstrates clinical merit
  • Identify opportunities earlier in the shift to allow time for resolution 

 An appropriate Observation rate reduction of 8.7% is typical for CORTEX users in their first year. 

INPT Conversions

 

 

Denial Risk

 

A denial costs the hospital valuable revenue, wastes the time of a physician advisor, and can lead to a cycle of appeals.  CORTEX uses evidence-based medicine to help find patients set as INPT that may not have the clinical documentation to support Inpatient status.  CORTEX gives real-time alerts when a patient's status does not square with the clinical merit, giving your staff the insight they need to prevent downstream denials.  

  • Automated presentation of patients’ conditions  
  • Data-driven evidence-based medicine 
  • Real-time alerts for status “discrepancies​” 

32% Denial reduction is common for many CORTEX users. 

Denial Risk

 

CORTEX allows health systems to take a new approach to UM

  • Automatically identification and stratification of cases
  • Automated, clear presentation of patients’ conditions  
  • Data-driven insights based on evidence-based medicine 
  • Real-time alerts  of status “discrepancies​" 

 

Don't Just Take It From Us

Below you'll find select resources aimed at supporting and informing health system leaders - from supplementing the role of the physician advisor to adopting centralized review to reframing payer relations through analytics, schedule a demo today to learn how XSOLIS can support you.

resources sherri
CASE STUDY

Covenant Health (9 hospitals)

Covenant Health not only transformed their UR, but how they collaborate with payers on utilization management.

View Case Study →
AdventHealth Webinar Cover
WEBINAR

AI in Healthcare: The Benefits to UR

AdventHealth in Florida shares how they are using artificial intelligence to support utilization review and physician advisor staffs. 

View On Demand →

mark roberts
VIDEO

Mark Roberts, Banner Health

Mark Roberts, Director of Care Coordination, shares his experience at the XCHANGE conference and with the CORTEX platform.

View →