Utilization Management Centered on a Clear Patient View, Not the Administrative Process

For many hospitals, 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.

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Equip your organization for financial success and operational efficiency

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 most likely at risk to help nurses spend more time on the cases that 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 helps payer relations be 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 on medical necessity for each case, bringing payers and providers together to review cases with the same 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 up front, greatly expediting the review process 

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

Payer Communication

 

 

Inpatient Conversions

CORTEX predicts 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 current actual 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 qualifies 
  • 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 money, wastes the time of a physician advisor, and can reflect poorly on the hospital.  CORTEX uses evidence-based medicine to help find patients set as INP that may not have the clinical documentation to support Inpatient status.  CORTEX gives real-time alerts when a patient's status does not equal the patient's clinical conditions.  

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

32% Denial reduction is common for many CORTEX users. 

Denial Risk

 

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CORTEX gives hospitals the chance 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​" 

Your peers have taken the next step. Learn more from our clients:

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CASE STUDY

Cititzens Medical Center - TX

XSOLIS partnered with CMC to quickly and decisively get their facility live with utilization review technology to support their team before another vendor's contract ended.

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CASE STUDY

Springhill Medical Center

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

View Case Study →

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VIDEO

Renee Dunagan, Citizens Medical Center

Renee Dunagan, Supervisor of Case Management at CMC in Victoria, TX, shares the impact CORTEX has had on her hospital.

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