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XSOLIS' Utilization Review platform, CORTEX®, acts as a shared framework for case review between payer and provider - backed by analytics focused on the true clinical merit of the case.
CORTEX for Payers gives payer staff a real-time view of each patient case escalated to them by the provider, expediting the review process while reducing redundancy - all without the need for digging through the electronic medical record.
When analytics are above a certain threshold, payer and provider agree to automated approval. We call this Precision Utilization Management. You might expect:
Get real-time access to patient medical records
Get guidance on the appropriateness of inpatient status
Reduces friction with provider partners
Healthcare can’t remain a zero-sum game. XSOLIS CEO Joan Butters recently joined Humana SVP George Renaudin for an in-depth discussion on the state of today’s payer-provider relationships.
Their conversation covers three themes: zooming out to the status quo and why it can’t stand; zooming in to what XSOLIS and Humana are doing to transform the discipline of utilization management; zooming back out to how the industry can adopt this forward momentum.