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Consuming up to 30% of overall healthcare spending while increasing annually, waste and administrative complexity are eating healthcare . As the lifeblood of revenue operations for their organizations, practitioners of utilization review – both nurses and physicians – are the first line of defense against these threats. In the age of Big Data, these leaders can leverage new methods, technologies and the latest advances in computer science in their quest to build the smarter future of healthcare.
Payers and providers have for too long been at odds when determining medical necessity. Without a shared framework for making level of care determinations, reimbursement and care remain misaligned. Standards are only effective if they are accepted and adhered to by all parties. Traditional criteria have not adapted to the changing needs of today’s healthcare system; however, real-time predictive analytics serve as a neutral framework to bridge the divide between payer and provider.
2018 has been a pivotal year in healthcare; in 2019, innovation will continue to accelerate. This white paper explores trends that are shaping the conversation on utilization management. Where will 2019 lead us? Read on for our key insights and hear from our CEO, Joan Butters.
While innovation is rapidly transforming operations and decision-making, traditional screening criteria still rely on solitary, diagnosis-specific data points to drive determinations.
This white paper explores how XSOLIS' Artificial Intelligence helps nurses and clinicians produce accurate, defensible decisions on severity of illness and intensity of service.