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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.
As AI-driven technology and solutions continue to prove their value, precision, performance and productivity will increase the quality of care patients receive and pave the way for the data-driven future of healthcare. Yet without the proper framework, even advances in technology don’t mean that individuals and organizations make the most out of the opportunities that arise.
Uniting human knowledge with advanced technology is the core of the smart utilization methodology. Hospitals can use the five pillars of smart utilization as guideposts for creating their own smart utilization processes and workflows.
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.