From escalating costs, clinician shortages, and budget cuts, health systems across the country are facing operational and financial hurdles. Among the most problematic issues are high denial rates, leading to significant revenue loss and administrative burden. Coupled with this, inefficient communication channels between health systems and payers often result in strained relationships, delayed patient care, and an overwhelming amount of unnecessary manual work like faxing, phone calls, and paperwork. This administrative overload diverts time and resources away from direct patient care and crucial clinical reviews, hindering overall efficiency and the ability to achieve organizational goals.
AnMed, a health system committed to high-quality patient care and operational excellence, faced these challenges. Recognizing the need for a transformative solution, they turned to Xsolis and its AI-powered platform to automate and streamline utilization management and support case management. AnMed's journey with Xsolis, starting with CORTEX and evolving to the advanced Dragonfly platform, is a case study in how strategic AI adoption can impact a health system including increased operational efficiency and staff satisfaction, strengthened payer collaboration, and a more sustainable way to ensure high-quality patient care.
The implementation of Dragonfly marked a shift in AnMed's operational efficiency. The platform’s AI capabilities were instrumental in optimizing workflows and prioritizing cases, ensuring that clinical teams could focus their efforts on the most complex patients.
Shelley Stone, Director of Care Coordination, Utilization Management, and Clinical Documentation Integrity at AnMed, captures this impact: “Xsolis has helped us become much more efficient, leading to increased productivity and staff satisfaction. The platform facilitates better internal communication between our UM nurses, advisors, and providers, and allows us to focus our clinical expertise on ensuring patients receive the care they need.”
By automating much of the manual, administrative work, Dragonfly effectively reduced the administrative lift that previously consumed significant staff time. This efficiency translated directly into improved patient throughput, as staff could dedicate more time to complex cases and those requiring physician advisor escalation.
As Stone highlights, "The Xsolis platform helps us prioritize patients who need the most attention, improving patient throughput and resource management. We can now reallocate staff to focus on more complex cases or those requiring escalation to our Physician Advisors.”
Beyond operational gains, utilizing Dragonfly has significantly boosted staff satisfaction. Initially, there was apprehension among staff when introducing AI into their workflows, fueled by concerns about job displacement. However, these anxieties quickly dissipated as the AI platform quickly allowed clinical professionals to leverage their skills more effectively. Staff found that their jobs became more focused and less burdened by tedious tasks, leading to increased job satisfaction. They realized that Xsolis enhanced their value within the organization by freeing them to tackle new projects and areas of work previously out of reach.
An important area of impact for AnMed has been in payer collaboration and the accurate assignment of patient status. Achieving consensus with payers on inpatient versus observation status was a source of constant friction and high denial rates. Xsolis' Precision UM, particularly with a large national payer, revolutionized this dynamic. Precision UM is the highest level of automation that occurs between payers and providers, as both parties agree to automate appropriate case decisions based on historical alignment. By aligning on agreed-upon Care Level Score™ (CLSTM) thresholds, patients are now automatically assigned the correct status, significantly reducing manual reviews and administrative back-and-forth.
Stone elaborates on this: “Utilizing Precision UM with a large national payer helps us, on both sides, avoid unnecessary review and administrative work. Based on agreed upon CLS thresholds, patients are automatically placed in observation or inpatient status or may require further review. This agreement prevents abrasion between AnMed and our payer partner.”
This real-time collaboration has not only dramatically reduced observation rates for AnMed – seeing a drop from the high forties and fifties for Medicare Advantage plan payers to an overall 19-22% – but has also fostered a more cooperative relationship with payers, benefiting both sides. The ability to provide an accurate representation of patient acuity is also important for compliance and financial integrity and has led to a substantial return on investment.
The impact of working with Xsolis extends to case management and direct patient care.
Stone emphasizes how Xsolis data is integrated into daily rounding: "At AnMed, we utilize Dragonfly not only for utilization management, but also to support case management. We incorporate Xsolis data, including Geometric Mean Length of Stay (GMLOS) and real-time patient status, into our daily rounding. The Care Level Score™ enables treating providers to see patient acuity in real-time."
This provides nursing units and case managers with real-time insights into patient status, GMLOS, and acuity, fostering a deeper understanding of the utilization review process and the importance of accurate documentation. This awareness ensures that care is tailored to each patient's needs and accurately reflects the services that are provided.
"Ensuring patients receive the right care, at the right time and place, is vital for patient satisfaction. Xsolis supports this by accurately displaying patient acuity. This helps our teams provide care tailored to each patient's needs and gives an accurate representation of the care provided to other departments at AnMed as well as to payers,” says Stone.
Looking to the future due to the success they’ve experienced, AnMed is interested in expanding its utilization of Xsolis' AI capabilities. One significant area of focus is the emergency department (ED).
"We're also exploring innovative ways to utilize Xsolis' AI technology for patient status in the ED. Our goal is to initiate patient reviews as soon as they enter the ED, as the faster we can start that process, the better," notes Stone. This proactive approach aims to improve efficiency and accuracy from the start of a patient's journey at the health system.
AnMed also sees potential for AI to enhance post-acute care planning. "We would also like to further leverage Xsolis' AI capabilities in our case management work, specifically to help predict the appropriate post-acute care setting. Can we utilize AI to better plan for patients' post-discharge needs, ensuring appropriate length of stay and reducing readmissions?" said Stone.
This approach underscores AnMed's commitment to continuous improvement, using AI not just for current challenges but as a tool to optimize the patient continuum of care and ensure success in an evolving healthcare environment.
To learn more about Xsolis’ solutions visit www.xsolis.com.
The editorial staff had no role in this post's creation.