As revenue cycle management becomes the heartbeat of healthcare administration, providers are seeking to upgrade their tech game, with 62% looking to expand capabilities in the near future. With inpatient denial rates increasing more than 50% in just the last two years, harnessing the power of technology and artificial intelligence in revenue cycle management software is imperative.[1] Al technology can reduce avoidable denials from the offset through better alignment and more accurate medical necessity decisions, in addition to streamlining essential functions in case management, care coordination and utilization review.
Leveraging AI for hospital solutions
Through a partnership between Xsolis, the industry-leading AI and predictive analytics software provider, and Providence Health System, a not-for-profit Catholic health system, Providence streamlined its review processes during an initial 8-month phase, achieving significant benefits including decreasing observation length of stay by 32%, helping to ensure more timely patient discharge—leading to more than $40 million in savings for Providence to date.
The Xsolis software provides constantly updating AI-powered medical necessity scores for patients to reduce administrative work and accelerate utilization review and case management.A flexible display of the patient census in a prioritized work queue helps evaluate patients based on real-time data, which identifies near-term discharges—successfully reducing length of stay and improving patient throughput.
Providence Health System first deployed Xsolis' AI and predictive analytics software in October 2023 at eight hospitals in Oregon and plans to bring it to 28 more facilities across that state as well as Alaska, Montana, New Mexico, Texas and Washington as well as extending the platform to its networked health plans, fostering collaboration between healthcare providers and payers.
Payers benefit from increased collaboration with their connected providers during concurrent authorizations. Bi-directional communication streamlines the authorization process end-to-end and enabling shared objective data and real-time analytics, thereby accelerating alignment—up to 83% faster review times on qualifying automated cases.[2]
To ensure appropriate reimbursement, the platform provides visibility into missed conversion opportunities along with concurrent denial trending and analytics via its Care Level Score—a constantly updating AI-powered medical necessity score. This tool enables easy identification of trends for faster decisions on case reviews and opportunities for process improvement.
"Expanding our collaboration with Xsolis not only streamlines crucial utilization review processes but also sets a new standard in healthcare by leveraging AI to focus our valuable clinical resources on our core mission—caring for our patients and serving the communities across the Pacific Northwest and beyond," said Adar Palis, group vice president of clinical and revenue cycle applications at Providence.
This strategic partnership underscores both the health system’s commitment to setting industry standards for utilizing technology in healthcare, and Xsolis’ commitment to solving some of the most pervasive operational challenges in healthcare today.
A track record of “getting it right”
The expansion builds on Xsolis’ track record as an AI in healthcare leader and is also a testament to Providence’s role as a frontrunner in integrating advanced AI solutions to streamline healthcare operations, reduce administrative overhead and enhance support for care teams, keeping patient care at the heart of their efforts. Xsolis’ purpose-built AI solutions are equipped to elevate the work of clinical staff because of a specialized focus and deep expertise improving medical necessity decision-making.
Xsolis’ solutions focus on leveraging insights from AI within provider workflows throughout the entire lifecycle of care. The platform synthesizes clinical and financial data from EMRs to create a real-time clinical profile of the patient. Xsolis’ AI continuously evaluates medical necessity based on evidence-based medicine and has delivered more than 2.7 billion predictions worldwide since 2013 from billions of data points from relevant cases from both providers and health plans. By recognizing clinical patterns, AI generates highly precise predictive analytics that determine the level and setting of care that is most appropriate for the patient.
Xsolis is a trusted partner to more than 500 hospitals, including many of the country’s top health systems and forward-thinking AI and health tech leaders like Providence.
Joan Butters, CEO and co-founder of Xsolis states, “By challenging the status quo and embracing AI-driven solutions, Providence has demonstrated how technology can be leveraged to improve operational efficiency, enhance care coordination, and ultimately the patient experience. We look forward to contributing to their continued success.”