Humana Using Communication & Analytics Platform For Utilization Review With Participating Providers
XSOLIS, the company solving operational challenges in healthcare, is partnering with Humana Inc., a leading health and well-being company, to offer its real-time, predictive analytics platform for utilization review processes between Humana and participating providers. Alongside and in collaboration with participating XSOLIS client health systems, Humana will be adopting Precision Utilization Management (Precision UM), a process by which XSOLIS analytics identify and stratify a subset of member cases for “touchless” status determinations for medical inpatient treatment. These touchless determinations ensure that clinicians at both hospital and health plan have more time to focus on the person, not the process, ensuring appropriate care is matched with the right coverage, each time.
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XSOLIS’ SaaS platform, CORTEX®, extracts data directly from the hospital electronic medical record and analyzes the full clinical picture for each patient throughout their hospital stay. CORTEX is available online and on-demand to staff at both hospital and insurer and provides a complete, analytics-driven view of patients. With CORTEX, providers can escalate certain cases to Humana to be reviewed and approved in real time. CORTEX facilitates interaction between payers and providers during the utilization review process, eliminating the friction and much of the administrative work typically experienced during review activities.
“Our relationship with our providers is paramount,” said George Renaudin, Senior Vice President at Humana. “XSOLIS offers us the opportunity to significantly reduce provider abrasion, increase our review effectiveness and streamline our efficiency in care management on behalf of our team and health plan members. We were the first of our peers to pilot this new approach to utilization management and we are proud to engage a growing list of participating providers in adopting this framework.”
“We have an unprecedented opportunity to create a future where each person – as a patient and a member – receives care that is adequately and efficiently managed,” said Joan Butters, Chief Executive Officer at XSOLIS. “Our partners at Humana saw the opportunity to create this change in the industry and together with their provider partners, have made a leap forward with true innovation. Together, we are seizing the opportunity to reframe how payers and providers determine medical necessity and manage utilization to create a smarter future for healthcare.”
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