Xsolis and Beacon Health System Leverage Gen AI to Make Medical Necessity Reviews More Efficient

AI is popping up everywhere in healthcare.  The problem is that there is a lot of vaporware out there which talks of leveraging AI, but hasn’t actually implemented it yet.  That’s why it was refreshing to learn about Xsolis leveraging generative AI to help Beacon Health System with the challenge that is medical necessity reviews.

To really dive into the details, I sat down with Heather Wagner, MBA, BSN, RN, Director of Utilization Review and Case Management at Beacon Health System and Wendy Reynolds, DHA, MBA, BSN, RN, Director of Clinical Consultants at Xsolis.  We kick off the interview by learning about why Beacon Health System originally chose to partner with Xsolis a number of years ago.  Wagner shared the details of that decision and some of the impact their organization experienced moving the largely paper processes into electronic ones. For example, Xsolis enabled their utilization review team to work remotely and serve a higher volume of patients.  Plus, she shared how the move to Xsolis benefited their organization as they added new hospitals – applying Xsolis’ standardized processes to achieve more consistency.

Then, we dove into Xsolis’ implementation of generative AI tools that complement their predictive AI.  Beacon Health System was the first to raise their hand to pilot a medical necessity use case.  Wagner shared details about how gen AI really benefitted her team and how she approached implementation of the solution.

We also asked Reynolds to share how payers have responded to this change and some of the benefits of gen AI being applied to this use case.  Wagner describes how the 3-month pilot helped her team to reduce the time it took to do the initial review by 68%.  They went from spending 15 minutes on average to 4.7 minutes to complete the initial review.  This was a significant time savings that allowed her staff more time to focus on nursing duties and feel more accomplished at the end of their workday.

As we wrapped up, Reynolds shared what other gen AI tools are on the horizon at Xsolis and how they’re working to continue reducing the administrative burden in healthcare for providers and payers.  Plus, as we head into the HFMA Annual conference, I asked Reynolds and Wagner to share what their peers at HFMA and other financial or clinical leaders need to know if they’re considering this gen AI solution, or others like it.

“We’re dealing with payers and trying to reduce that friction,” said Wagner, “so if that nurse on both sides of the table is reviewing the same information in the same format, it allows them to have a fair say of what’s best for the patient in each case.”

Check out our interview with Heather Wagner at Beacon Health System and Wendy Reynolds at Xsolis to learn more about how they’re leveraging great technology and AI to reduce the administrative burden on their healthcare staff.

Learn more about Beacon Health System: https://www.beaconhealthsystem.org/

Learn more about Xsolis: https://www.xsolis.com/

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