Aligning Stakeholders with the “Why” to Drive Transformation in UM & Case Management
In the spring of 2021, Carle Health’s Brandie Anderton, RN, BSN, MSN, Director of Inpatient Case Management, Central and West Region and her team in Utilization Management (UM) and Case Management recognized the need for a more standardized approach to their daily operations. With support from their dedicated Xsolis Nurse Optimization Consultant, they redesigned their workflows, integrating Xsolis’ Care Level Score™ (CLS™) and machine learning capabilities.
According to Brandie, “The Xsolis platform significantly improved our efficiency and played a key role in our decision to centralize our UM program. As our workflows became more streamlined, the system’s consistency and precision made a noticeable difference.”
This collaboration not only optimized Carle Health’s UM and case management workflows but also allowed the organization to strengthen its Physician Advisory Program.
“Xsolis helped us refine our workflows, especially when it comes to determining patient status in the ‘gray zone,’” Brandie explained. “We’ve also been able to ensure that our physician advisors are reviewing the right cases at the right time.”
Moreover, Xsolis’ Dragonfly has enabled Carle Health’s UM nurses to engage more thoughtfully with each case and participate in more impactful discussions to improve patient outcomes.
However, as many in healthcare can attest, implementing change isn’t always easy—particularly when it challenges longstanding practices. To ensure the successful adoption of Dragonfly across the health system, Brandie and her team had to carefully manage change. One of their key strategies was to help all stakeholders understand why the transition was necessary, and how it connected to their everyday tasks.
“A critical part of driving adoption was educating our teams about how Xsolis’ AI capabilities would improve care delivery and ultimately benefit our patients,” she emphasized. “Once everyone understood the ‘why,’ we saw greater alignment and commitment across the board.”
Bridging the Payer-Provider Divide with AI-Driven Technology
Carle Health’s UM and Case Management team then partnered with Xsolis to connect with health plans through Dragonfly. This collaboration has opened a new, more efficient channel for communication between the health system and its payers.
“Using Dragonfly to connect with health plans has created a streamlined process we didn’t have before,” Brandie said. “Now, both parties can collaborate more effectively, especially when reviewing complex cases.”
The increased efficiency has been one of the biggest benefits of this ongoing collaboration. Carle Health’s UM team can now build stronger, more productive relationships with health plans, and Brandie is optimistic about how these relationships will continue to evolve.
“As we expand our partnerships with more health plans and move away from traditional UM processes, we’re hopeful that this approach will help reduce the friction between payers and providers,” she said. “We’re working toward a more seamless, collaborative process for all involved.”
Carle Health & Xsolis: A Partnership Driving Transformative Change
Implementing these significant changes in UM and case management wouldn’t have been possible without the continuous support of Xsolis.
“The expertise Xsolis provides—especially with team members who have clinical backgrounds—has been invaluable,” Brandie noted. “Having someone who understands the nuances of UM nursing and can connect the dots for us is critical to the success of this initiative.”
As Carle Health adapts and pivots to meet the evolving needs of its UM and Case Management teams, Brandie knows she can rely on her Xsolis account team for swift resolutions to any challenges that arise.
“Xsolis is incredibly responsive and genuinely values client feedback,” she said. “They listen to our needs, and they don’t hesitate to implement effective solutions in real time.”
Thanks to the partnership with Xsolis, Carle Health has been able to empower its team to deliver high-quality, adaptable patient care. The combination of advanced technology and dedicated consultative support has allowed the organization to optimize workflows, foster better collaboration both internally and with payers, and ensure that patients receive the best care possible.