Navigating the Challenges of Doing More with Less in a Growing Healthcare System
Dr. Debbie Schardt, MBA-HCA, RN, AVP of Revenue Cycle and Utilization Management at MultiCare Health System, acutely feels the weight of trying to do more with less at her health system. At MultiCare Health System, which comprises 13 hospitals, a behavioral health network, and a network of clinics and is growing quickly, Debbie’s team oversees utilization management (UM), which is a support service within revenue cycle. Her team manages the notification of admission, the concurrent review process, behavioral health utilization review, concurrent denials and appeals, and retrospective audits and denials. The physician advisor group also reports up through Debbie’s team.
Her team understands the pressing need to continually work smarter, not harder, to improve patient and financial health outcomes. This is critical given the significant administrative waste in the U.S. healthcare system. Studies estimate that administrative costs account for 34% of total U.S. healthcare expenditures, over $1 trillion annually¹.
This burden on healthcare professionals significantly affects patient care and contributes to widespread burnout. In fact, almost three-quarters of healthcare workers report that the time and effort required to complete clinical documentation impedes their ability to provide optimal patient care². Moreover, 1 in 3 healthcare workers plan to leave their job within the next year, underscoring the severity of this issue³. Recognizing these challenges, Debbie and her team aim to alleviate the strain on healthcare staff and improve overall job satisfaction and system performance, ultimately enhancing patient care and outcomes.
Transforming Utilization Review: From Operational Efficiency to Strategic Alignment Using AI
In 2016, Debbie’s team faced organizational changes as utilization review moved under revenue cycle. The team now collaborates across MultiCare’s revenue cycle, including patient financial services, clinical documentation improvement (CDI), and health information management (HIM).
In 2017, MultiCare implemented Xsolis’ AI-driven and machine learning platform and Xsolis helped facilitate this transition. According to Debbie, “The Xsolis platform initially increased our efficiency and contributed to centralizing our UM program as workflows improved and became more consistent.”
With such a broad scope, Debbie’s team needed to better understand which patients required their attention. Utilizing Xsolis’ Care Level Score™ (CLS), driven by real-time predictive analytics and machine learning, the team can appropriately prioritize patients and ensure they’re reviewing the right cases at the right time. This has allowed them to streamline the UM process, leading to workforce optimization and decreased staff burnout, as the team can now focus on true clinical work.
“Xsolis empowers our nurses to have more meaningful conversations with providers and physician advisors about cases that may need better documentation, which can then be presented to the UM Committee,” said Debbie. “This makes them feel empowered to make a difference.”
Eight years into the partnership with Xsolis, Debbie’s team has gone beyond optimizing MultiCare’s UM workflows. Xsolis’ AI-driven solutions now help the team create, implement, and activate their UM strategy to drive improved patient outcomes, and enhanced system financial performance.
“The Xsolis platform helps us make strategic decisions,” said Debbie. “It enables our staff to work more efficiently at the top of their licenses, and it fosters an environment of greater employee engagement.”
Xsolis-Enabled Collaboration: Transforming MultiCare’s Relationships with Health Plan Partners
Although working with Xsolis ensured a seamless UM process at MultiCare, Debbie’s team still faced challenges when it came to collaborating with their health plan partners. Prior to utilizing the Xsolis platform, Dragonfly (formerly CORTEX), the only real collaboration between MultiCare and their payers was via the EMR. MultiCare was one of the first providers on the Dragonfly to connect with health plans through the platform. According to Debbie, “Xsolis put a tremendous amount of thought into the strategic decision to bring health plans onto the platform.”
MultiCare now collaborates with three health plans through Dragonfly and utilizes Precision UM – automating appropriate cases based on historical alignment – with one of those health plans. Debbie’s team also now has collaborative meetings with their health plans to discuss stalled cases, noticeable patterns, and any issues. Both parties can now come to the table and say, “we need to do this better for all of us and for the patient,” and both teams feel better leaving those conversations.
“The biggest benefit from connecting with health plans via Dragonfly is efficiency. We have opened a channel of communication that we’ve not had before with health plans, allowing both parties to focus on and review the most complex cases.”
Dr. Debbie Schardt, MBA-HCA, RN
AVP of Revenue Cycle and Utilization Management
MultiCare Health System
MultiCare and Xsolis: A Collaborative Partnership for Navigating Healthcare’s Complexities with Significant ROI
Throughout her career, Debbie has worked with hundreds of vendors. However, she says that Xsolis stands out for its excellence and collaboration with their clients. As Debbie explains, “Xsolis has a unique product that has transformed the utilization review process and disrupted the industry – which was sorely needed. We desperately needed change, and Xsolis delivered it.”
And although there is always a cost to doing business, including the cost of change, MultiCare has experienced a significant return on investment. Using Xsolis’ AI-powered technologies, MultiCare’s clinicians were able to work more efficiently and collaborate more effectively with their health plan partners. This resulted in savings of over $8 million for MultiCare in the 2023 calendar year alone
Beyond the financial benefit, Debbie states that working with Xsolis “has improved employee satisfaction and retention. I would strongly recommend Xsolis to any prospective client, as they will reap tremendous financial and strategic benefits.”
The healthcare system is facing significant financial pressures, administrative burdens, and staff burnout. With various stakeholders and competing priorities, it’s easy to lose sight of the most important stakeholder – the patient. However, Debbie notes that Xsolis helps her team at MultiCare foster more meaningful conversations and ultimately improve patient outcomes. “By making the right choices up front through our partnership with Xsolis, we’re doing better by our patients,” Debbie said.
¹ https://www.mckinsey.com/industries/healthcare/our-insights/administrative-simplification-how-to-save-a-quarter-trillion-dollars-in-US-healthcare#/
² https://brand.amia.org/m/3756a1d9ddf0ea58/original/PowerPoint-Presentation.pdf
³ https://www.tebra.com/theintake/medical-deep-dives/tips-and-trends/staffing-shortages-and-sleep-deprivation-the-post-covid-healthcare-crisis