Real-Time Visibility, Proactive Care: Beacon Health’s Data-Driven Approach Using AI
Beacon Health System’s utilization review and case management success, according to Heather Wagner, MBA, BSN, RN, Director of Utilization Review and Case Management, hinges on embracing the following three mindsets across the organization.
- Agility is crucial to analyze operations and quickly pivot to improve patient and financial outcomes.
- It’s vital to not be afraid of challenging how things have historically been done.
- Innovating processes to ensure the best-fit workflows is vital to ensure success.
Beacon Health’s partnership with Xsolis has enabled Heather’s team to execute on all three approaches since the beginning of the partnership in 2019.
Since 2019, when Beacon Health implemented the Xsolis platform, Dragonfly, change has been the only constant. But Heather’s team has relied on standardization and consistency, enabled by Dragonfly’s AI and machine learning capabilities and predictive analytics.
“The biggest benefits of working with Xsolis are consistency and standardization,” said Heather. “With Xsolis, I am assured that when my nurses review a chart, they’re all reviewing it the same way with the same lens, ensuring a very consistent process and leading to improved outcomes.”
A cornerstone of streamlining utilization review across Beacon Health System is Xsolis’ Care Level Score™ (CLS™), which allows Heather’s team to quickly determine which cases need to be prioritized and reviewed. The Beacon Health Utilization Review and Case Management teams use the CLS as their truth, and even their Leadership Team is familiar with the model that drives patient care decisions. Heather says that by utilizing objective data insights provided by Dragonfly, “my team can review patients in the hospital in real-time to make the best decisions about which patients need our immediate attention and any necessary pivots in our care strategies across the health system.”
These improvements, enabled by partnering with Xsolis, have been matched only by the increased efficiency in utilization review and case management across Beacon Health. Since 2019, Beacon Health has added two hospitals to their health system, yet they only needed to add one nurse FTE to manage the workload. This was due to the increased productivity created by utilizing Dragonfly.
Beacon Health’s Collaborative Approach to Payer Alignment
Heather emphasizes that forging collaborative partnerships and relationships with health plans is another vital element in enhancing the utilization review and case management process. Beacon Health was originally connected with three health plan partners through Dragonfly. In December 2023, Beacon Health implemented Precision UM with a large national health plan. Using AI and machine learning, Precision UM automates inpatient determinations that are mutually agreed upon by both parties.
“Connecting with payers through Dragonfly has allowed us to significantly decrease administrative tasks,” Heather said. “By utilizing Xsolis’ Precision UM with a large national payer, we’ve seen specific cases automatically approved. This enables our clinicians to focus their time and expertise on the more complex, ‘gray area’ cases, ensuring we make the best decisions for the appropriate level of care.”
In addition to using Precision UM with a large national payer, Beacon Health’s Utilization Review Team has implemented an innovative approach with one of their commercial health plans to increase alignment. Biweekly, Beacon Health physician advisors meet with the health plan medical directors to conduct face-to-face, peer-to-peer clinical rounds.
Heather highlights the face-to-face conversations as highly productive, leading to workflow optimizations and improvements in the quality of care. Furthermore, this collaboration has expanded beyond utilization review.
“Improving the relationship and collaboration with this commercial health plan partner throughout the utilization review process has allowed Beacon Health to expand this to case management and contracting,” said Heather.
Harnessing the Innovative Power of AI Beyond Utilization Review
Building on Beacon Health’s initial AI successes with Xsolis, they have significantly accelerated the use of AI over the past six to nine months. ”Beacon Health is focused on leveraging AI as a tool to enhance the work we do each day,” said Heather. “Xsolis led the charge in terms of AI-powered solutions utilized at Beacon Health, which we implemented back in 2019.”
This year, Beacon Health took their AI efforts a step further by creating a dedicated department to identify and implement AI tools that can improve efficiency across the organization. Recently, Beacon Health implemented an ambient listening tool to help their primary care physicians ensure complete and timely clinical documentation during patient visits. Their hospitalists will be the next group to use the tool.
Beacon Health is also exploring generative AI, having agreed to be a development partner for Xsolis’ GenAI tool for initial reviews. This is expected to enable Beacon Health’s nurses to focus more on critical thinking and patient care, rather than spending time on documentation.
In addition to new AI initiatives, Beacon Health is excited about their migration to Xsolis’ Dragonfly platform, formerly known as CORTEX. The health system transitioned to Dragonfly in October 2024, with the goal of optimizing workflows and reducing the cognitive burden on their nursing staff. Heather reports that within the first week, Beacon’s nurses not only expressed their enthusiasm for Dragonfly, but also praised the unmatched partnership and support they’ve received from Xsolis, unique among their experiences with other vendors.
Far beyond a typical vendor relationship, Xsolis has become an integral, indispensable ally in Beacon’s journey of innovation and agility.
“Xsolis is not just a vendor or third party,” Heather affirms, “but a true partner that walks alongside us, supporting our every strategic pivot and adjustment.” In an industry rife with challenges, this level of commitment and collaboration has proven vital to Beacon’s success.
Heather said Xsolis is “here to truly partner with their clients and support them” – a testament to the power of a partner that advocates relentlessly, bringing the latest innovations to help health systems like Beacon Health achieve their most ambitious goals.