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Problem Tech Solves

Tech Brief

Healthcare is rife with friction, which has contributed to a health system that is mired in inefficiencies. XSOLIS is the key to transforming this opposition into a beneficial partnership between stakeholders in healthcare decision-making. Using its rich datasets, XSOLIS creates an aggregated view of clinical data that increases alignment and ensures a more efficient healthcare system that benefits providers, payers, and consumers alike. CORTEX acts as a shared framework for case review and authorization between payer and provider. Its objective clinical insights enable task automation within utilization review, increasing workflow efficiencies so clinicians can engage in more meaningful work. Payers, in turn, have a trusted and auditable framework for processing status determinations and automating authorizations, reducing costly and time-consuming back-end work. This gives payer staff a real-time view of each case escalated to them by the provider, expediting the review process while reducing redundancy – all without needing to dig through the electronic medical record. Payers and providers can also jointly set an analytics threshold for automating inpatient determinations based on true clinical merit, a process XSOLIS calls Precision UM.

Tech Differentiators

XSOLIS’ proprietary Care Level Score + Machine Learning is what truly sets the company apart. Grounded in evidence-based medicine and supported by artificial intelligence, XSOLIS continuously analyzes the full spectrum of real-time patient data directly from electronic medical records to assess a patient’s likelihood of inpatient status. It then assigns each patient a corresponding score ranging from 0-157, with scores greater than 75 indicating a higher likelihood of inpatient and scores less than 75 indicating a lower likelihood. This determination offers a clinically driven assessment of patient status and objective medical necessity, empowering providers to make actionable decisions based on real-time insights. To enable this, XSOLIS' machine learning technology churns through hundreds of billions of datapoints across its customer network. CORTEX intakes and stores these datapoints to present an index score that helps determine criteria for inpatient care in the unique healthcare setting, region, and insurer markets. By taking a continuous, objective look at all factors surrounding a patient’s care, utilization review teams can streamline workflows and focus efforts on revenue-sensitive and mismatched cases – saving time and money by removing a large amount of data gathering for nurses and allowing them to focus on the patient’s clinical picture. The Care Level Score (CLS) was designed to be intuitive to clinical decision-making, assessing the complete view of the patient and aligning with how doctors approach patient diagnoses. CORTEX then leverages the CLS to prioritize case review, enabling nurses and clinicians to undertake more accurate, efficient, and defensible reviews for medical necessity decisions.


Covenant Health, a Knoxville, Tennessee-based nonprofit health system that includes nine acute-care hospitals, sought to reduce denials while improving the utilization management team’s workload by allowing them to focus on managing care and performing key clinical reviews over manual, clerical work. After go-live with XSOLIS, Covenant Health saw a 10% average monthly decrease in concurrent denials which increased to a 50% average monthly decrease, reduced case touches and duplicative administrative work for both their staff and the payer, and enhanced payer relationships. While Covenant Health was undergoing EMR conversion, Humana Mid-South identified that it was going to lose access to Covenant’s EMR records. Both parties could not afford to go back to faxing and turned to XSOLIS for a better, more collaborative solution, which was concepted in 2017 and went live in 2018. As a result, XSOLIS continues to save Humana 15-17 minutes per case review and identifies and eliminates case reviews with 99% or higher accuracy on 40% of all inpatient cases. Doylestown Health, a nonprofit multi-specialty hospital outside of Philadelphia, was looking for a better way to approach utilization review amid nursing shortages and staffing issues. After adopting XSOLIS’ solution in 2019, in just six months Doylestown had improved observation rates by 20%, improved observation to in-patient conversion by 37%, and experienced a 4.6x return on investment. Three years later, Doylestown Health is currently experiencing around 7.23x ROI, and has increased employee job satisfaction by creating a more efficient way to review patient charts and plan their day.

Why Us