What’s on the horizon for Population Health? What obstacles and opportunities are ahead for Value-Based Care? XCHANGE 2019’s Thursday Keynote session will tackle those topics and more.
AdventHealth will use real-time predictive analytics to reduce variation, increase efficiency in the utilization review process.
How do some of the largest systems in the nation manage care and utilization at scale? As Executive Director for AdventHealth (formerly known as Adventist Health System) in Florida, Lynn Leoce has unique insight into what is needed for effective leadership at a network level – in her position, she is responsible for overseeing all clinical documentation improvement and care coordination teams and initiatives at over 40 hospitals in multiple states.
Technology is reshaping the discipline of utilization review. Today’s nurse often have computers and data science at their disposal, yet using them effectively can be daunting. In an upcoming webinar, Lynn Leoce, Executive Director at AdventHealth, and Michelle Wyatt, Director of Clinical Best Practices at XSOLIS, will explore the process of embracing technology, using the backdrop of AdventHealth’s partnership with XSOLIS. Lynn will share how XSOLIS’ technology will prove to be a strategic advantage to AdventHealth and Michelle will examine the process of change management for leaders and staff.
Utilization review forms the first line of defense for revenue sensitive cases for hospitals; physician advisors serve as the backbone and second line for cases requiring greater scrutiny or closer inspection. While undertaking a second-level review, a physician advisor (PA) brings to bear years of clinical experience and regulatory expertise – it is a highly skilled job and PAs are often in short supply. Typically, utilization review staff use one of two methods to determine if the case should be escalated to a physician advisor: their own clinical judgement or technology. While the former has been relied upon for years, technology is increasingly used to support physician advisors. And if the right technology is put in place, escalations to PAs should decrease, not increase. It’s not about casting a wider net – it’s about using technology as a double-layered approach: first, to ensure that the right cases are identified and reviewed by nurses up front, second, to ensure that only the right cases are escalated to PAs for review.
Utilization management is part of the lifeblood of the revenue cycle. Case managers and UR staff man the front lines of helping hospitals stay solvent, yet they are often just trying to stay sane doing it because of the administrative jigsaw puzzle they are forced to piece together day after day.