How Creative Solutions in Healthcare consolidated 20 referral portals and surfaced 50%+ more referral volume

By replacing a fragmented, 20-portal referral process with exacare ai, Creative Solutions in Healthcare cut hospital response times by 90%, now tracks 50%+ more referral volume than its old CRM ever saw, and took all 160 skilled nursing facilities live in just 48 hours.

Introduction

"Before exacare ai, everything was very fragmented, disjointed. We didn't have any insights. Since implementing exacare ai, it's been transformational."

Creative Solutions in Healthcare is the largest skilled nursing operator in Texas. At the time it rolled out exacare ai in early 2026, the organization operated 160 skilled nursing facilities, 22 assisted living communities, and 182 entities in total, all in one state. Founded in 2000, the organization has built that portfolio from a single building.

At that scale, speed is hard to sustain with manual work. Before exacare ai, admissions ran across roughly 20 disconnected referral systems, manual CRM entry, and hospital packets that could run hundreds of pages, and any enterprise-level view had to be stitched together by hand in spreadsheets.

With exacare ai, Creative Solutions consolidated that entire process into one platform and brought the whole portfolio onto it in just two days, giving more than 3,000 users, from facility teams to corporate leadership, a shared workflow and a shared set of data for the first time.

Key Results

• 90% faster referral responses to hospitals, down from the 24-to-48-hour turnaround the team reported before exacare ai
• 50% more referral volume tracked: the team now processes up to 8,000 referrals per month, compared with the roughly 4,000 to 5,000 per month they could previously track in their old CRM
• 15,000 referrals processed in the first two months, including 1,500 in the first 48 hours after go-live
• Acceptance rate grew from 52% to 60% of referrals between April and June 2026
• Clinical review of 200-to-300-page packets dropped to under 20 minutes
• 160 skilled nursing facilities and 3,000+ users live within 48 hours, eight weeks from contract signature

The Customer

Creative Solutions in Healthcare is a Fort Worth, Texas-based operator of skilled nursing, assisted living, and independent living communities, exclusively in Texas. Founded in 2000 with one facility, the organization had grown to 160 skilled nursing facilities and 182 total entities by the time it implemented exacare ai in early 2026.

Growth through acquisition has been central to how Creative Solutions operates, and it shapes what the organization needs from its systems. Every new building brings its own referral sources, payer mix, and workflows, so the admission process has to absorb change constantly. The team uses exacare ai for that admission process end-to-end: receiving referrals from hospitals, reviewing clinical fit, verifying financial and payer information, and getting to a fast, confident yes or no.

The business office is a deliberate part of that process. For Ashley, who oversees billing and collections across all facilities, involving financial verification at the very start of the referral is a matter of risk mitigation: setting expectations early, confirming the right payer source, and flagging complex financial situations during admissions so the team can plan ahead.

Customer Snapshot

• Customer Since: March 2026
• Size at implementation: 160 skilled nursing facilities, 22 assisted living communities, 182 entities, 3,000+ platform users
• Region: Texas
• Industry: Skilled Nursing, Assisted Living, Independent Living
• Products: Admissions Engine, Insurance Verification, eSign

The Stakeholders

Leila Jones, VP of Government Affairs & Communications

Leila Jones has spent more than eight years at Creative Solutions, rising from Director of Social Media in 2018 to Vice President of Communications in 2020, and into her current role leading government affairs and communications in 2025. Her background in large-scale digital and brand projects, including leading a team that revitalized more than 100 individual facility websites in three months, made her a natural fit to drive the enterprise side of the exacare ai rollout: evaluating the platform, consolidating logins, onboarding 3,000 users on a compressed timeline, and turning the new referral data into insight leadership can act on.

Chuck Moody, Senior Vice President of Clinical Services

Chuck Moody has led clinical services at Creative Solutions for more than two decades, joining in 2003 when the organization was only a few years old, and has watched it grow into the largest skilled nursing operator in Texas. His teams, including Directors of Nursing and nursing administration, carry the clinical side of referral review: reading hospital documentation, judging clinical fit, and protecting the quality of every admission decision.

Ashley Bott, VP of Accounts Receivable

Ashley Bott oversees billing and collections for all Creative Solutions facilities. She rejoined the organization in late 2025 after more than a decade in revenue cycle leadership across Texas post-acute care, including roles directing revenue collections for 38 skilled nursing facilities at Cantex and revenue cycle operations for 58 communities at Regency Integrated Health Services. That background across Medicare, Medicaid, and managed care shapes her focus in the admission process: verifying payer sources early, identifying complicated financial situations before admission, and reducing downstream collection risk.

Sydni Wall, Referral Program Coordinator

Sydni Wall has coordinated the referral program at Creative Solutions since 2023 and was part of the exacare ai evaluation and implementation from the start. She sits closest to the day-to-day flow of referrals from hospitals into facilities, and led much of the training and end-user preparation that made a 48-hour, 160-facility go-live possible.

The Challenge: A Fast-Growing Operator on a Fragmented Process

Creative Solutions had scale, experienced people, and a clear standard for responsiveness. What it did not have was a unified way to handle the referrals flowing in from hospitals across the state.

"Our world before exacare ai was very chaotic. We were receiving referrals from about 20 different systems, and only two of those platforms gave us any reporting or true insight."

The workflow around each referral was manual and siloed. Staff logged into individual portals, pulled information out, sent it to the review team, and entered updates into a CRM by hand. A hospital could wait a day or two for a final answer.

For clinical teams, the harder problem was the sheer weight of documentation attached to each referral.

"The challenge was just time. You'd get a referral with 200, 300 pages of hospital documentation and be expected to answer in 30 minutes. You can't read 300 pages in 30 minutes."

Speed was only part of the risk. Every referral decision also carried financial consequences that could follow the organization for months, and the fragmented process kept the business office too far from the moment those decisions were made.

"In my role, this is the riskiest part, the very beginning of the patient's journey: setting expectations and making sure we have the right payer source from the start."

The frustration ran all the way up the organization.

"At both the facility level and the enterprise level, we didn't have any information to act on."

By the time the team started evaluating solutions, the verdict on the old process was unanimous.

"Across the board, I don't think anyone really felt like we were winning admissions."

The Solution: One Platform for the Entire Admissions Process

When Creative Solutions set out to unify admissions, the team ran a thorough search, demoing nearly every option in the industry.

"The very last demo that we did was with exacare ai, and they blew everyone out of the water. We had a checklist of things that we were looking for to solve the pain points we had identified, and exacare ai checked every single one of those boxes."

The evaluation was deliberately broad inside the organization too, so the people who would live in the platform every day helped shape the decision.

"We did about 12 demo calls with exacare ai. It started off with just a small group, and then we brought in our corporate leadership team, and then we brought in regionals."

Clinical buy-in came quickly. For Chuck, the value of AI-streamlined referral review was obvious the moment he saw it.

"I was like, 'Hell yeah, that's the way to go.'"

For the business office, the appeal was moving financial verification to the front of the process, catching payer issues before admission instead of untangling them after.

"My 'aha!' moment was seeing how it could help us identify our niche markets: patients with trickier payer sources or more complicated financial situations. They need the care and services, we just have to put the right resources behind them."

With buy-in from clinical, financial, and operational leadership, the decision was made. The question became how fast Creative Solutions could get 160 facilities onto the platform.

The Implementation: Full Portfolio in Just Two Days

The project moved from contract signature to launch in eight weeks, and the go-live, all 160 facilities, happened in just 48 hours at the end.

That was possible because of an ambitious rollout plan. Creative Solutions chose not to run a pilot. Instead, the team held train-the-trainer sessions that reached more than 2,000 end users and turned everything on at once in late March 2026.

A go-live that fast could have left facilities stranded, but the support didn't stop at launch. The exacare ai team kept a regular cadence with Creative Solutions through the first six weeks, answering end-user questions and reviewing adoption with leadership, and the touchpoints continue today, from operational data check-ins to product feedback that feeds directly into the exacare ai roadmap.

"We're a very agile company, and that's something we pride ourselves on. We can't believe that we have partners like exacare ai that are as agile as us."

The Impact

Hospital response times are down 90%+

For hospital partners, the clearest change was how quickly Creative Solutions could deliver a decision.

"Before exacare ai, we were averaging around 24 to 48 hours before we were giving the hospitals a final yes or no. Within the first two weeks of launching exacare ai, we noticed that timeframe drop quite drastically."

The data bears that out. Median time to accept has fallen every single week since go-live, at a steady volume of roughly 1,000 accepted referrals per week, and the improvement on the turnaround Sydni described now tops 90%.

Referral volume tracked grew by more than 50%

The old CRM captured only what staff manually entered from the two reportable platforms, so leadership's picture of monthly referral volume was an estimate at best. On exacare ai, the team is processing up to 8,000 referrals per month across the portfolio, roughly 50% above even the high end of that estimate.

"Before exacare ai, we were averaging about 4,000 to 5,000 referrals per month across our 160 locations. In our first 48 hours, we had already hit 1,500, so we knew immediately we were capturing a lot more referrals. Now we've been live for just under two months, and we've processed 15,000."

For Ashley, the volume jump came with a discovery.

"We were amazed at how many referrals were not being logged or monitored. That gave us a lot of insight into how we can support operations in the buildings, whether that's helping them feel more clinically capable, navigate complex payer situations, or answer reimbursement questions."

Acceptance rate grew from 52% to 60%

As review got faster and more consistent, the share of referrals the team said yes to climbed eight percentage points between April and June 2026. Creative Solutions is not just seeing more referrals; it is accepting more of them, with the business office and clinical teams involved earlier in each decision.

Clinical review of 300-page packets now takes minutes

For clinical teams, the change shows up on every big packet.

"exacare ai highlights the parts we want to see, which has dropped review time to less than 15 or 20 minutes and saved our DONs and nursing administration hours of work. That's helped speed up our referral processing, and it's equaled out to additional census."

Teams have also found that exacare ai's suggestions consistently line up with their own judgment, which has built the confidence to respond quicker.

Census and enterprise visibility are improving together

Alongside the speed gains, the organization now has something it never had before: a shared, real-time view of the referral pipeline across every building.

"Obviously our census is improving. Definitely across the board we've seen an uptick. But the biggest win has been the visibility, seeing where we have opportunities in the process, or where we might need to dedicate more resources."

The team is only months into establishing its baseline, but a few early signals already have leadership's attention: steady referral volume that previously had to be pieced together manually across platforms, initial insights into decline reasons, and accept and win rates broken out by region, which show where operationally strong buildings can support others.

That combination, sharper decisions at corporate and an easier workflow in the buildings, is what has won over the whole organization.

"Our leadership team is so excited about finally having data and insights we can make informed decisions with, and our facility teams are loving exacare ai because they have a workflow tool. It funnels everything together, creates efficiencies, and streamlines the entire process."

What's Next

Creative Solutions sees the current rollout as the beginning. The team is excited about the managed care add-on, discharge planning, and auto-decisioning, along with tighter two-way connections to their EHR and to the referral platforms hospitals already use.

That expansion is already underway. In June, Creative Solutions began piloting eSign, the digital signature feature built directly into exacare ai, moving admission paperwork into the same platform as the referral itself. Early feedback from the pilot buildings was immediate: business office teams found it far easier than their old document workflow, with families signing on a tablet at the front desk instead of working through printed packets. In early August, eSign rolled out across all of Creative Solutions' facilities..

For the business office, the next frontier is catching financially complex situations even earlier, from Medicaid eligibility to guardianship needs, so the right people are involved before a resident arrives rather than after.

"We can see those situations ahead of time and already be working on them. From an AR perspective, it's going to reduce DSO, start the collection process much sooner, and let the business office manager be organically involved in financial verification."

Asked whether she would recommend exacare ai, Leila does not hesitate.

"We are totally going to be a part of exacare ai for a long time. We are 100% bought in. I would recommend exacare ai to absolutely everyone. I already do, and I'll keep doing it."