This document discusses how technology can help streamline case manager processes and improve outcomes. It evaluates the current healthcare environment and how technology advances like workflows and dashboards can enhance productivity. It also presents a case study where collaboration technology helped a managed care provider eliminate paper-based systems and improve productivity and customer service. The document advocates that organizations evaluate how technology can improve quality of care.

1. Technology Connects Case Managers to Better Processes, Improved OutcomesChris Boue, President & CEOCH Mack

2. ObjectivesEvaluate current healthcare environment and demands on case managers.Analyze how technology advances can streamline productivity, while cutting administrative costs and improving quality of care in a managed care environment.“This is so cool…I’m flying this thing with my Palm Pilot.”Evaluate your own organization and consider how technology can improve quality of care for your membersContent to CoverIdentify healthcare IT landscape from different points of view: employer, government, and private payer perspectives.Explain how technology and tools, specifically workflows and dashboards, can enhance productivity.Discuss a specific case study, detailing how collaboration technology helped a managed-care provider eliminate paper-based systems and improve productivity and customer service.

3. Technology in Today’s Healthcare OrganizationsTechnology advances in the past few decades have revolutionized the way health care organizations:Relate to their customers,Conduct business operations, and Organize themselves

4. Looking Forward, Looking BackIncentivesPerformanceOutcomes

5. Technology’s role in Care Management

6. U.S. Healthcare Performance and Future Challenges

7. Healthcare Economics

8. New Incentives and Processes: Pay for Performance….A work in progress

9. Pay for Performance….A grading challenge

10. Pay for Performance….It’s about improvement

11. BusinessCost managementDemand managementValue management

12. GovernmentCMS (Medicare and Medicaid)Special Needs Plans (SNPs)Medicare Part D

13. Long Term Care - Service Delivery

14. Case ManagementPatientsProvidersAccreditation

15. The view of care management has been revolutionized

16. In many ways…..

17. Home and Community Based Services (HCBS) Care CoordinationSpecialist - PCP - Behavioral Health Specialist - Social Worker

18. Case ManagementConsumer-centered marketCreating valueIntegration

19. Consumer-centered market

20. Consumer-centered market

21. Stakeholder communication via portalsIntegrating data from multiple sources Eligibility, Medical/PBM claims, Care management, Profile/PHR , FSASelf Service Tools Web Portals, IVR/FAX ServicesDelivering multiple applications Enrollment, Disease Management, Wellness, Decision Support, Predictive ModelingImplementing data enabled communication services Sending email, text, automated phone calls, live voice notifications based upon user profile Turning paper based solutions into paperlessSupporting Member and Provider Communication and Engagement Strategies

22. Software application: portalsData SourcesDataExchangeApplication MarketplaceEnd UsersDeliveryNetworkPortalAppPortalAppPortalAppCare Management

23. Databases

24. Text

25. Web

26. Email

27. PhonePortalAppMobile

28. US Mail

29. Fax

30. Live VoicePortal Example- Providers

31. Integrated Portal - Providers

32. Portal Example- Patients (wellness)Four main features:Interactive online software: fitness tracker, workout generator, calorie counter, meal plans and more.Website content that is regularly updated by in-house experts.Advanced social networking community features including: personal homepages, teams, and more.Regular email newsletters.

33. Portal Example- Patients (wellness)

34. Software ApplicationsUtilization ManagementCase ManagementClaims

35. Role Based Design

36. Utilization ManagementWorkflowAuto-adjudicationIntegration

37. WorkflowsWith workflows, the right job goes to the right people, at the right timeWorkflows helps the user to:Reduce the number of pended claimsMaximize team efficiencyProcess more workExceed service commitmentsMonitor and adjust work tasks in real timeProactively identify backlogs or bottlenecks

38. Workflow: System Example

39. Workflow: Forms Management

40. Workflow: Document Management

41. The technology battlefield:Siloed dataIntegration

42. Integration

43. Integrated Case Management: Connected Care Integrated Care ManagementFunctionsPREDICTIVEMODELMEMBERPROFILINGIMPROVEDOUTCOMESClaimsDataCaseMgt.Chronic ConditionsRX DataServiceMgt.ReferralMgt.ClinicalDataReportsOperationalInsightQ ContinuumDataOtherData

44. Case Study: 800 users Automating key business process and workflows provides consistent delivery and contract compliance for a Fortune 500 managed care organization. A Fortune 500 company focusing on Medicaid and Medicare that offers a variety of health plans for families, children, the aged, blind, and disabled, as well as prescription drug plans. The company served more than 2.5 million members nationwide as of December 31, 2008. The priority for this company was to automate processes, eliminate redundant data entry, improve productivity and accuracy, while reducing support costs and increasing efficiencies. The Company wished to “retire” multiple, dispersed legacy systems in place and focus on:

45. Case Study: 800 users Key Drivers: • Centralizing information • Improving member and provider satisfaction • Enhancing the interactivity of medical management • Improving the accuracy of information and authorizations • Supporting new programs and markets, as the Company grows

46. Case Study: Impact