PPO saves three FTEs with case manager software - preferred provider organization - CAPP CARE, LINC's Case Management Assistant - What Works - Company Business and Marketing - Column

Health Management Technology, Oct, 1998

SOURCES: Janice Woo, Director and Nancy Neslen, Manager Healthcare Management CAPP CARE 4000 MacArthur Blvd., Suite 1000 Newport Beach, Calif. 92660 Fax: (714) 251-2270

PROBLEM: CAPPCARE, based in Newport Beach, Calif., is one of the country's leading national preferred provider organizations. Our preferred provider networks reach 43 states and are comprised of more than 225,000 health care provider locations and 10,000 facilities nationwide. We offer a combination of health care management services to effectively coordinate medical services and benefits before, during, and after the delivery of care. Included in this service is case management. Case managers maintain regular contact with the physicians and patients, recommending appropriate, cost-effective alternatives designed to maintain or improve quality of life. Frequent verbal and written contact is maintained with the payer, and a case summary and return-on-investment analysis are provided upon closure of the case.

All our analytical reporting was done manually. Savings were also manually calculated, and as a result the occurrence of not reporting hard savings was high. Some management reports could take up to six months to produce.

Our company also utilizes telecommuting options for some of our case managers. In the past when a case manager was out of the office, file sharing was not an option and case managers only had access to information in their own patient files, thus limiting the continuity of care that could be provided to patients. We had high costs associated with paper purchasing, storing, and disposing and costs involved with the amount of time it took to manually do effective patient reporting, time management, and the opening of cases.

SOLUTION:

After we narrowed down the list of vendors to a few, we invited them to do a demonstration for our case management, health care management, and information technology departments. Then, we required a detailed request for purchase (RFP). We then surveyed references utilizing a rating tool. An on-site visit was made to one of the clients who had been using Case Manager Assistant (CMA) from LINC to find out how they used the software to increase productivity and how they rated technical support from the vendor.

COMPONENTS: Software: Case Manager Assistant (CMA) from LINC, part of Object Products; Intranetware.

Network: Novell network, (already in place) and Citrix Server that we were purchasing for the telecommuters.

Training: Training was done on-site. We took a train-the-trainer approach with LINC's trainers first instructing our trainers which took five days. The training of our case managers took about a month.

COST: $22,500 for CMA software including 20 user hook-ups and annual maintenance services.

INSTALLATION: Data conversion was done the last week in November 1996. We phased in case managers gradually, finishing implementation by the end of December 1996.

STAFF, PATIENTS SERVED: 14 case managers, three administrative staff and two management staff use the system. Our case managers have an average case load of 40 patients.

BENEFITS

Savings: The single biggest savings was made in the reduction of the number of full-time administrators from five to two. The implementation of CMA has allowed us to streamline our workflow, and incorporate processes that have resulted in effective, quality data management and reduced our need for hardcopy documentation and related paper costs.

Productivity: The invoicing process is streamlined so that we require only one person to actually do the billing. Because savings are documented at the case manager level and calculated within the application we can now show savings to our customers through effective patient reporting, efficient time management, and timely opening of cases. Our customers can see their ROI with every patient and management report. We are now 100 percent compliant with our company's standard for management reports, producing them in 30 days.

Patient care: The patients are better serviced, since the case managers now have access to all patient files versus only their own case loads. Home-based case coordinators can take time away from their duties without worrying that coworkers will not have sufficient information to appropriately manage a case.