Case management tool saves time, money
Case management tool saves time, money
CMs spend more time with members
Premera Blue Cross’ new Case Management Collaboration Tool allows case managers to spend more time working with members, helping the company save an estimated $9.6 million a year.
Using the new tool, Premera’s case managers have been able to increase their capacity by more than 25%, cutting the time it takes to open a new case by 40 minutes and reducing research time by 70%.
Premera’s 55 case managers coordinate care for its high-risk members with chronic diseases or complex medical needs.
The added capacity provided by the tool is the equivalent of hiring about 12 additional nurse case managers who would be able to reach about 1,500 more members, helping avoid hospitalizations and additional medical cost for those members, estimates John Castiglia, MD, Premera senior vice president and chief medical officer for the Mountlake Terrace, WA-based health plan.
Based on past experience, Premera estimates that each case manager helps avoid $800,000 to $900,000 in unnecessary medical costs by helping members receive care in appropriate settings and avoid complications that could result in hospitalization.
"In today’s environment, we need to be concerned with providing access and improving the quality of care that our members receive, as well as helping to control the cost of the care," Castiglia says.
A team of Premera case managers worked with consultants to develop the tool using a commercially available software product.
"We sat down with the other case managers and asked what was needed to make things easier for case managers. We asked what their biggest headaches were and what challenges, either administrative or operational, they encountered in their day-to-day work," says Linda Coulson, RN, BSN, Premera’s director of case management.
The case managers reported that the paperwork and the multiple steps involved in opening a case were the most time-consuming part of their job. At that time, it took between two and 2½ hours from the time the case manager got a referral until the member was actually engaged in the case management program, she says.
At Premera, case managers make outbound calls to explain their services and send members an introductory packet and a consent form. The case manager works with the member and his or her physician to jointly develop a plan of care.
"There are a lot of steps to getting a patient established in a case management program. There are telephone calls back and forth, letters, consent forms, and research, depending on whether or not the case manager is familiar with the patient’s diagnosis and treatment options," Coulson says.
Before the new system, case managers were doing a lot of their tasks manually and tracking them on paper. The case management program at Premera has been accredited by URAC, which requires additional tasks and paperwork.
The case managers had to use at least two separate computer systems to open and monitor cases.
"We had multiple case management systems, which we are consolidating. At one time, the case managers had to go to two or three different places. Now they have to go to one place to see all their cases and all the tasks they have to do for that case," Coulson says.
When case managers log onto their computers, the online tool shows them all of their cases along with a list of the tasks they must complete daily and the steps it takes to engage a member into case management.
It helps them organize their workload to give the members with the most critical needs the highest priority.
For instance, the case managers can enter a date for a follow-up call to a member and have a reminder show up on their trigger list for that day.
"The Case Management Collaboration Tool helps the case managers work more efficiently, resulting in better care for the members they are following. It gives them more time to spend with members and less time spent on administrative work," Coulson says.
The new tool also creates consistency in how case managers communicate with their members.
"For instance, we know we need to talk to the members about safety, but the case managers don’t have to remember that because the tool prompts them along," Coulson says.
If a case manager has to cover for a colleague, he or she can get easy access to all of that case manager’s cases and be able to see what tasks have been completed, what needs to be done, and what the other case manager planned to do that day.
In addition to creating an efficient tracking tool for the case managers, Premera added links to other resources the case management use frequently, such as the American Heart Association web site or medical literature sites.
The tool also includes links to the Premera medical policies and clinical guidelines as well as to the URAC standards.
"The case managers no longer have to switch from the internal Premera web site to the URAC web site or another Internet site. This shortens the time it takes them to do their daily work," she says. When case managers find a helpful Internet site, they save it to the share drive so other case managers can use it.
"In organizations like ours, where there are a lot of case managers, they don’t know what information their colleagues have found or where they saved it. We found that case managers were doing a lot of duplication in their searches. This makes it possible for them to share information easily," she says.
For instance, if a case manager types in "diabetes," he or she has access to all of the literature that other Premera case managers have found useful on that subject.
The eight case managers who were actively involved in development the tool used it in a pilot project in the fall of 2004. After the initial kinks were worked out, the tool was rolled out gradually, beginning in February 2005, to about 10 case managers at a time.
The training on the tool generally takes around a couple hours, Coulson says.
Overall, case managers reported a 17% increase in job satisfaction following the implementation of the tool, she reports.
Although there was some initial resistance and skepticism about using the new tool, particularly among the more experienced case managers who had limited computer experience, the people who were most resistant have given the developers ideas for additional enhancements and are now enthusiastic about the new system, Coulson adds.
"In hindsight, we should have been communicating more with the staff during each step of development instead of just having a pilot team work on the tool and roll it out. As we make enhancements, we are providing weekly updates to the staff," she says.
Premera Blue Cross new Case Management Collaboration Tool allows case managers to spend more time working with members, helping the company save an estimated $9.6 million a year.Subscribe Now for Access
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