Technology, patient-centric care put company on top
Computer system is at heart of program
A sophisticated technology system helps the 2,400 case managers at Intracorp coordinate the care of nearly 2 million people each year and helps the company track outcomes information.
Intracorp, with headquarters in Philadelphia, has been named the nation’s leading case management services provider by Business Insurance magazine, an industry publication that reports on corporate risk, employee benefits, and managed health care issues.
The ranking is based on gross revenues generated by case management services.
The heart of Intracorp’s case management program is the Intracorp Case Management System (ICMS), a sophisticated patient-centric computer system that enables the case manager to work in a variety of settings and still have access to all the information on every patient.
"Our technology goes beyond a note-taking and billing system to being a comprehensive system which allows our case manager to access all the information collected about one person across benefit lines. The system facilitates the collection of the information we need to document and demonstrate outcomes, and helps the case manager operate more efficiently and effectively," says Fred Scardellette, vice president of product management and marketing.
Intracorp provides case management services in three primary markets: health care, workers compensation, and disability.
Intracorp’s health care case management services can provide a case manager for complex, high-cost, high-severity conditions, in addition to linking disability and disease management programs and nurse advocacy programs.
Integrated case management
Case managers in the workers’ compensation and disability areas provide early intervention, medical management, and return-to-work assistance and provide access to quality medical care and safe and productive return to work. Complex and high-severity cases can easily be routed to field case managers with knowledge of community resources, or to on-site medical and return-to-work specialists.
The company also offers physician advisor services that provide consultation and peer review services to Intracorp’s nurse case managers or to customers who have their own nurses but don’t have physicians on staff.
The company employs nurse case managers who work in call centers in major U.S. cities who do telephonic case management and 1,000 case managers who work out of their homes and are able to visit with patients in their own homes. They also have access to physicians and community resources and can easily access the company’s technology through laptops.
"The case managers can connect to our database whether from one of our offices or in the field and retrieve information in real time," Scardellette says.
The ICMS system is used in all three lines of business.
"It allows us to build a picture of the individual and take an integrated view. This helps us to facilitate integrated case management across benefit plans, whether that person has our health care products or has filed a workers compensation or disability claim. The case manager has a holistic view of everything that may be going on with that person," he adds.
The company’s data include information such as patient demographics, employer name, nature of the job, physical requirements of the job, a list of illnesses by ICD-9 codes, any comorbidities, information on the primary care providers and other treating providers, and the treatment plan from all providers. The computer program includes a to-do list on which the case managers keep track of what they need to do for each patient. The template is color-coded, quickly showing what the case manager needs to do on that particular day.
The system gives the case managers the ability to sort their data in ways that make their job easier and deliver the best outcomes for those who are ill or injured. For example, a case manager can sort her cases to identify multiple cases being treated with the same provider. That way, she can talk to the physician about several patients with one phone call.
"Our system offers many efficiencies and many tools such as guidelines, jurisdictional information, and special instructions, all to help case managers do their jobs more effectively and to allow our professionals to focus on case activity and achieving outcomes," Scardellette says.
The system generates any communication that may be required, such as status reports or updates for the physicians or the clients.
The system documents the case management activities and contacts for reports that are given to the customer and other trading partners, he says.
Three levels of cases
Intracorp has developed an expert system that assists in identifying which cases should be referred to case management. There are three levels of cases: those that definitely need case management; those for which case management would not add value; and those in a gray zone. In these cases, company personnel look further into the situation before deciding on a referral.
The work request for case management goes to a manager whose responsibility it is to triage the cases to the appropriate person. The manager look at the patient’s condition, the caseload of case managers who might be experts in that particular condition, the geographic area, and the contract with the employer and makes the assignment.
Some customers who contract with Intracorp specify which types of cases they want to be handled by case management. Others leave it up to Intracorp to determine which cases would benefit most from case management.
If prior experience, such as pharmacy data, indicates that someone might benefit from disease management, patients are sent a letter with information on the benefits of disease management and an invitation to participate in the disease management program.
"Severity and complexity are a trigger within most of the programs," Scardellette says.
The case managers may handle the initial contact by telephone and, depending on the circumstances of the case, may call on case managers in the field to go to the job site or the hospital if necessary.
In many instances, Intracorp has dedicated case management units for particular clients, with the ability to send case managers in the field to the home or hospital if necessary.
"With the high-severity and high-cost patients, the case manager who is assigned is typically someone who specializes in that area of medicine," Scardellette says. A case manager who is an expert on burn trauma would handle the care of someone who is a burn victim.
If the patient requires an organ transplant, a specialist in transplants would coordinate his or her care.
"In some complex cases, there is a quarterback case manager who is the primary contact as well as other case managers in other specialties," says Scardellette.
The company tracks outcomes using metrics that are different for each specific service or product. For instance, the workers’ compensation case managers track return to work.
"Many of the measures that are important to our customers are outcomes and financial metrics. They want to know that their employees are getting the appropriate levels of quality, cost-effective care," he says.
The company measures outcomes by several methods, depending on the clients’ health plan designs. For example, Intracorp tracks length of inpatient hospital stays relative to intervention in a disabling condition.
"We operate within the definition of the client’s health care or disability benefit plan designs as well as jurisdictional requirements governed by the workers compensation system, Scardellette says.
Among the disease management outcomes the company tracks are reduction in the severity of illness, compliance with treatment therapies, and compliance with recommended tests.