Insurance Company Reduces Costs and Improves Patient Care With Custom, Cloud-Based CCM Solution

THE CHALLENGE

Outdated Data Collection Processes Negatively Impacted Quality Of Complex Patient Care

Ntiva was hired by HealthCare Services Corporation to build a custom Complex Case Management (CCM) solution for Blue Cross and Blue Shield of Illinois (BCBSIL).

Complex Case Management is the coordination of care and services for those members experiencing a catastrophic event, many of which have multiple chronic conditions that have had an adverse event causing immediate medical attention. The CCM department works with contracted healthcare providers to track care information to ensure the best possible program of care. This requires information to be exchanged between provider and BCBSIL that originates in provider systems, such as electronic medical/health record systems.

To accomplish this, provider organizations had to both manually extract copies of care information and enter data in hundreds of fields to provide BCBSIL nurse liaisons with the information needed to coordinate patient care. This meant that provider organizations had to enter the care data twice. This heavy data-entry burden often resulted in provider organizations having to pay staff overtime, and it affected the overall quality of the patient care data being collected for care coordination.

THE SOLUTION

New Complex Case Management Design Migrates Data to the Cloud and Eliminates Manual Processes

Ntiva worked with the client to build a customized, scalable, cloud based, solution that was able to migrate data from all EMR and EHR formats and systems for utilization management and denials. The design caters to all technical skill sets and removes manual processes. Payers now use a Complex Case Management integration channel to export data from their system, upload to Secure File Transfer Protocol (sftp), and the information is parsed categorically to all appropriate needs. The compliant system design is branded with BCBSIL logos, iconography, and user experience to ensure continuity across the board.

THE RESULTS

Increased Efficiency, Lower Costs and Better Data Collection

This cloud-based Complex Case Management system offers a secure, scalable, and connected platform where Providers and Nurse Liaisons can work efficiently.  Not only does it eliminate demands for higher fees due to workload and data-entry errors associated with manual entry, it is also designed to compile prefilled data and provides opportunities for all parties to enter and analyze information in real time. In addition, this updated system is NCQA and HITRUST approved, ensuring compliance while making auditing easier.