ikaCM

Efficient Case Management Workflows Informed by Powerful Business Intelligence

Complex cases need careful and often equally complex interventions. Coordination of myriad providers (e.g., primary care physicians, specialists, physical therapists, chiropractors), facilities, family members, public resources and other services presents a challenge to even the most seasoned case managers. ikaCM is a comprehensive solution fueling case management excellence, optimizing resources while ensuring no essential information slips through the cracks.

Streamlined Member Identification and Assignment

The first challenge is identifying the proper members for case management. ikaCM employs a multi-faceted approach to rapidly and accurately bring members the services they need: 

• ikaCM uses input from multiple sources — medical claims, pharmacy claims, authorizations, inpatient admissions, lab/imaging data, health risk questionnaires — to automatically identify candidates.
   
• Diagnosis codes used to create triggers for case management are entirely user configurable; codes can be added or deleted to meet a health plan's unique business rules.
   
• Patients who require case management can be manually assigned by case managers, utilization coordinators, hospital nurses, quality department nurses, providers and members themselves.

Identified cases are populated in a patient registry for the case management supervisor before populating case manager queues. The system selects a case manager based on predefined criteria, such as the case manager's area of expertise, geographic criteria or both. 

Comprehensive Assessment, Goal Setting and Coordination

Members will be listed in the case manager's work queue in order of priority based on the status of their conditions. Case managers begin their work with case-specific assessments, fueled by access to industry-leading guidelines:

• For admitted patients, case managers can use ikaCM to set goals, establish care plans, coordinate level of care decisions between the health plan, providers and the patient, and perform concurrent review and inpatient management. The system can then facilitate discharge planning activities, such as crutch use and fall prevention training.
   
• For ambulatory patients, case managers can also use ikaCM to set goals, establish care plans, coordinate level of care decisions between the health plan, providers and the patient, and perform concurrent review and ambulatory management. 

ikaCRM can also track and ensure the coordination of special needs such as transport, financial, counseling and community programs.

The goal of every case management program is member recovery, as assessed by maximal medical improvement (MMI), back to work/school, etc. If a patient is fully recovered, the case is closed, and patient data is archived for future use and forwarded to underwriting and actuarial analysis. Patients with chronic conditions are referred to disease management without loss of information continuity or transparency; should their conditions worsen to the point that they meet the case management criteria, they can move fluidly back into these services.

Support to Keep Complex Cases Close at Hand

To ensure that case management programs are functioning at peak efficiency, ikaCM delivers a range of functionality that streamlines traditionally cumbersome health plan processes and creates a common communication platform for members, providers and case managers:

• ikaCM automatically generates a patient executive dashboard or personal health record (PHR) that contains:
  
  
  • The patient's personal information
     
  • Information on the patient's provider
     
  • Cost of care (all medical, dental, pharmacy claims)
     
  • Disease log, a central repository of all clinical information whether the patient has single or multiple conditions
     
  • Prescriptions log of all prescriptions
     
  • Care plan that is specific to the patient's condition(s)
     
  • Appointments/notes, for manual scheduling and for recording free-text notes
     
  • Patient assessments, consent forms and proxy forms
     
• Case managers, providers and members receive flags based on the health plan's predefined rules for different conditions, closing gaps in care.
   
• Needed services can be scheduled and documented.
   
• Data can be easily shared with other care management systems.
   
• Medicare Advantage Special Needs Plan (SNP) members can receive their own customizable, member-centric care plans.
   
• Progress toward goals can be periodically evaluated and programs can be objectively assessed for their return on investment through comprehensive reporting capabilities.

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