Saving $17M and optimizing case  management

Centralized op model modernizes antiquated workflows and establishes measurable performance benchmarks

Project Summary

Client: One of the largest integrated health care delivery and financing systems in America

Challenge: At-risk member identification was unmanaged, inefficient, and costly

Approach: Develop a standardized operating model for agility and consistency

Outcomes: Significant annualized savings, increase in members served, improved patient satisfaction

Challenge

The client’s case management department relied on claims history and at-home calls from nurses to proactively identify at-risk members. Unmanaged and inefficient, this process led to:​

  • Low productivity from inconsistent performance expectations​
  • Low ROI (Return on Investment) as nurses spent too much time in admin and away from patients​
  • Sub-optimal risk identification from months-long claims evaluation

Approach

Lumevity worked with case management leaders and operational excellence teams to develop a Standardized Operating Model (SOM). The model: ​

  • Established consistent communication routines and measurable performance benchmarks​
  • Implemented an RPA triggering and routing system to holistically evaluate members for risk​
  • Modernized antiquated workflows via agile workshops and mindsets

Outcomes

>200%

More members served than previous system

~$17M

Saved in annualized costs

Reduced ER Visits

And increased patient satisfaction

Activated Employees

In an agile mindset

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