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


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


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



More members served than previous system


Saved in annualized costs

Reduced ER Visits

And increased patient satisfaction

Activated Employees

In an agile mindset

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