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Decision Support


Health plan installs

care-management platform

The continued use of manual processes raised a real concern for program

changes and tracking with newer and more robust state and federal regulations.
ommunity Health Plan (CHP) in Washing- CHP was created in 1992 by a group of community
ton faced several challenges that needed to health centers across Washington state. The state-wide
be addressed in order to achieve its goal of health plan provides coverage for people in 33 Wash-
deploying a patient-centric delegated care- ington counties, delivering services to members through
management system. For years, care managers at CHP more than 300 primary care sites, 90 hospitals and
used multiple, disparate systems for case management 8,000 specialists. Overall, CHP offers access to locally
(CM), disease management (DM) and utilization man- delivered treatment and services for more than 240,000
agement (UM) – resulting in information silos. Without individuals.
an integrated system, there was a lack of evidence-based The continued use of manual processes raised a real
clinical pathways to ensure consistent care planning and concern for program changes and tracking with newer
management of patients. As a result, data collection and more robust state and federal regulations, Hewett
was not robust, tracking was explains. “We realized that if
inadequate and reporting was we continued with a manual
not streamlined. system, we would face po-
In keeping with its vi- tential risk with data integrity
sion and to meet organiza- issues and the inability to pro-
tional needs, CHP decided duce comprehensive report-
to deploy a patient-centric ing. In preparing for increased
care-management system regulatory requirements and

that emphasized collabora- accreditation plans, we con-
tion between care managers, cluded that increased integra-

members and physicians, tion between UM, CM and
supporting the medical home DM were imperative.”

SHOWLINE philosophy. CHP envisioned
Sandra Hewett, director of care management at
CHP was also cognizant
the future deployment of a
Community Health Plan, was charged with overseeing
of the need to meet the new

the implementation of the organization’s integrated
delegated care-management
care-management software solution.
HIPAA regulations, and the

service model, where the need for robust tracking and
primary physicians in its community health centers reporting capabilities when it pursued National Com-
would actively participate in and/or lead patient care mittee for Quality Assurance (NCQA) accreditation
management. in 2010.
“The manual systems – some paper-based – created
ineffi ciencies, lowered data integrity and decreased co- Recruitment takes a role
ordination of care for the patient,” says Sandra Hewett, Given the nationwide shortage of nurses, CHP, like
Nelson Publishing
director of care management at CHP. “In UM, time- other organizations, also faced the challenges of recruiting
consuming audits for continuity and coordination of care and retaining qualifi ed RN staff. Moreover, the lack of
2500 Tamiami Tr N
reporting led to inaccuracies due to manual processing. effi cient integrated information systems further exacer-
Nokomis, FL 34275
Management of patient records in a manual-processing bated the diffi cultly in recruiting, training and retaining
environment was ineffi cient and led to the potential risk nursing staff, while further adding to the annual operat-
of lost paper fi les as medical records were transferred ing costs. These issues loomed large as the health plan
between departments. It was also clear to everyone the looked toward future expansion, which would require
current manual processes would not scale effectively as better connection and integration.
our organizational needs and programs grew.” The CHP team concluded the organization would need
HHMT1002 ZeOmega FINAL.indd 40MT1002 ZeOmega FINAL.indd 40 11/25/2010 2:23:05 PM/25/2010 2:23:05 PM
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