We understand the challenges in implementing a case management program. From cost to implementation to return on investment, we work with organizations to develop care management business models. Building on our successes and lessons learned we use our experience and knowledge to significantly reduce the amount of time it takes, and risk involved, when transforming care management concepts into sustainable effective population management models of care.

Case Management Program Development

Building successful case management for high-need, high-cost patients is more important than ever as healthcare shifts from a fee-for-service structure to value-based payment programs. Maximizing our body of knowledge gained from our successes and lessons learned we significantly reduce the amount of time it takes, and risk involved, when transforming case management concepts into sustainable effective models of care.

End-to-end services include:

  • Program development based on evidence-based guidelines and standards of
  • Tailored interventions to individual patient needs
  • Staff models job descriptions, and competency assessments
  • Policy and procedures
  • Change management
  • Engagement strategies
  • Staff training curriculum design and material acquisition/development
  • Selection and purchase of case management software or creating case management work flow schemas in an existing software
  • Performance measures and monitoring framework design
  • Return on Investment strategies
  • Delegation and risk contracting

NCQA CM-LTSS and CM Accreditation

Achieving NCQA Accreditation gives organizations a competitive advantage in the marketplace, setting higher standards in CM and CM-LTSS program structure, process, and outcomes. Our expert consultants have over 20 years providing direct case management services, developing case management programs in many health care settings such as hospitals, community health centers, physician practices, and health plans. Since 2008 they have used this experience in addition to their NCQA surveyor experiences to work with clients to successfully achieve the highest levels of CM and CM-LTSS accreditation.

Accreditation management services include:

  • Accreditation standards training.
  • Strengths-based survey readiness assessment and planning.
  • Project plan development and project management.
  • Policy and procedure development and work flow design
  • Review/design of performance measures and improvement activities.
  • Coordination and management of project plan activities.
  • Survey presentation preparation and supporting documentation.
  • Post-accreditation management of compliance with standards.