Premera Case Management Collaboration Tool Allows More Members to Be Served While Reducing Costs by Almost $10 Million a Year.

MOUNTLAKE TERRACE, Wash. -- Keeping track of the multitude of tasks required to help members with complex medical needs is no easy job, but a new online tool used by Premera Blue Cross case managers is proving to be just what the doctor ordered.

Not only does this tool, known as the Case Management Collaboration Tool, improve member quality of care by allowing Premera's 55 case managers to make the most of the time they spend with each member in their caseload, it is proving its value by helping save at least an estimated $9.6 million a year in avoided medical costs.

According to second quarter 2005 numbers just compiled, Premera's case managers have been able to increase their capacity by 25 percent, meaning more members receive the case management services that improve quality and help avoid unnecessary medical costs.

"In today's environment we need to be concerned with providing access and improving the quality of care that our members receive, as well as helping to control the cost of the care," said Dr. John Castiglia, Premera Senior Vice President and Chief Medical Officer.

Premera assigns a specially trained case management nurse to its high-risk members with chronic diseases or complex medical needs. Premera's case management program has been effective in reducing medical costs in these high-risk populations. In fact, Premera's experience shows each case management nurse can help avoid $800,000 to $900,000 in unnecessary medical costs achieved by helping members receive care in appropriate settings and avoid complications that require re-hospitalizations or other, more intensive medical interventions.

Premera case managers worked with Cap Gemini and Microsoft in 2004 to design and build the Collaboration Tool using Microsoft SharePoint software. The tool helps organize daily tasks, provides easy access to research and forms, and allows case managers to more easily monitor each member's case.

Before development of the collaboration tool, these specially trained nurses had to use at least two separate computer systems to open and monitor cases and do research, and often relied on pen and paper to write notes to remind themselves of tasks needing attention.

After a brief pilot project, the tool was made available last May to all of Premera's case managers. Since then, the tool has achieved remarkable efficiencies -- it has cut the time needed to open a new case by 40 minutes, reduced research time by 70 percent and, most importantly, it has allowed Premera to provide case management services to more members without having to increase the number of case management nurses.

The added capacity provided by the tool, Castiglia estimates, is the equivalent of hiring about 12 additional nurses, able to reach about 1,500 more members with help, and resulting in fewer re-hospitalizations and avoided medical costs of between $9.6 million and $10.8 million a year.

"I've been able to organize my workload so that I can put the highest priority members first," said Premera case management nurse Jan Hudson. Case management nurse Jennifer Windau said that the new tool not only improves her efficiency, but it allows her to provide members with more education about their conditions and information on the resources available to them.

"When I call, I am aware of all the tasks I need to complete, and as a result of that, I feel like I'm able to give better care," she said.

The Case Management Collaboration Tool is just one of a number of initiatives and member resources that support a larger initiative Premera calls Destination: Health. The twin goals of the initiative are better health for Premera members and sustainable health-care costs.

To review a case study and a video on Premera's Case Management Collaboration Tool, please go to: http://www.microsoft.com/resources/casestudies/CaseStudy.asp? CaseStudyID=16910 (Due to its length, this URL may need to be copied/pasted into your Internet browser's address field. Remove the extra space if one exists.)

Our mission is to provide peace of mind to our members about their health-care coverage. We provide health insurance and related services to more than 1.3 million people in Washington and Alaska. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1957. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, and long-term care insurance, and other related services, in multiple western states.