Health plans today are grappling with disparate IT systems, reliance on manual processes, antiquated systems and rigid paper-based work processes that lead to laborious, multi-step setups, inefficient day-to-day care management, impaired decision-making and poor member outcomes.

Making Unstructured Data Actionable:

According to a recent Health Management Technology article, “Of the 1.2 billion clinical documents produced in the United States each year, approximately 60 percent contain valuable information trapped in unstructured documents that are unavailable for clinical use, quality measurement and data mining.” According to Gartner, this unstructured information must be digitized and integrated in an automated fashion to facilitate a 360-degree view of the member. Ultera® Care Manager helps care managers access this data so it is actionable.

Health plan Care Managers need the flexibility to communicate with groups at: payers, hospital systems, large-scale durable medical equipment companies and skilled nursing facilities, as well as independent organizations, including: home health care, adult foster care homes and others who often cannot afford to upgrade their own IT infrastructure. These groups provide information and feedback critical to improving member care. However, many of these groups rely on simple phone and fax communication that may get lost before being properly recorded.

IPD Ultera® Care Manager adds missing capabilities to your current administrative systems to provide an integrated “care management workbench” without the need for a large-scale replacement project. Ultera® efficiently manages member care, from the initial prior authorization process through the completion of the member’s care plan. Ultera® Care Manager uses the latest enterprise-class BPM, ECM, BRE, Analytics and Collaboration functionality from the IBM platform for depth of functionality, performance, stability and long-term support.

IPD integrates with existing systems such as EHR and eligibility systems to capture and store critical member information. The IPD solution also incorporates all supporting information, regardless of its source (fax, web, paper form, rules-driven decision support questionnaires, etc.). Through the “Active Content” features, IPD automates setup and follow-up tasks, including:

  • Prior authorization
  • Creation of an electronic case folder
  • Prompts, reminders and escalations
  • Establishment of new tasks, based on incoming documents or data
  • Ability to check for the completeness of a case
  • Multidisciplinary care team notification
  • Referral management