Jumpstart Your Transformation
We understand that healthcare transformation is a journey, not a destination. JLG Health Solutions partners with you every step of the way, providing expert guidance and support to navigate complex challenges. To see how we've helped other organizations on their journey, explore our client stories below.
Care Management Program Redesign
Client Story: Large Not-for-profit Health Plan
A large not-for-profit payer recognized the need to reorganize and redesign its care management program to improve resource use optimization and enhance patient outcomes. The existing program was fragmented, lacked a consistent approach, and did not effectively leverage the diverse skill sets of its team members.
JLG Health Solutions was engaged to augment the payer's internal medical management leadership team and lead the redesign of the care management program. This involved:
- Conducting a comprehensive gap assessment to identify areas for improvement in the existing program, including processes, workflows, and resource allocation.
- Providing leadership coaching and development to the payer's medical management team, enhancing their ability to drive change and lead the program redesign.
- Developing new program processes and workflows that aligned with the interdisciplinary regional model, ensuring team members operated according to their license type.
- Developing and delivering training and education programs for care management staff, focusing on new processes, workflows, and best practices.
- Collaborating with the payer's IT department to optimize technology systems (EMR) to support the new care management model.
- Developing dashboards and performance monitoring tools to track program effectiveness and identify areas for ongoing improvement.
- Providing ongoing management support through leadership augmentation, ensuring successful implementation and sustainability of the redesigned program.
The Result?
- The payer successfully transitioned to an interdisciplinary regional care management model, optimizing resource use and enhancing patient outcomes.
- The payer’s medical management leadership team was strengthened through coaching and development, improving their ability to drive change and lead the program.
- Program processes and workflows were streamlined, resulting in improved efficiency and effectiveness.
- Staff training and education enhanced the team's ability to deliver high-quality care management services.
- Technology system optimizations (EMR) improved data collection and reporting, supporting performance monitoring and decision-making.
- Dashboards and performance monitoring tools provided real-time insights, enabling the payer to track program effectiveness and make data-driven improvements.
Risk Stratification Optimization
Client Story: Large Not-for-profit Health Plan
A health plan was struggling to accurately identify its highest-risk members for care management programs. Their existing method for determining risk wasn't working well, leading to inefficient use of resources. Lower-risk members were getting intensive care, while those with serious needs were being missed. The plan's leaders recognized the need to improve their risk identification process to make their programs more effective and use resources wisely. They also needed to improve communication and collaboration between their medical economics, actuarial, and analytics teams.
JLG Health Solutions was engaged to augment the payer's internal SMEs
to analyze and improve the health plan's risk identification process. This involved:
- Researching Best Practices: Studying industry standards and new approaches to risk identification.
- Analyzing Data: Examining member data, claims, and healthcare usage to pinpoint key risk factors.
- Facilitating Collaboration: Bringing together the plan's medical economics, actuarial, and analytics teams to share knowledge and agree on the new process.
- Developing and Testing Models: Creating and testing different risk identification models with new factors and calculations to improve accuracy.
- Implementing the New Process: Helping the plan put the improved process into action, including training and ongoing support.
- Establishing Ongoing Improvement: Setting up a system to monitor and refine the risk identification process over time.
- Improving interdepartmental communication: Fostering better communication between the involved departments.
The Result?
The health plan successfully implemented an improved risk identification process that significantly increased the accuracy of appropriate risk level identification (i.e. high risk vs. rising risk) for its members. Additional results:
- Care management resources were used more effectively, ensuring the right members received the right level of support.
- More effective targeting resulted in improved care management outcomes, leading to better patient health and lower healthcare costs.
- Collaboration between the medical economics, actuarial, and analytics teams improved, resulting in better communication and data-driven decisions.