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Health Plans Explore New Tools to Simplify and Automate Care Management Programs and Improve Health Outcomes

Posted on: Wednesday, 2 November 2005, 12:01 CST

QCSI provides practitioners with integrated tools to manage their expanding roles in healthcare

Quality Care Solutions Inc. (QCSI(R)), a leading provider of advanced information technology and enterprise application software and services for health insurers and benefits administrators, announced today the deployment of its comprehensive Care Management solution designed to simplify and automate the care management process and improve health outcomes. With the inherent demands of consumer-driven healthcare, QCSI puts technology into the hands of practitioners faced with managing their expanding roles in disease and case management, supporting preventive care and empowering consumers to participate in their own health care management.

A health plan's medical utilization can account for more than 85% of its overall costs. QCSI's Care Management solution gives organizations control over health care data needed to manage these costs throughout the continuum of care. QNXT Case Management allows health plans to seamlessly integrate workflows for authorization and referral management in utilization review, concurrent review, discharge planning, disease management, complex case management and chronic care management programs.

Network Health Plan Applauds QNXT Case Management

"QCSI's case management functionality covers real-world needs of case managers and supervisors, providing us with the integrated tools to effectively and proactively manage member care, assessments, notes, histories and claims," stated Darla Schmidt, R.N., case management coordinator of Network Health Plan. "The system also allows us to better manage our workloads through user-defined 'events' for follow-up calls, correspondence such as medical screening reminders or visits."

Schmidt continued, "From a management standpoint, our supervisors are able to evaluate current workloads of our case managers and assign records as necessary -- without affecting the level of care we give our members, because we are able to maintain complete member information in a single case management record. Furthermore, it gives our inpatient case management coordinators the ability to identify and refer cases into our ambulatory case management system so we can provide preventive care to our members to proactively address health issues before they turn into critical and costly health care problems. We are extremely pleased with the functionality of QCSI's Care Management solution."

"We have delivered on our commitment to providing a complete, integrated care management solution to complement our administrative functional capabilities," stated Dave Engert, CEO of QCSI. "We are extremely pleased to see that Network Health Plan has embraced our solution and is now beginning to realize the value of our enterprise solutions."

Benefits of QCSI's Care Management solution include:

-- Improved Decision-Making with Real-Time Data Access Available as an optional add-on product with the QNXT enterprise application system, QNXT Case Management takes advantage of the claims and benefits information within QNXT, allowing case managers access to real-time data and the ability to proactively identify members for case management interventions more quickly, improving the quality of health care outcomes.

-- Reduced Health Care Costs Proactively identifying the 20 percent of a health plan's membership that generates the highest costs and encouraging high-risk members to participate in chronic care management programs allows members to stay healthier, ultimately reducing medical costs and improving overall customer satisfaction.

-- Customized Assessments and Protocols Based on a Health Plan's Unique Needs With flexible workflows and stratified queuing, QNXT Case Management is fully configurable, enabling health plans to individually define and create assessments and events for the management of their unique membership by population and disease state.

-- Complete Case Management Capabilities The integration of case management capabilities within QNXT allows case managers to quickly identify and profile members based on current claims activity, set up treatment plans and authorize appropriate services.

-- Integrated Predictive Modeling Tools QNXT Case Management integrates predictive modeling tools at appropriate points in the workflow and uses the medical claims inherent in the QNXT core system to identify risk factors such as future health care costs and utilization.

-- Integrated Utilization Management With QNXT's integrated utilization management capabilities, health plans can automate the authorization, pre-certification and referral workflows from within a case management record.

About QCSI

Cited by a global independent research company as a leader for health care claims platforms and claims platforms for consumer-directed health and claims platforms with integrated medical management, QCSI is empowering companies for "The Next Healthcare Economy, Without Information Boundaries." The company is celebrating more than 11 years of delivering advanced technology enterprise solutions that empower health insurers and benefits administrators to automate health care administration, lower the cost of care and improve outcomes. QCSI's service oriented architecture (SOA) applications enable health plans to reduce costs, improve customer service, increase profitability, expand market share and prepare for government regulations, including HIPAA. Our award-winning enterprise applications include the QNXT product family (Medical, Dental, Case Management, Accounts Receivable, View and Connect), and the Web-based MyHealthBank suite (Transact, Direct, Navigator and Finance), proven applications and solutions for the rapidly growing consumer-directed health care segment. Headquartered in Phoenix, QCSI can be contacted at 888-940-6432 or info@qcsi.com, or visit our Web site at www.qcsi.com for more information.

QNXT, QMACS, QCSI and MyHealthBank are trademarks or registered trademarks of QCSI. U.S. Patent No. 6,879,959. Other marks referenced herein are the service marks, trademarks or registered trademarks of their respective holders.

Source: Business Wire

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