Case Study 3:
A Disease & Case Management Company Builds a “Total Solution” Without Adding Computer Staff or Hardware

A disease & case management company responsible for over 3,000,000 lives in states across the country was building its own case management system and a data warehouse for the claims data of these clients. Before purchasing SmartCare®, in tandem with the 3M CRG software, it had hired a data scrubbing company to clean the claims data regularly received from two of its larger HMO customers, running sizable monthly charges. While it had a skilled IT staff, they were already overloaded with the responsibilities of running the computer network for over 100 users at different sites, Internet access, and development of the new system and data warehouse.

It is difficult to clearly show the results of disease management, and the nature of the work makes it imperative to track services and outcomes with good software. Since the company had been unable to find any software for disease management service tracking to meet its growing needs, it decided to make a major investment in building its own. But the added task of building a decision-support system with the ability to merge the data from its new system with claims data from multiple HMOs would be very difficult to model and require more development staff and time to construct.

By purchasing SmartCare®, all of this development work was avoided. They did not have to build a custom decision-support system, nor did they have to deal with merging data from multiple systems into a single database. SmartCare®’s data mining functionality was able to include all of the fields in both the claims data and their new patient tracking system, and then allow users even to cross-tab them together. Vantage Point worked with their IT database administrator to obtain record layouts of all data sources, and then mapped them into the unified SmartCare® import format in less than 3 weeks. One IT staffperson was required to write a stored procedure to extract the claims data provided by the scrubbing service.

Rather than hire additional technical or analytical staff, the company was able to have an administrative assistant learn the software. This person not only runs the reports and creates ad hoc queries, but also serves as the coordinator for many other projects at the company. They have run 20 million record files through SmartCare®, using an existing server after inexpensively expanding it. Now that they can see all of their data so much more clearly, they are reconsidering the need for the scrubbing service.