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One of the nation’s top 10 largest health insurers needed to arm their care managers with powerful digital tool to conduct in-home assessments. The tool needed to help the care manager ask all of the right questions and support a trust-building conversation between the care manager and the member. 

Collaboratively, SDLC Partners built an application that enables care managers to engage members in the field while staying focused on asking critical questions and capturing crucial information.

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The Challenge

A care manager has a challenging jobtraveling to a member’s home or nursing facility to gather information about the quality of care the member is receivingThrough these quarterly in-home visits, the care manager assesses needs, address gaps in care, and triggers escalations, with the goal of delivering a caring, personal experience. While the care manager is building rapport, he or she must focus on the goal of the interaction, capturing key information despite common distractions found in the home or care facility.  

Care managers were using a tool to support their visits; however they spent more time on managing the tool (for example, performing manual data validations) than understanding the members’ unique situations and needs.   

The health plan wanted a new digital tool that allowed care managers to transition easily from the office to the field, enabling intuitive, conversational member interactions.  

Naturally, the new tool needed to support secure offline data collection and seamless integration with enterprise systems back at the plan’s home office. 

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The Solution

The care management solution delivers baseline features that one would expect in a care management platform – note capture, assessments, medication reconciliation, care plan, and signature capture, to name a few.  

The new solution extended NCQAcompliant functionality that allowed the care manager to focus on engaging the member in priority areas and topics.  Most importantly, the intuitive mobile interface functions the way care managers think in the field. The functionality is modular, giving quick access to forms, medication lists, care plans, and notes.  

The care management solution allows care managers to: 

  • work dependably, online and offline, and with secure, bidirectional synchronization 
  • work intuitively – return to a previous screen or task without losing data  
  • search services and care plans  
  • instantly update or initiate referrals  
  • estimate needs, like ADL assistance, that can be scheduled immediately 
  • coordinate care for challenging care situations like LTSS and frequent readmissions 
  • capture the member’s signature for verification  
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The Results

SDLC’s Human-Centered Design Practice collaborated with the health plan to generate the solution concept, design, and architecture. Because of its workflow flexibility, the application has an intuitive interface that facilitates member engagement and meaningful exchange.  

The client achieved significant savings per member due to the positive impact on the member experience with their care manager, as well as enhancing the member’s level of engagement. Ongoing value is generated by avoiding unnecessary inpatient admissions to hospital or skilled nursing facilities, achieving greater quality of life for members and cost containment for the payer and provider ecosystem. 

If your health plan needs to reinvent the in-home/in-facility care management experience, solutions like this one can automate tedious tasks while empowering care managers to focus on the needs of members.   

If you would like to see a demonstration and learn how this type of solution can streamline and enable case/care management engagement and time, cost savings, contact SDLC Partners. 

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