Casenet Overview

Seamless Collaborative Health Management
Casenet® enables seamless, collaborative health management
which allows individuals and their care teams to coordinate on
achieving maximum health at an affordable price.
Casenet’s solutions are designed to deliver efocient health
management by providing a timely, seamless qow of actionable
information between care managers, partners, providers, individuals, families and systems. Casenet solutions include a comprehensive suite of extensible, enterprise care management software
and services which enable our customers to improve care
coordination and the quality and delivery of care. The Casenet
care management solution, TruCare®, is architected to be easily
scalable and can support small to very large enterprise customers.
TruCare is qexible enough to support one or a combination of
membership programs including Medicaid, Medicare, Medicare
and long-term care.
Additionally, TruCare has been designed to easily integrate with
other systems including EMRs, HIEs, predictive modeling and
other analytic tools, mobile monitoring devices and collaborative
care partners. TruCare delivers:
Improved Outcomes and Compliance
ŠEnhanced care coordination and early intervention
using TruCare Mobile™
ŠImproved HEDIS measures 60%1
ŠStructured, reportable notes
Reduced Cost of Care
ŠEliminated 12% of total data entry errors2
ŠReduced claims payment errors 60%3
ŠPreferred setting support to reduce need for more
expensive care facilities
Augmented Care Management Team Productivity and
ŠSegmented populations and LOBs enable delivery
of the right information
ŠPrinted member-centered care plans and case
ŠAutomated 22% of outpatient and 34% of inpatient
authorization determinations4
Increased Satisfaction
ŠEngaged members supported through home and
community-based services
ŠTargeted LOB management meet employer and
other market requirements
ŠIntegrated UM, CM and DM in a single platform
empowers staff
TruCare Overview
The Casenet TruCare platform includes case, disease, utilization
and home and community services management modules and
intervention tools for total population management. These
solutions enable organizations to align to their unique requirements and to adapt quickly to changing market and regulatory
dynamics. TruCare supports large enterprise customers that
require tremendous scalability, have many lines of business with
beneots that are complex and complicated to administer, and
require comprehensive conoguration for each targeted member
population. TruCare is also qexible enough to support one, or a
combination, of a variety of membership programs including
Medicaid, Medicare, Medicare-Duals, LTMC, SSI, CHIP, TANF and
SNIP. TruCarehas been in production for over 3 yearssupporting
28 healthcare organizations and over 4.8M lives.
TruCare offers an unparalleled intersection of clinical content,
business rules and workqow that make TruCare unique in the care
management market today. With a single platform for utilization,
case and disease management, TruCare delivers unmatched
qexibility to implement, coordinate and manage clinical, wellness
and quality programs. Utilizing a unique application framework
and superior administrative tools, non-technical business users
can perform system and clinical conoguration without requiring
technical or programming resources. Bringing all modules and
associated clinical programs into a single care management
solution is essential to optimizing productivity and improving care
Differential Care Management
At the heart of the TruCare system is a highly client-conogurable
foundation called differential care management (DCM). The
advanced DCM architecture enables TruCare to scale for growth,
accommodate diverse lines of business, support specioc employer group or government program health management requirements and manage disparate populations, both from a member
and health plan rules perspective. DCM enables organizations to
identify and target populations having unique risk characteristics
and to deliver specioc care management programs for those
members. Building this capability into the core of the product is
essential to properly supporting care management programs
specioc to member populations.
DCM also provides healthcare and business afoliations with the
ability to identify and isolate their insured life populations from one
another, driving specioc and different initiatives towards each
individual population. Within TruCare, a schema hierarchy is used
to replicate each customer’s business structure. There are a total
of nine levels that can be used to organize the various member
populations managed by a care management organization according to different needs such as: employer group purchasing
preferences, product lines, and speciocity in type, scope, and level
of intensity of service. Assessments and care plans can be
conogured by end users and care plans can be created on the qy.
This client-deoned conoguration reduces administrative activities
for care managers and ensures that the appropriate programs,
clinical content and administrative templates are automatically
presented, based on the associated member and available
services. In this model, care coordinators and nurses do not have
to investigate or determine which assessment, care plan or
interventions are required. TruCare will present the appropriate
clinical and administrative templates, based on client-deoned rules,
which signiocantly improve care manager efociency while ensuring
compliance and business policies.
TruCare Components
The TruCare platform includes the following modules:
Utilization management/appeals, case management and
disease management
TruCare Actions® - Rules engine used to target populations
having unique risk characteristics for the delivery of specioc
care management programs for those members,
Correspondence Engine
Jasper Reporting: 90+ standard & optional reports available out
of the box
40 Assessments & Care Plans are available out of the box
Optional Features include:
TruCare Home & Community Services™ - Supports waiver
programs including those of Medicaid and other
government-sponsored programs
TruCare Transportation™ - Schedules, tracks and submits ride
requests for high acuity patients
TruCare Mobile™ - Tablet application for care managers in the
TruCare Remote® - Off line, disconnected capability
TruCare Connect® - Provider and Member portals
1, 2, 3, 4
Centene Case Study
Casenet, LLC
36 Crosby Drive
Bedford, MA 01730
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Product Integration
TruCare delivers integrated UM, CM and DM modules on a single
platform with all care management operations and information
presented within a single, easy to navigate member record.
Bringing all modules and associated clinical programs into a single
care management solution is essential to optimizing productivity,
efociency and improving care outcomes.
The Differential Care Management (DCM) framework and client-deoned membership populations provide Casenet clients the ability
to synchronize application workqow and content with rules that are
specioc to the member and their plans unique requirements.
Client-deoned, customized workqow rules can drive tasks and
associated content (assessments, notes) to users and customized
work queues. The associated content can then be customized to
capture specioc care management information via assessments,
care plans and note templates.
From a case management perspective, TruCare supports the ability
to automatically identify potential opportunities for case and
disease management programs via the TruCare Actions automated
identiocation and actions process. Using the TruCare Actions
client-deoned identiocation rules and actions, Casenet clients can
effectively manage all segments of their population. Additionally,
the DCM framework is integrated with all workqow operations and
can be customized to meet the unique needs of delegated entities
or specioc membership populations. The combination of membership-specioc, client-deoned conoguration and automated workqow
capabilities delivered with the TruCare application provide Casenet
clients with the tools and capabilities to meet the needs of all
segments of the population.
System Integration
TruCare includes a number of standard integration interfaces.
These include: web services, data feeds, 278 messaging, LDAP
support, faxing, telephony, integration with clinical guideline tools
(McKesson InterQual® and CareWebQI®), and integration
with Wolters Kluwer Medi-Span. TruCare also has conoguration
options to enable the integration with other websites and provides
multiple integration points for exchanging data and interoperating
with existing clinical systems including HIEs and EMRs as well as
standard protocols such as HL7 and ADT. Leveraging a proven
integration suite of pre-built components, Casenet is able to
provide qexible and cost effective integration capabilities to
internal legacy systems or external partner systems.