L.A. Care Enhances Case Management Efficiency and Outcomes

The Challenge

L.A. Care, a health plan serving more than two million members, has a mission to provide access to quality health care for vulnerable and low-income communities and residents across the Los Angeles area.

L.A. Care’s case management team often faced difficulty in closing gaps in care due to data lags. Without real-time admission, discharge, and transfer (ADT) notifications, they had difficulty performing timely outreach to members and ensuring members got the follow up care they needed.

Additionally, the lack of visibility into patient data made it difficult to collaborate easily with other providers across the continuum, limiting their ability to offer support to members facing ongoing health challenges and unmet needs. This visibility gap also risked negatively impacting care outcomes, preventing members from achieving their care goals, and disrupting L.A. Care’s ability to connect them with necessary services promptly.

The Solution

PointClickCare’s Care & Utilization Optimization solution provides health plans access to the data they need to collaborate across the health care ecosystem to ensure their members gain access to the right care, by the right provider, in the right setting and level of care.

Gema Salas, Health Information Ecosystem Program Manager for L.A. Care, shared, “PointClickCare has really helped us identify and close gaps in care. Our teams can now quickly spot where there’s a need and step in to provide the support our members need, right when they need it. It’s reduced a lot of delays we used to face.”

Driven by the ability to collaborate across care teams offered by Care & Utilization Optimization, L.A. Care knew they were selecting a tool that promotes member and population health to reduce the total cost of care.

The Outcome

With Care & Utilization Optimization (CUO) as their solution of choice, L.A. Care found that they were able to achieve substantial time savings and improved outcomes for transitions of care. “Prior to the solution, there was a time lag in receiving information — we weren’t able to receive it in real time,” Salas noted.

The CUO solution provides health plans with the data needed to quickly spot high-risk members in acute care and engage providers for timely intervention. PointClickCare’s network ensures seamless data sharing across care settings, improving coordination and outcomes. “Identifying members with high readmission rates or those frequently visiting the ED instead of their PCP or specialists allows us to reach out, not only to the member but also to their providers, ensuring that members receive appropriate care and are directed to their PCP or specialists, rather than the ED,” said Salas.

Learn More

If you’re interested in implementing Care & Utilization Optimization to help your organization achieve results like those experienced by L.A. Care, learn more here.