C O L L A B O R A T I V E C A SE M A N A G E M EN T

Innovative Payor Dashboard Achieves Measurable Results, Benefiting Both Payor

and Case Management
Lynn Bree, BA, CPHQ, CPUM, CMAC

Case managers’ unique position requires that they serve as advocate and liaison for the patient, physician, hospital administration and in many
cases, payor organizations. Though essential, case management’s responsibilities, as they pertain to payor organizations, often represent a
substantial investment of both time and resources and significantly impact the amount of time case managers are able to spend with their patient.
Specifically, payor requests for clinical case reviews occupy a considerable portion of case managers’ time in many organizations.
This article examines an innovative Payor Dashboard that one organization implemented to minimize the time care givers invest in performing case
reviews, while providing payors with a user-friendly interface for accessing clinical information.

Identifying the Need
In 2005, Aurora health care system in Milwaukee, WI (Aurora)
began their transition to an electronic health record (EHR) system. As
the process began, Aurora’s Regional Manager of Case Management,
along with the organization’s Director of Managed
Care Operations (MCO), immediately recognized the need for a
system that would integrate with the EHR and provide payors access
to clinical information while creating a more efficient work process
for case managers.
“The Payor Dashboard would provide
payors with easier access to
clinical information and reduce the
amount of time the case managers
were spending relaying clinical
information to commercial payors.”
Prior to the implementation of the Payor Dashboard, St. Luke's
Medical Center, Aurora's 500+ bed quaternary referral center, was
receiving more than 1,800 review requests per month. This was in
addition to the on-site nurse reviews for the payors. This volume of
review placed a considerable strain on the facility’s case managers,
and requests would only increase if the on-site reviewers no longer
had access to the medical record. This prompted the Regional
Manager and the Director of MCO to begin to look for a more
efficient method of exchanging clinical information that would meet
both the organization’s and the payor’s needs while minimizing the
time spent by case management in performing reviews. The payors
were already viewing their census online, and the idea was to use this
concept to control access and allow payors to “drill-down” into the
patient's information.
The Business Case
At the time the EHR system was implemented, Aurora’s Regional
Manager and the Director of MCO spoke with the organization’s IT
department to ensure that they were aware of the need for external
access to the EHR, and to gauge the feasibility of such a project.
In 2006, these two leaders drafted and presented the business case
for the Payor Dashboard to the organization’s financial and senior
leadership. The intent of the plan was to justify the cost of the project
– which was primarily IT programming time – and demonstrate that
the Payor Dashboard would provide payors with easier access to
clinical information and reduce the amount of time the case managers
were spending relaying clinical information to commercial payors.
Prior to the Payor Dashboard’s implementation, case managers were
not only responsible for receiving the request for review, but they were
also tasked with performing the clinical review and submitting the
information either via phone call or fax. In the context of 1,800 review
requests per month, the nature of this process was labor intensive.
Additionally, a key selling point presented in the business case
outlined the amount of time the current process detracted from case
management’s role in managing and progressing the plan of care for
the facility’s patients, specifically the “at risk” populations such as
Medicare and Medicaid.
The Design Team and Implementation Process
The “design team” for the Payor Dashboard primarily consisted
of three key stakeholders: the organization’s Corporate IT Planner,
Regional Manager of Case Management and Director of MCO.
The Regional Manager and Director of MCO were the strongest
advocates for the system, and as they directed and presented the
business case, these individuals serve as the administrators for the
program with the payors.
The Corporate IT Planner’s primary role in the process was to
manage the development, programming and implementation of the
system. This was an extensive undertaking as the Payor Dashboard is
not a purchased product, but rather it was designed entirely by the
staff at Aurora.
To implement the system, the Aurora team initially partnered
with one payor. This allowed the organization to essentially pilot the
program and identify any issues on a limited scope basis before
launching the product system-wide to all 14 acute care facilities, as
well as multiple payors. The pilot allowed the payor to provide
feedback, make recommendations and opened dialogue between the
dashboard’s design team to identify areas of improvement. Once the
system had been successfully launched at Aurora St. Lukes, the
Dashboard was implemented in all Aurora Health Care’s acute care
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Innovative Payor Dashboard Achieves Measurable Results, Benefiting Both Payor and Case Management
(continued from page 3)

facilities and the process of configuring the Dashboard to
accommodate multiple providers began.
The Payor Dashboard is a portal, which allows the organization
to control access to its medical records. The idea for this format was
prompted by the organization’s current system, which gave providers
the ability to access an online census. The methodology was to allow
payors to subsequently “drill-down” into a specific patient from the
online census. Remaining in compliance with HIPPA regulations
was a natural requirement in implementing the new system;
therefore building upon the census allowed for controlled access.
With this in mind, the first step in the configuration process was
to expand on the existing relationships with provider representatives.
Each provider group has a designated contractual provider
representative who administers the process from within the payor.
Payors were provided with subscriber agreements designed to hold
them accountable in training and managing their users. Each
payor’s staff is trained only once via a webinar and it is the provider
representative’s responsibility to ensure that any incoming or
replacement staff are trained.
By submitting a subscriber agreement, a provider consents to
primarily accessing clinical information via the Payor Dashboard.
Providers that have multiple divisions and products, such as
Medicare or Pediatrics, must agree to “all or none,” preventing
scenarios in which the system administrators must determine which
payor’s division or product is to be accessed via the system and
which is not.
The Model
Each nurse case manager from the provider is assigned login
information, which they must use to access the Dashboard via a
designated area on Aurora’s website. Once the payor has logged into
the system:
• The payor’s nurse reviewer chooses the Aurora facility for which
they would like to review records. Then the user chooses a time
frame for the patients in question. For example, patients
admitted from July 1 – July 10, 2010
• Once the hospital and date range are entered, the system
populates the census with all patients for which the payor is a
Once a payor has accessed a patient’s profile, they have the
ability to view the patient’s demographic information in a format
similar to a face sheet. They can access information regarding the
patient’s physician(s), such as a list of physicians on the case
including their respective office phone numbers. The record also
identifies patient-specific information such as:
• Laboratory results
• Vital signs
• Nurses’ notes
• Therapy and/or respiratory therapy notes
• Dictated Physician notes
• Dictations (Op reports)
• Laboratory reports
• Dictated Consults
• Chaplain information
• Discharge planning information
• Medication records - orders can be sorted by type or date
Moreover, the system offers the ability to graph results. For
example, if a reviewer is examining the record of a patient who has
uncontrolled blood sugars or any abnormal lab result, the reviewer
has the ability to click on today’s lab value for that item, and the value
will display as a graph for the patient’s stay (see figure A). This allows
the user to view the control or response to treatment at a glance – he
or she can easily determine whether the patient’s blood sugar is in
good control or the WBC levels are returning to normal range.
One of the most important components of the system is its ability
to track all activity. The Dashboard displays a history of every individual
who has been in the record and when the record was accessed.
This critical feature is necessary in order to remain in compliance with
GLUCOSE
July 2010
150 -
125 -
mg/dL

primary payor. The system also displays any patients who have 100 -
been discharged within five days
75 -
• Once the user selects a patient, they are directed to a page that
lists the patient’s information 50 -

• At no point is the user accessing the patient’s full medical 25 -

record, rather certain sections of the record are being provided 0- 7th 8th 9th 10th 11th 12th 13th
to them. The payor can only access what has been activated for 4:42pm 3:30am 4:00am 5:05am 5:15am 6:30am 8:20am

them to view Figure A

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Innovative Payor Dashboard Achieves Measurable Results, Benefiting Both Payor and Case Management
(continued from page 4)

HIPPA. Additionally, as a security measure, users are only able to view
records and render a decision; printing is not permitted.
From the payor’s perspective, the ability to select on the screen
whether to approve or deny the patient’s stay or request a higher level
of review with a case manager is vital. Approvals are routed directly to
the organization’s business office, and a denial or a request for more
information from the facility’s case manager is sent via email to the
organization’s case management department. Email subject lines do
not contain the patient’s name, rather his or her bed number. This
allows a case manager, who may be covering a unit for their colleague,
to stay informed of a request or denial that needs to be addressed.
The system simplified the manual review process for the
organization’s case managers. If providers request further
information, the case manager is notified via email to that facility's
case management department. She then logs into the organization’s
case management tracking system and completes a review, which the
payor can access via the portal. This eliminates the need for case
managers to make phone calls, print information and send faxes to
satisfy the request, which saves costly resources.
Benefits and Outcomes
As previously mentioned, Aurora implemented the Payor
Dashboard throughout the entire 15- facility system (a new hospital
opened in 2010). The Dashboard is now available to a large number
of the organization’s high-volume contracted payors.
Perhaps the clearest indicator of the Payor Dashboard’s
effectiveness is the decrease in review requests – from more than
1,800 per month at Aurora St. Luke's alone in 2007 to 350-500 per
month in 2008. The drastic decrease in review requests has returned a
great measure of valuable time to the organization’s case managers,
which can now be spent attending to progressing the patient’s plan of
care. In approximately 85% of cases, payors can certify and/or
authorize days on their own without requesting case management
assistance in obtaining or clarifying clinical information.
Furthermore, the Dashboard allows the organization to transfer and
share time-sensitive records quickly. For example, a Medicare patient
requests an appeal of their discharge, requiring the organization to deliver
the medical record to the QIO within 24 hours. Prior to the Dashboard’s
implementation, this was often a challenging feat. Printing directly from
the EHR system sometimes led to a number of issues including: the
printing job being delayed for hours causing the case managers to “cue-up”
multiple requests; the record being sent to the wrong printer; or if the print
job executed after standard operating hours, pages would accumulate on a
printer causing jams. Once the record was actually in hand, it had to be
sent via fax to the QIO. This sometimes meant faxing hundreds of pages.
Aurora partnered with the state of Wisconsin’s QIO to provide
them instant online access via the Payor Dashboard, eliminating the
need to print and fax health records. As the QIO is not a payor, their
access is limited to only the one specific patient in question that is
unlocked for them for a specific number of days. The QIO has been
very pleased with this arrangement, and it has proven to be a much
more efficient process than the traditional method.
The system’s success has prompted the organization to pilot the
Dashboard in facilitating the nursing home evaluation process for the
transitioning of patients to nursing homes beginning summer 2010.
Lynn Bree, BA, CPHQ, CPUM, CMAC, has been the Regional Manager
of Case Management at Aurora Health Care since 1997. She earned
bachelors degrees in both health care administration and business from
Ottawa University in Brookfield, WI. During her career she has over 25
years of health care experience in utilization/case management, as well
as experience in quality in both the QIO and acute hospital settings.

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