Case Study: CareCore National

The Client: CareCore National (CCN) partners with a variety of health plans to manage their radiology programs. Among the important management tools CareCore provides is the scheduling of appointments. When patients make appointments with their providers, they are seamlessly transferred to CareCore for accurate, reliable scheduling.

To achieve quality in a variety of marketing areas, CareCore works closely with clients to ensure effective, efficient, and cohesive communications. Among the benefits for health plans working with CareCore are

Immediate reductions in current radiology spending.
Utilization increases managed to appropriate trend levels.
Increased service quality and customer satisfaction.
Significant return on investment.

The Challenge: The success of the CareCore concept depends largely on the strength that state-of-the-art technology can provide. The demand for its product led to rapid growth and that very same demand strained the existing system to capacity…and beyond. The “staff was too consumed with keeping the old system running to take on the arduous task of developing a new solution in house,” remarked William Moore, CIO. Time was a critical factor because new business was onboard as well as in-the-works and the old legacy system was under severe duress. Time was also a critical factor for the Oxclove team. A new system needed to be functioning satisfactorily within just 4 months. “The legacy application and database needed to morph into a more robust platform in virtually no time,” explains Ric Dragon, CEO. The system needed to be revamped and improved to add web based access for customers preferring electronic transmission to phone or fax.

The Solution: Oxclove Workshop developed a new, improved application in the time allotted. It was built in the .Net 2.0 framework, making extensive use of XML, service oriented architecture and AJAX to dramatically improve performance. The underlying database was upgraded to MS Sql Server 2005. Oxclove developed a business rules engine to process service requests based on health plan eligibility criteria and various state insurance regulations. These rules change frequently, and updates to the application logic via the rules engine can be immediately, while the application is running. Using older programming methods, Care Core could only update this application logic after hours, putting it into effect the next business day after programming was complete. This caused lags between the time new plan rules went into effect and when they were incorporated in the CareCore application.

The new architecture enables CareCore to maintain required levels of service as the company growth continues at a fast pace. New service offerings for Cardiology and Oncology that utilize the same applications have been introduced. A web portal, HIPAA compliant, has been developed and implemented by Oxclove so health care providers can access the CareCore services over the web, rather than by phone or fax. Patients are now scheduled for important procedures immediately through the portal, rather than waiting for phone or fax confirmations. This is providing substantial time and cost savings for the medical practitioners and the health insurers that pay for their services. After just two months in operation, the portal is being used for one in three requests. CareCore reports that this amounts to tens of thousands of eligibility verifications and procedures scheduled per day. The web portal is replacing expensive and time consuming call center, fax and mail processing, so the cost savings are substantial even as volume continues to grow.

What’s more, Oxclove was relied upon to intervene to resolve issues with other applications. The Oxclove team worked tirelessly well into the night and on the weekends to develop the system and train staff on its proper use. Along the way, Oxclove became a partner to the CareCore team, sometimes even entering into vendor relations in order to provide the promised exceptional CareCore service to an entire network of users from business partners to potential clients and existing vendors. As is often the case, what started as an assignment has grown into a long-lasting, mutually beneficial relationship.