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Case Management

KEPRO Case Management improves the health of members while decreasing care costs associated with episodic health events.

Obtain Vital Services Without Costly or Unnecessary Expenditures.

Hospital admissions and readmissions, plus the unnecessary use of emergency departments, medical services, and equipment can send your costs skyrocketing. That’s why you need the advanced, comprehensive Case Management services only KEPRO can offer. We promote cost-effective quality outcomes through frequent communication and coordination among our RN case managers, each member, healthcare provider, family or caregiver, other vendors, and community resources. Our program is completely voluntary for members. 

Case management is necessary when members have:

  • Acute healthcare needs, diagnoses, or hospitalizations
  • Complex medical issues and co-morbidities
  • Complex hospital discharge requirements
  • Complex social issues 

We Target Potential High-Cost Claims Before They Happen. 

Eligible members at greatest risk for high cost medical claims are our primary targets. We empower members to take control of their health, make informed healthcare decisions, and work more collaboratively with their physicians. Each of our RN case managers is an extension of the member’s physician practice. We work collaboratively with physicians to help members realize their health goals. 

We Provide Care Transition Management for Post-Discharge Patients. 

Care Transition management targets eligible members requiring short-term coordination beyond their discharge from an acute care, rehabilitation, or skilled nursing facility. While the member is still hospitalized, our RN case manager calls, (or visits the facility), and involves the participant’s family, and their physician to facilitate post-discharge follow-up, reconcile medications, and coordinate services. Transition management follows the member post discharge for up to 30 days. Our goal is to prevent readmissions and increase compliance with physician prescribed treatment plans. 

KEPRO Can Administer Complex Case Management for Your Most Costly Members.

KEPRO Complex Case Management is a longer term, intensive support program for high risk and at-risk individuals, the most costly one-to-two percent of your population. We emphasize appropriate utilization and access to services and the most effective care, and act as an advocate for each member. Our case managers help members understand and comply with prescribed medications and keep follow-up visits with providers. Better self-management improves quality of life and reduces costs. 

Our program focuses on: 

  • Cancer, transplant, end-stage chronic disease, serious co-morbidities, and multiple chronic conditions
  • Care involving multiple providers that is often not coordinated
  • Serious psychological, pain management, social problems, and other potential cost drivers 

We Bring Added Cost Efficiency to Clients with Stop Loss Relationships.

Our Care Coordination program proactively manages all cases identified as eligible for case management, without requiring member consent. We target eligible members who require coordination of services to ensure they are getting the right care at the right time, according to their benefit plans. RN case managers also work with each member’s medical team to coordinate healthcare needs. Care coordination allows our case managers to track, monitor, and report health utilization. This results in early, proactive management of your members and increased savings and return on investment for you. 

Consider Optional KEPRO Services that Can Add Value.

ONSITE ASSESSMENTS 

If our clinical experts have concerns about the validity of a phone interview, or the member’s condition is so complex that telephone outreach may be inadequate to truly assess the expected treatment course, our medical director may authorize an onsite assessment. 

24/7 NURSE ADVICE LINE & COVERAGE 

Our 24/7 Nurse Advice Line provides vital and compassionate support to members, from simple first aid to calming instructions in a life-threatening situation. Our nurse advice line uses advanced technology and evidence-based software to provide personalized support any time, day or night. 

Find an Answer

Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

KEPRO Headquarters

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777 East Park Drive, Harrisburg, PA 17111
Toll-free: 800.222.0771
Phone: 717.564.8288
Fax: 717.564.3862