Executive Summary:
When Hills & Dales, a long-standing provider for individuals with Intellectual and Developmental Disabilities (IDD), found itself buried under fragmented EHR systems, manual documentation processes, and disconnected care workflows, leadership knew change was necessary. Their journey with iCM wasn’t just a technology upgrade; it was a transformation in how IDD service delivery, regulatory compliance, and cross-team communication happened across the organization.
By consolidating multiple vendors, replacing paper-based and spreadsheet-driven documentation with streamlined digital EHR processes, and unlocking actionable operational data insights, iCM became a true partner in Hills & Dales’ organizational growth. This IDD care management case study explores how Chief Executive Officer Jack Mescher and his team leveraged iCM’s all-in-one EHR platform to improve Medicaid compliance, eliminate inefficiencies, and adopt a forward-looking approach to data-driven disability services.
About Hills & Dales:
Hills & Dales is a cornerstone of the IDD provider community in Eastern Iowa. With 450 employees serving 218 clients, the organization provides a continuum of IDD services, including:
- 24/7 residential programs
- Home and Community-Based Services (HCBS)
- Outpatient services
Their mission is deeply personal: supporting meaningful lives for people with disabilities through person-centered care delivery.
Chief Executive Officer Jack Mescher brings more than a decade of experience in the IDD services sector. His journey began as a Direct Support Professional (DSP) while in college - a role he fell into by chance but soon discovered as his calling. Over 12 years, he grew into leadership roles spanning government relations, board membership, and finally executive leadership in 2021, taking the helm during the height of the COVID-19 pandemic.
Jack’s leadership is rooted in first-hand experience across every level of IDD service operations, giving him a unique perspective on the workflow challenges, staff burden, and the importance of technology-enabled innovation in sustaining high-quality care.
The Challenge: Fragmented Systems, Manual Processes, & Limited Visibility
Like many IDD service providers, Hills & Dales faced growing operational complexity but was constrained by outdated, siloed systems. Key challenges included:
1. Multiple Vendors, No Integration:
The organization relied on several EHR and workflow vendors, none of which communicated with each other. This patchwork of tools left staff duplicating work, introduced errors, and created confusion during audits, billing reviews, and compliance checks.
“We had a number of different vendors… and they were all divorced, they didn’t speak to each other. It was kind of a cluster.”
– Jack Mescher
2. Communication Divide Between Teams:
The health team and program staff, both essential to quality IDD service delivery, worked in silos. Information didn’t flow seamlessly, creating delays in updates and inconsistencies in care coordination.
3. Manual Documentation Bottlenecks:
Before iCM, staff wrote lengthy narrative care notes for every client interaction. Reviewing them required a full-time note reader, whose sole job was to check accuracy and completeness. This slowed care documentation workflows and delayed corrective actions
4. Reliance On Spreadsheets for Key Operations:
From billing status to medication errors and incident reports, Hills & Dales tracked critical data in 600+ Excel spreadsheets. This created version control issues, wasted staff time, and left leadership without real-time organizational visibility.
5. Compliance & Training Risks:
Under Medicaid and HCBS regulations, staff must maintain active certifications. Tracking this manually across hundreds of employees created gaps, exposing the organization to regulatory compliance risks. Hills & Dales had dedicated staff and strong leadership, but legacy technology limitations were holding them back.
The Solution: An All-In-One Platform
After meeting iCM at a conference, Hills & Dales saw an opportunity to unify their systems and modernize operations. iCM delivered an all-in-one EHR solution for IDD providers that addressed their diverse needs.
1. Vendor Consolidation & Cost Efficiency:
By implementing iCM, Hills & Dales eliminated four to five separate vendors and hundreds of spreadsheets. All essential functions, including documentation, billing, training management, and compliance tracking, were centralized into one modern cloud-based EHR platform.
“We were able to sunset four or five vendors, plus probably 600 Excel spreadsheets, by switching to iCM.”
2. Seamless Communication Between Teams:
iCM bridged the communication gap between health and program staff. Updates and records are now accessible through real-time centralized records, ensuring every team member works from a single source of truth.
3. Streamlined Documentation Processes:
Narrative notes were replaced with push-button documentation in iCM’s CareTracker module. This standardized process reduced human errors, decreased staff workload, and eliminated the need for a dedicated note reader, allowing resources to be redirected toward data monitoring and quality improvement.
4. Integrated Training Management:
iCM’s built-in Learning Management System (LMS) tied training compliance directly to service delivery. Staff who fall out of compliance (such as expired CPR certifications) are automatically restricted from documenting.
“We shouldn’t ever have non-trained people documenting. With iCM, that’s now enforced.”
5. Actionable Data Insights:
One of the most transformative outcomes was iCM’s ability to capture tens of thousands of data points and convert them into real-time operational dashboards. Leadership can now:
- Identify service locations with higher or lower community outings
- Pinpoint staff or sites with elevated incident trends
- Track referral sources and service utilization
- Monitor billing accuracy and medication errors in real time
This shift from reactive oversight to proactive IDD management has been game-changing.
“Instead of blanket training for everyone, we can now target specific staff or locations because the data supports it.”
Key Outcomes & Impact:
1. Reduced Complexity & Vendor Consolidation:
Hills & Dales transitioned from fragmented systems to a single integrated IDD EHR platform. By retiring legacy vendors and hundreds of spreadsheets, they reduced costs, errors, and staff frustration.
“Having everything under one roof has been a game changer. Instead of jumping between vendors and spreadsheets, our teams finally work from one place.”
2. Greater Accuracy & Streamlined Documentation:
By replacing narrative notes with structured EHR documentation, staff focused more on service delivery while leadership gained cleaner, more reliable care data.
“Our documentation is no longer about chasing words - it’s about capturing the right data in the right way, every time.”
3. Stronger Compliance Through Integrated Training:
Training compliance is now enforced in real time. Expired certifications automatically block documentation, improving audit readiness and client safety assurance.
“It gives me peace of mind knowing compliance isn’t just tracked - it’s enforced in real time.”
4. Resource Optimization & Workforce Efficiency:
Manual note checking and spreadsheet management were eliminated, allowing staff to focus on high-impact operational improvements and service quality initiatives
“We’ve shifted people from low-value work into roles that actually move the organization forward. That’s not just efficiency - it’s empowerment.”
5. Leadership Visibility & Data-Driven Insights:
With real-time EHR dashboards, leadership moved from reactive decision-making to proactive strategic planning, supported by data instead of assumptions.
“I don’t have to guess anymore. The data tells me where to focus, which makes our decisions sharper and our outcomes stronger.”
6. Improved Audit Readiness & Billing Confidence:
With billing and compliance embedded into one system, audits became simpler and billing processes more defensible.
“When an auditor asks a question, we don’t scramble anymore - the information is already there, accurate and complete.”
Future-Ready: Embracing AI
Jack is enthusiastic about iCM’s commitment to AI-powered EHR innovation, including automated dashboards, anomaly detection, and compliance optimization.
“AI that curates our data, builds dashboards, and flags issues before we see them - that’s the future. And we want to be part of it.”
Areas for Enhancement:
While highly satisfied, Jack identified some legacy features that felt clunky compared to newer ones and highlighted ICF/ID billing optimization as a priority. These enhancements are already on iCM’s roadmap as part of its continuous platform improvement strategy.
Conclusion: A Champion for Smarter Service
With iCM, Hills & Dales transitioned from fragmented, manual IDD systems to an integrated, insight-driven EHR solution that empowers staff, strengthens compliance, and elevates client service. Under Jack Mescher’s leadership, the organization represents what it means to be an iCM Champion.
“The cost-value proposition is clear. ICM is compatible with state regulations, saves money, and gives insights every provider should want. I don’t give recommendations lightly, but I recommend iCM with pride.
