Community-based case management for uninsured patients with chronic diseases: effects on acute care utilization and costs

Prof Case Manag. Nov-Dec 2012;17(6):267-75. doi: 10.1097/NCM.0b013e3182687f2b.

Abstract

Purpose of the study: To examine the effects of a community-based case management program on acute health care utilization and associated costs in uninsured patients with 1 or more chronic diseases.

Primary practice setting: Large regional academic medical center that provides health care services for the vast majority of indigent patients in the area.

Methodology and sample: This was a retrospective study of 83 patients who enrolled in a case management program between April 2007 and August 2008 on the basis of 1 or more emergency department visits or acute hospitalizations. Paired t tests were used to compare utilization and costs before and after enrollment.

Results: Overall, acute outpatient encounters decreased by 62% and inpatient admissions by 53%, whereas primary care visits increased by 162%. Participation in the case management program was also associated with a 41% reduction in overall aggregate costs, from $16,208 preintervention to $9,541 postintervention (p = .004).

Implications for case management practice: The results of this study suggest that intensive case management can reduce acute care utilization and costs and increase primary care follow-up among uninsured patients with certain chronic diseases.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case Management / economics
  • Case Management / organization & administration*
  • Chronic Disease
  • Community Health Services / statistics & numerical data
  • Continuity of Patient Care*
  • Female
  • Health Care Costs
  • Health Care Surveys
  • Health Resources / statistics & numerical data*
  • Health Services Accessibility
  • Health Services Needs and Demand
  • Humans
  • Male
  • Medically Uninsured / statistics & numerical data*
  • Middle Aged
  • Retrospective Studies
  • Statistics as Topic
  • Time Factors
  • United States
  • Young Adult