Americans have long recognized the flaws inherent in the nation’s healthcare delivery system. The U.S. has the highest healthcare expenditures in the world and yet lags desperately behind other countries in terms of critical public health indicators including life expectancy and disease rates. This has led policy makers, medical professionals, and everyday citizens to wonder what causes the debilitating inefficiency in our current system.

While the answer is undoubtedly complex, involving a number of factors, one of the most significant and clear contributing elements is our lack of case management for vulnerable patients. This is especially true for our nation’s elderly, who are often at higher risk for a host of pre and post-treatment complications including medication errors, dissatisfaction, and confusion over medical instructions at the time of discharge. These high risk geriatric patients often end up back in the hospital, straining an already taxed healthcare system and causing undesirable economic and emotional ramifications for the patients and their families.


But recent research examining the effects of case management on hospital re-admissions rates has yielded some very promising results. These studies suggest that case management, when well planned and executed, can significantly lower the re-admission rates of high risk patients.

A Look at the Evidence

One such study which was run by Emblem Health recruited a total of 542 patients. These patients were then divided into an intervention and a baseline (control) group – 298 patients and 244 patients respectively. The intervention group was provided with point of care case management by a team of nurses, pharmacists, social workers, and other health professionals. The study found that around 17.6% of the baseline group that received no case management was re-admitted to the hospital following initial discharge. In contrast, only about 12% of the intervention group had to be re-admitted. Although the percentage drop may not seem that large, it represents quite a significant amount in terms of healthcare dollars saved.

Another study conducted by Cigna specifically examined a group of 3,988 post-treatment, high risk patients. The researchers in this study utilized telephone outreach methods for case management and their results were impressive – a 22% drop in hospital re-admission rates for patients receiving the telephone calls. In their published report, Cigna stressed the importance of establishing a connection between case managers and patients early on. In this study, patients were contacted within 24 hours of leaving the hospital, shortening the time period during which complications requiring re-admission may arise.

What Does Case Management Look Like?

Now that there is ample evidence supporting the inclusion of case management, particularly for high risk patients, many health professionals and patients are asking what this model should look like in practice. According to experts in the field, effective patient case management should include:

  • Assessment of individual patient risk including factors such as age, co-morbidities, socioeconomic level, literacy, medication history, and recent hospital visits
  • Effective communication between the patient and health care provider concerning post-treatment instructions.
  • Reconciliation of medication where the patient’s medications at time of admittance are compared with those at time of discharge
  • Patient focused discharge plans that are well organized and easily understood

Effective and appropriate case management for high risk individuals such as geriatric patients can mean the difference between a successful recovery and one thwarted by costly hospital re-admissions. Case management essentially bridges the gap to healthcare for patients, making it easier for them to remain happy and healthy.