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

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.