How Medical Case Management Can Save $1 Million

Social Solutions Blog

How Medical Case Management Can Save $1 Million

Over a period of four short months, the emergency room at Aurora Sinai Medical Center in Milwaukee was able to cut costs by $1 million. And, what might surprise many; they did it by improving medical access to low-income patients. How? Keep reading and find out!

The Case for Medical Case Management in the ER

Medical case management is hardly a new phenomenon, but it’s increasing presence in emergency departments signals a new approach to providing both emergency and community health care. Social workers, nurses, and other medical case managers are increasingly being used in the ER. Donna L. Mason, RN, MS, CEN, and manager of the adult emergency department at Vanderbilt University Medical Center, explains, “Emergency departments are faced with complex and difficult case management issues we have never been faced with in the past. . . More and more emergency departments are putting case managers on.”

Medical case management is particularly valuable in the ER where patients can enter with a wide range of needs and secondary conditions that might be impacting their overall health. They can provide better screening for hospital admissions and support for follow-up and referral services. While ER’s are traditionally focused on acute, immediate needs, connecting patients with case management services ensure more holistic care. Working collaboratively with the ER clinicians, they make sure that care and discharge plans meet the physical, social, and emotional needs of patients.

Medical Case Management for the Frequent Flyers

As NPR reported, the Milwaukee hospital is using social workers and medical case management to encourage folks to stop using emergency rooms as their first-stop for medical care. Instead, they are connecting these individuals—many of them newly insured under the Affordable Care Act—with primary care doctors.

It’s one of those innovative ideas that seems so obvious after you hear about it. After assigning social workers to the ER full time, they identified over 300 individuals who visited the ER at least five times in four months. These “frequent flyers” accounted for 1,000+ ER visits in that same period of time. The initial effort selected 39 of those individuals and social workers spent the next eight months working to connect them with primary care doctors and clinics.

Just as important, the social workers focused on helping the patients to change their habit of going straight to the ER when they need medical care. Once they connected patients with a primary care provider, they made sure an initial visit was scheduled and at least two follow-up visits. In some cases, the social workers even attended the initial appointment with the patient.

At the center of these efforts is recognition of the very real constraints many of these patients face. Mark Huber, the hospital’s senior vice president of social responsibility, explains, “These are people who are in crisis all the time. They don’t know where they’re going to sleep or whether they can get groceries. They can’t think about making appointments and planning ahead.” Recognizing this reality, the social workers developed a plan that incorporated logistical constraints like finding transportation to the doctor’s office and childcare options during appointments.

How Can Your Organization Learn From The ER?

At the end of the day, integrating medical case management into ERs helps to reduce costs and improve patient experience. Like most case management programs, the pilot program at Aurora Sinai is labor intensive. But, the proof is in the pudding: for the 39 people receiving services as part of this pilot program, ER visits dropped by nearly 70% and costs fell by $1 million. Not too shabby to say the least!

If your organization is looking for ways to leverage health and human services resources to do more good, check out our whitepaper “Health and Human Services: Doing More with Less”

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