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

Abstract: In the US, persons without medical insurance have long relied on the emergency department (ED) as their principle source of medical care. Such utilization patterns often result in medical care that is fragmented, costly, and associated with poor health outcomes. Uninsured patients with chronic diseases have particularly high rates of ED utilization. Despite the far-reaching public health relevance of this problem, limited information is available on the extent to which community-based interventions, particularly those focused on preventive care, may impact ED overutilization and associated health outcomes. We conducted a retrospective study to examine the effects of a community-based case management program on acute health care utilization and associated costs in uninsured patients with one or more chronic diseases, including diabetes, hypertension, coronary artery disease, and congestive heart failure. The intervention consisted of an intensive case management program focused on redirecting the patient to community-based primary and preventive care. The study group included 83 patients who enrolled in a case management program between April 2007 and August 2008 on the basis of one or more emergency department visits or hospitalizations. We conducted a retrospective study using an administrative database and paired t-tests were used to compare utilization and costs before and after enrollment. Results: Intensive case management was associated with statistically significant decreases in both acute outpatient and inpatient utilization; overall aggregate costs were reduced by 41.1%. This study suggests that intensive case management is a cost-effective means of reducing acute health care services among uninsured patients with chronic diseases.