1. Glendenning-Napoli, Alison BSN, RN-BC
  2. Dowling, Beverly CPA, CHFP
  3. Pulvino, John PA-C
  4. Baillargeon, Gwen MS
  5. Raimer, Ben G. MD


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.