Estimating clinical and economic impact in case management programs

Case management programs are commonly offered by health plans, hospitals, freestanding case management vendors, and others to various purchasers of these services. Case management programs are materially different from standard medical management or disease management programs in a number of ways. The patients have complex medical conditions combined with many other variables that tend to increase their costs and patterns of utilization. Purchasers of case management services frequently demand some form of performance guarantees as evidence that these case management programs are reducing utilization and medical costs. Inherent challenges of high variation in clinical and cost characteristics of the case management population make it difficult to develop standard return on investment performance guarantees. There are, however, other methodologies and statistical approaches to measure and evaluate program performance. We seek to outline major limiting issues that differentiate case management financial impact analyses from other clinical programs, and to define a framework for beginning a dialogue between suppliers and purchasers of these services to create a program value proposition.