Preparing for New Primary Care Models: The Role of Professional Case Management

Area of Science:

• Primary Care Innovation
• Health Services Research
• Case Management

Background:

• Primary care is evolving, necessitating innovative models to address complex patient needs.
• The Making Care Primary (MCP) initiative offers a framework for future primary care reform.
• Value-based care models emphasize outcomes and holistic patient well-being.

Purpose of the Study:

• To raise awareness of innovative primary care models, specifically MCP.
• To provide professional case managers (PCMs) and leaders with evidence-based best practices.
• To demonstrate the impact of case management on key outcomes in value-based primary care.

Main Methods:

• Review of case management research from the last 10 years.
• Analysis of findings related to MCP's core domains: care management, care integration, and community connections.
• Synthesis of evidence from systematic, narrative, and scoping reviews.

Main Results:

• Case management interventions significantly impact outcomes in value-based primary care.
• Identified essential case management structures, processes, and outcomes for diverse patient needs.
• Evidence supports person-centered, holistic care leading to improved patient health and well-being.

Conclusions:

• Professional case managers (PCMs) are critical to the success of evolving primary care models.
• PCMs play a vital role in primary care teams, especially for patients with complex chronic conditions and social needs.
• Summarized evidence offers guidance on best case management practices to enhance health outcomes.