Prairie States Clients Save With Case Management – Over $3.5 Million In 2017

Prairie States recently revealed the significant savings garnered by their Case Management program in a report showing their efforts saved their clients over three and a half million dollars in 2017. The Case Management (CM) team reduces costs and improves health outcomes by working with both members and healthcare providers to ensure quality, safety, medical necessity, and cost control.

Guiding members through the complexities of the healthcare system, registered nurses navigate the treatment of critical and non-critical conditions. Prairie States’ Case Management RNs combine their expertise across a wide range of specialties, assisting members facing cancer care, traumas, dialysis, multiple chronic conditions, transplants, and high-risk pregnancies.

As severe, complex, and catastrophic illnesses may require numerous procedures, treatments, physicians, and settings, a high degree of coordination by the CM team helps get the members the right care in the right place at the right time. Through constant communication with the member and their providers, the nurses evaluate the appropriateness of care and negotiate discounts for procedures and specialty medications. They arrange for care at centers of excellence and manage the transitions of care that follow.

Clients experienced a total savings of $3,610,062 in 2017 through Prairie States’ Case Management program, just one part of Prairie States’ multi-faceted Health Management Services. The success of this service is reliant on its seamless integration with other Prairie States services, and smooth execution of appropriate treatment. With an emphasis on early intervention, a supportive delivery approach, and positive quality outcomes, the “soft savings” from costs that are avoided are considerable: earlier intervention and well-managed follow-through leads to fewer readmissions and better health outcomes.