Case Management: Quality Care, Personal Attention, Unmatched Savings

In 2020, Case Management saved Prairie States clients a grand total of $6,293,003.00. Significant savings like these are directly linked to the efforts of our Health Services team – and they’re another example of how our customers benefit from the Prairie States way of managing health plans.

Designed to ensure quality, safety, appropriateness of setting and cost control, Case Management helps members when they need it most. Our Registered Nurses, who hold certifications expressly for this program, engage members facing a variety of medical issues including cancer care, dialysis, multiple chronic conditions, traumas, high-risk pregnancies, transplants, and more.

To reduce complications – and avoid costly readmissions – our Case Management nurses stay engaged with the member throughout recovery. Following major surgeries, inpatient stays and maternity, and in coordination with condition management efforts, those same nurses manage members’ transitions of care. They offer clear, detailed discharge education, and monitor follow-through with physician appointments, dressing changes and medication adherence.

In 2020, 85% of patients identified to participate in Case Management were actively engaged in the program—far greater than the national rate of 30-45%. And, of the Case Management participants being monitored for readmission in 2020, none were readmitted. That’s a patient readmission rate of 0%—compared to a typical rate of 10-30% for hospitals nationwide.

The exceptional patient care and plan savings are by design. With nurses comprising over 30 percent of our staff, the depth of our clinical expertise and experience are unique in the industry. From diagnosis to recovery, Prairie States’ Case Management team tracks every step of the treatment process. Active engagement gets members the quality care and attention they deserve – all at the best value for their plan.