Case management interventions have gained increasing attention in healthcare systems worldwide due to the growing complexity of health systems and the need to support patients, particularly those with complex medical needs. A recent systematic review aimed to assess the cost-effectiveness of case management interventions, shedding light on their potential impact and value in healthcare.
The healthcare landscape is evolving, with aging populations and increasing multimorbidity presenting challenges for patients and healthcare systems. Navigating these complex systems can be daunting for patients, affecting their well-being and straining healthcare resources. Case management programs aim to address these challenges by guiding individuals with complex medical needs through the healthcare system to improve its effectiveness and efficiency. This collaborative approach involves various stakeholders, including patients, caregivers, healthcare professionals, and the community.
The Case Management Society of America defines case management as a “collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.” This definition highlights the comprehensive nature of case management, which seeks to bridge gaps in care, enhance communication, and improve patient outcomes.
While case management is not a new concept, its application has expanded over the years. Initially, it was practiced primarily in nursing and social services, but its scope now encompasses various medical disciplines. Case management programs address the challenges associated with episodic care, focusing on care coordination to improve efficiency within healthcare systems.
One notable aspect of case management programs is their ability to address the unique needs of aging populations with multiple chronic conditions. These programs aim to maintain patients in their homes for as long as possible, ensuring that they receive the necessary care and support. Case managers play a pivotal role in informing and guiding patients and their families, bridging gaps in care, and supporting healthcare providers by conserving valuable personnel resources.
Despite the potential benefits of case management, a systematic review found that no previous study had specifically evaluated the cost-effectiveness of these programs. Previous systematic reviews had focused on the overall effectiveness of case management, showing positive outcomes, such as reduced hospital use and improved satisfaction with care for patients with chronic illnesses. However, the question of whether case management is cost-effective remained unanswered.
The systematic review aimed to fill this gap by conducting a thorough analysis of existing studies. It included 29 studies that compared case management interventions with usual care, focusing on cost-effectiveness. These studies represented various patient groups, including those with psychiatric disorders, older patients, patients with dementia, and patients with diabetes, among others.
The case management interventions studied were diverse, encompassing components such as case finding and assessment, case planning, navigation and coordination, monitoring, and health education. Case managers, who came from various healthcare professions, played a crucial role in delivering these interventions.
The outcomes and costs assessed in the studies were highly heterogeneous. They included patient utility measures, health effect measures, healthcare system measures, and program-specific measures. Costs considered in the analyses varied, encompassing intervention costs, direct medical costs, direct non-medical costs, and indirect costs.
The economic analyses conducted in these studies produced a range of results. Some studies found that case management interventions were less effective and more costly than usual care, while others found they were less effective but less costly. In contrast, some interventions were both more effective and less costly, demonstrating cost-effectiveness. However, a significant number of studies found that case management interventions were more effective but more costly.
Interestingly, no clear patterns emerged to identify common characteristics that would make case management interventions more likely to be cost-effective. Factors such as the case management model, type of case manager, patient group, healthcare system, study design, and time horizon did not consistently correlate with cost-effectiveness.
Despite the variations in case management interventions and outcomes assessed, the systematic review indicated that existing studies often met quality criteria and, in many cases, produced cost-effective or even cost-saving results. This suggests that case management holds promise as a method to support patients with complex care needs.
However, the review also highlighted the need for further research to better understand what makes some case management interventions cost-effective while others are not. The high variability among case management approaches underscores the importance of continued study and evaluation to determine the most cost-effective way to provide care coordination.
In conclusion, case management interventions have shown promise in supporting patients navigating complex healthcare systems. While the existing evidence suggests that many of these interventions are cost-effective, further research is needed to identify the key factors that contribute to their cost-effectiveness. As healthcare systems worldwide grapple with the challenges of an aging population and increasing multimorbidity, case management may play an essential role in improving patient outcomes and optimizing resource allocation. Policymakers and healthcare providers should consider case management as a valuable component of patient-oriented healthcare systems and support rigorous evaluation of these programs.