Case Management: Bringing Together Service and Savings

Prairie States has announced the latest yearly client savings numbers achieved by its Case Management program—a clinical service that advocates on behalf of members facing severe and complex medical conditions. The goal: the best possible outcome for the member.

In 2019, the Case Management program saved Prairie States clients a grand total of $6,068,255.34.

Designed to ensure quality, safety, appropriateness of service and setting, 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 2019, 74% 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 2019, none were readmitted. That’s a patient readmission rate of 0%—compared to a typical rate of 10-30% for hospitals nationwide.

“The primary goal of the Case Management program is exceptional patient care and achieving the best possible result for every member,” said Prairie States CEO Felicia Wilhelm. “From the moment someone enters the program, our team is with them every step of the way, ensuring the highest level of care at the best possible value. Through early intervention, well-managed follow-through and effective cost management, the annual savings we are able to achieve for Prairie States clients is profound.”

Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.
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