In 2018, Case Management saved Prairie States clients a grand total of $6,057,890.82, up from the $3.6 million in savings seen in 2017. The Case Management program is a clinical service that advocates on behalf of members facing severe and complex medical conditions. The goal:  the best possible health outcomes at the best value for the plan.
Of the thousands of patients identified to participate in Case Management in 2018, 82.7% were actively participating in the program. “That’s a phenomenal number, far beyond the industry averages,” says company vice president Jessica West MSN, RN, who heads Prairie States’ Clinical and Health Management Services. “It’s that high level of engagement that makes the program so successful. Early intervention, that initial contact, well managed follow-through, making sure the member knows what the goals are – all of those things have an impact.” 
Prairie States Case Management focuses on multiple components of patient care, including quality, safety, appropriateness of setting and cost. Registered Nurses, who hold certifications expressly for this program, work with members facing a variety of medical conditions such as cancer care, renal failure, traumas, high-risk pregnancies, multiple chronic conditions, transplants, and other ailments and disorders.
To reduce complications – and avoid costly readmissions – the Case Management program stays engaged with the member throughout recovery. Following surgeries, inpatient stays, maternity and condition management needs, Registered Nurses manage Transitions of Care. They offer clear, detailed discharge education, and monitor follow-through with physician appointments, dressing changes, and medication adherence.
Prairie States CEO Felicia Wilhelm agrees. “I’ve been approached by others in the industry, asking me how we do it,” says Wilhelm. “It’s all about our nurses, all of them in-house. No one else makes the investment in clinical staff that we do. From the moment a member enters the program, our team is with them every step of the way. That makes for better outcomes and real cost savings."

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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