Case management linked to increase in primary care visits, decrease in hospitalizations
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Key takeaways:
- Health care organizations are increasingly using case management to address social and health needs.
- Case management may boost primary care use by helping patients overcome barriers to care.
Social needs case management was associated with a 3% increase in primary care use and an 11% decrease in hospitalizations, a recent study in Annals of Internal Medicine found.
According to Mark D. Fleming, PhD, MS, an assistant professor at the University of California, Berkely School of Public Health, and colleagues, social needs case management is becoming a common strategy among health care organizations to address social and health needs.
“These programs connect patients to resources such as food assistance, housing, transportation, or income benefits, in addition to facilitating access to health care and behavioral health services,” they wrote.
It has been suggested that these strategies could increase accessibility to primary and preventive care while decreasing the need for acute care, Fleming and colleagues added.
To determine the impact of case management, Fleming and colleagues conducted a secondary analysis of a randomized encouragement study that assigned participants at high risk for acute care to social needs case management or a control group.
Participants in the case management group were assigned to a case manager who evaluated their needs, created a management plan and provided continual support by coordinating public health benefits and collaborating with primary care providers.
Overall, there were 21,422 participants in the intervention group and 22,389 participants in the control group. Among all participants, 60% were women and 49.1% were aged 49 years or younger.
The researchers found that the intervention group had significantly higher rates of primary care visits compared with the control group (incidence RR [IRR] = 1.03; 95% CI, 1-1.07).
There were no significant differences between the two groups for behavioral health visits, specialty care visits, jail intakes or psychiatric emergency visits, according to Fleming and colleagues.
Although the researchers said they could not directly measure the effect of primary care use on hospitalizations, they estimated that the findings would “amount to 6.6 primary care visits per averted hospitalization.”
Because social factors also play a role in access to primary and preventive care, the researchers added that social needs case management could help patients overcome barriers.
“For example, case managers supported access to transportation, were a trusted source of information and health care navigation, and facilitated insurance coverage and social services benefits applications,” they wrote. “The trend toward reduced psychiatric emergency visits suggests the intervention may also avert these disruptive episodes.”
One limitation of the study was that outcomes were examined 1 year after participant enrollment, but the impact of case management may take longer to develop.
“The intervention’s ability to improve use of outpatient services, such as behavioral health, could be constrained by system capacity,” the researchers wrote.
They concluded that the results “support the hypothesis that increased access to primary care could play an important role in reducing acute care use.”
Perspective
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Health care systems have only recently begun to recognize the importance of social determinants of health as a driver of health outcomes. A large-scale, randomized study of Medicaid beneficiaries in Contra Costa County, California conducted by Brown and colleagues in 2022 demonstrated an increase in primary care visits and a reduction in acute-care hospitalizations for patients offered telephonic or in-person social needs case management over a 1-year time period. Given the potential for social needs case management to shift health care utilization from high-cost inpatient hospitalization to lower cost outpatient settings, it is hoped that larger, multicenter studies with robust outpatient services offerings and an extended evaluation period can be conducted to fully determine the benefits.
Perspective
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Many studies throughout the years have shown that increased primary care visits will result in a reduction in acute-care visits. Historically, primary care offices would just document that a patient “No-Showed,” but never asked why the patient didn’t make it to a visit, which basically ignored the reasons why it occurred. Studies like this show the importance of assessing social barriers with individual patients and whole communities and assisting the patient with overcoming these barriers to primary health care. Organizations such as the American Osteopathic Association have developed a Social Determinants of Health toolbox to assist the health care team in assessing, identifying and helping to resolve social barriers. This is all in an effort to improve preventive medical visits with the primary care providers.
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