Primary care case managers contribute to fewer ED visits, greater medication adherence

Case managers in the primary care setting are on the rise, in part due to the role they play in patient engagement as well as the emphasis they place on quality of care in today’s value-based healthcare landscape, according to CMSA Today.

Primary care case managers (PCCM) can assist a range of patients but are especially valuable when it comes to treating high-risk patients. Consider a high-risk, elderly patient who fails to show up for a primary care visit to refill her diabetic medication. Without that primary care visit, the patient lands in the ED due to diabetic complications and is discharged home with a prescription to treat her condition.

With a PCCM heading up a patient engagement team, this scenario may be less likely to occur, as PCCMs have made strides in reducing ED visits, increasing primary care provider visits, and avoiding medication errors. PCCMs often support patients through regular phone calls that ensure patients are aware of ways to reach their PCP after business hours and know where to find the closest urgent care facility, thus deterring patients from looking to the ED as their first choice for after-hours and weekend care, says CMSA Today.

PCCMs can also help uncover scenarios when a patient may be unable to make it to a PCP visit and thereby adhere to a medication regimen for transportation reasons. If a PCCM had called the high-risk, diabetic patient in this scenario and ask why she was unable to make her appointment, the ED visit may have been avoided. Knowing that a patient has transportation barriers would have alerted the PCCM to arrange for transportation for the patient and ask the PCP to send the patient’s prescription to the pharmacy while she waits for her new appointment, according to CMSA Today.

PCCMs can also help improve coordination of specialty care and prevent avoidable readmissions and readmissions. Overall, these efforts contribute to lower costs and better quality of care, according to Innovista data referenced in CMSA Today.