Case Management Benefit Scoring System

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Background

Caring for high-need, high-cost patients is an urgent concern within American health care delivery. Case management programs to improve quality and reduce costs for patients with complex needs are now being implemented across health systems. Yet multiple challenges exist in identifying the right patients to enroll in these programs.

Faculty from the University of Wisconsin-Madison (UW) have partnered with the UW academic health system (UW Health) to implement a benefit scoring system that is used to identify patients for enrollment into case management. The Case Management Benefit Scoring System Toolkit describes the implementation of this scoring system at UW Health.

Who should use this toolkit?

This toolkit is intended for researchers, healthcare administrators, and clinicians who are interested in understanding how a health system has implemented a strategy to identify patients for case management.

What does the toolkit contain?

This toolkit contains a flow chart of the process used by UW Health to assign priorities to each patient in their primary care population for enrollment into case management. The scoring system referred to in the flow chart was developed by faculty working at UW-Madison.

How should these tools be used?

Development of this toolkit

The case management benefit scoring system was developed by faculty at the University of Wisconsin (UW) School of Medicine and Public Health (Multiple Principal Investigators: Maureen Smith, MD MPH PhD; Menggang Yu, PhD) and the UW Health Innovation Program.

This implementation project was supported by PCORI grants HSD-1603-35039 and ME-1409-21219. Additional support was provided by the UW School of Medicine and Public Health’s Health Innovation Program and the UW Health Office of Population Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funders.

Please send questions, comments and suggestions to HIPxChange@hip.wisc.edu.

References

1. Smith MA, Nordby PA, Yu M, Jaffery J. A practical model for research with learning health systems: Building and implementing effective complex case management. Appl Ergon. 2020 Apr;84:103023.
2. Huling JD, Yu M, Smith M. Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects. Ann Appl Stat. 2019 Jun;13(2):824-847.

Toolkit Citation

Smith MA, Yu M, Huling J. Case Management Benefit Scoring System Toolkit. UW Health Innovation Program. Madison, WI; 2019. Available at http://www.hipxchange.org/BenefitScore