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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
- 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.
- 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
About the Developers
Dr. Maureen Smith, MD, PhD, MPH is a Professor in the University of Wisconsin – Madison School of Medicine and Public Health, Departments of Population Health SciencesFamily Medicine & Community Health and Director of UW Health Innovation Program as well as Director of the Community Academic Partnerships core of the NIH-CTSA funded Institute for Clinical and Translational Research. Dr. Smith’s research program examines the effectiveness of our health care system for aging and chronically ill persons.
Menggang Yu, PhD is a Professor with the University of Wisconsin – Madison Department of Biostatistics & Medical Informatics. Besides developing statistical methodology related to cancer research and clinical trials, Dr Yu is interested in health services and health outcome research.
Jared Huling, PhD is an Assistant Professor with the University of Minnesota’s Biostatistics Division. His research interests focus on the development of precision medicine, causal inference, and statistical learning methodology for the analysis of complex observational studies. He is particularly interested in addressing various forms of population heterogeneity with the aim of improving patient and health outcomes.