Case Study: Driving a Projected 10:1 ROI Through Case Management Improvements

A 375+ bed not-for-profit acute care facility was facing challenges across its case management program, including department infrastructure, staff workloads, utilization review, admission status and denials management. Communication between nursing and case management also needed improvement, while reliance on an outside vendor for record reviews was adding unnecessary expense.

An HCT interim leader conducted an in-depth assessment and worked alongside hospital leaders and staff to develop a collaborative action plan. The engagement strengthened department infrastructure, utilization management, interdisciplinary collaboration, denials management and length-of-stay processes to improve both operational and financial performance.

Key Results:

• Eliminated the need for an outside vendor for record reviews.

• Began reducing Medicare length of stay and Medi-Cal denials.

• Improved collaboration across case management and other departments.

• Established a performance dashboard to track and trend key initiatives.

• Projected $1.5 million to $2.4 million in financial impact, representing a 10:1 return on investment.