Provider Insider

Care Management

September 2022 | Issue No. 15

Care managers have expertise in identifying root causes for high ED utilization, connecting patients with community resources, helping to set goals and action plans, and supporting behavior change. This makes them uniquely suited to help patients avoid the ED unnecessarily.

RN care managers often reach out to patients after they have been to the ED and educate them as to how they might avoid the ED in the future, if appropriate. Additionally, RN care managers partner with primary care providers to support high-risk patients in between office visits.

Social determinants of health or “economic and social conditions that influence the health of people and communities”1-3 are cited as one of the largest contributing factors to avoidable ED utilization. Patient behavior and social conditions are complex and many patients benefit from an RN care manager who helps them on an ongoing basis.

Mr. Sanders* is a 61-year-old male with progressive Parkinson’s disease. He was living independently when C3 was contacted about his case.
C3 was contacted after Mr. Sanders made multiple visits to the emergency department. In one month, he had been seen a total of 11 times in the ED, with three of those visits resulting in hospital admission. Our RN care manager outreached Mr. Sanders and learned he was struggling to manage his Parkinson’s disease while living independently. The RN care manager also learned Mr. Sanders was having problems taking his medications correctly, and that his medical condition was declining. He did not have family members or friends to assist him with medications. He was very reluctant to transition to an assisted living arrangement, but recognized his struggle to manage his disease.
After further conversations, Mr. Sanders agreed to consider assisted living. The RN care manager worked with the patient, his insurance case manager, the hospital care management team, and his primary care provider to find an appropriate assisted living facility for him. After making the move, his visits to the ED decreased, and he was able to get to his regular PCP and specialist appointments.

*Patient name has been changed.

If you would like more information about how our RN care managers can support patients with high ED utilization, please contact Jennifer Countryman.

1What are social determinants of health? CDC. Accessed August 13, 2022.

2Agency for Health Care and Quality. Accessed on August 31, 2022.

3UnitedHealth: Healthcare could save $32B Annually by Diverting Avoidable ED Visits. Accessed on August 31, 2022.