Case Management: Engaging Members for Better Health

Contributing experts: Virginia Plaisance and Saurabh Tandon

Patients living with chronic conditions and facing serious diagnoses can feel overwhelmed when they engage with our healthcare system alone. Elevance Health’s National Committee for Quality Assurance (NCQA) - accredited case management nurses and staff are experts at simplifying and coordinating care. They know care works best when patients feel empowered to take part in it — and having a trusted guide makes that possible. Ongoing patient engagement leads to greater treatment adherence, improved chronic condition management, and fewer avoidable costs. Sustained support strengthens outcomes while helping lower the overall cost of care.¹

Improving Health Together

Our case managers help patients understand their care plans, schedule recommended appointments, and stay connected to their care providers — so care feels coordinated, continuous, and easier to navigate. Through consistent outreach and compassionate guidance, they empower patients to take an active role in their health while still layering in much needed support.

“My case manager, Lisa, kept in contact with my doctor’s office to get my power chair fixed. They worked together — keeping me first.”¹

-Anonymous member survey comment

Hands-on support helps patients feel seen, supported, and confident in managing their conditions — especially those with complex or chronic needs.

See How Case Management Can Make All the Difference

Lilliana, Medicaid member:

I didn’t really find out I was pregnant till I was about 4 1/2 months pregnant. I had an OB appointment and I told her “Hey, I have this lump on my neck. Is this pregnancy related? Do you have any clue?” And her exact words were “I don't know what this is.” I was really stressed out. It could either be cancer or something is just swollen. I honestly was nervous the whole time, not sure what's gonna happen.

Erin M., nurse case manager, Carelon:

II first got connected with Lilliana through our customer service team. During her pregnancy, she had been diagnosed with a lump on her thyroid or on her neck, and she wasn't sure if it was cancerous or if it was something else, and she was having trouble getting the access to care that she needed. She'd gone to both her surgeon’s office and also to her oncology office, and they had told her that her coverage that she had only covered her pregnancy. I just said, “You know, I will support you with what you need, and I'm here to help you get the access to those doctors. Let me come alongside you. Let me work with the doctor's offices and take that off of your plate, so that you can focus on what you need to focus on and what's most important to you.”

Lilliana, Medicaid member:

It, it was very comforting, kind of like having a second mom. It made such a difference because, before without her, it was like I was crying every week. With her, it was like, no, I've got it. Within a week, everything was handled. That's when they finally were like, you know, maybe we need to send you to an ear, nose, and throat specialist. He looked at what was already done, and he could tell immediately it was a tumor, but it was benign.

Erin M., nurse case manager, Carelon:

At the end the day, I hope that members come out of their experience with me feeling like they can advocate for themselves and feeling like they have a better understanding of their health plan ’cause insurance can be very confusing.

Lilliana, Medicaid member:

One thing that makes a really big, meaningful difference is having someone that’ll listen. It helps so much. It made everything a thousand times easier.

Erin M., nurse case manager, Carelon:

When I see members where I’ve made a big difference — and sometimes we don't even see the full impact that we've had on our members — and so when I get to see that on the other side, it’s just, it, it, it just blows me away.

Driving Value and Improving Outcomes

Data show better outcomes at lower costs.^2,3

96% say case management and population health programs have a positive impact on overall health

8% increase in primary care visits

64% of care providers report improved patient quality of life

8% rise in specialty care visits

14% decrease in inpatient medical expenses

$159 reduction per member per month (PMPM) in total impactable costs among participating members

41% reduction in nonacute spending

Member Story: the Power of a Helping Hand

Our case managers know at the center of every case is a person. The experience of one Medicaid member — we’ll call them Ms. S — shows how their compassion, persistence, and creativity can change a life.

Ms. S was living with lymphedema, which caused painful blisters on her legs that could progress to open sores. During a recent hospital stay, she found relief through a leg compression device that eased her symptoms and supported healing. Once discharged, however, she couldn’t find a medical supply store that would sell her a home unit and accept Medicaid.

That’s when her case manager stepped in: She began calling multiple equipment providers, only to hear the same response — either the stores didn’t accept Medicaid, or they couldn’t deliver to Ms. S’s rural area. Undeterred, the case manager reached out directly to the device manufacturer, who told her about a patient assistance program designed to help people access needed equipment when cost or distance stand in the way.

Through that program, a creative solution emerged. The manufacturer arranged to ship the compression unit directly to Ms. S’s home and scheduled a virtual training session to ensure she could use it safely and effectively.

“Words can’t express how appreciative I am,” Ms. S said to her case manager after her new compression device arrived at home —
a moment made possible through teamwork and persistence.

Data-Driven, Person-Centered Care

Our team of multistate licensed nurse case managers oversee health plan membership in the Commercial and Medicaid business segments. Throughout a patient’s journey, every interaction is backed by data and insights. We equip care providers and case managers with tools to identify risks earlier, personalize care plans, and measure progress — turning insight into action.

Our data-driven approach has helped us successfully engage members in care management services once we are able to speak with them.

In 2025, we successfully reached 8,450 members of Commercial and Medicaid health plans, and 52% of those we spoke with participated in care management — up from 25% in 2024.³

Supporting Care Providers, Too

For care providers, our case management program is an extension of their care team. It helps reduce administrative load, supports follow-up coordination, and keeps patients engaged between visits — so care providers can focus on prevention and clinical decision making.

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In the heart of rural West Virginia, our rural clinics are a beacon of hope, dedicated to helping every community member achieve comprehensive well-being; no matter their background or circumstance. We believe true health extends beyond standard guidelines. It requires a personal understanding of each patient's history, barriers, and goals for their health. Through their work with our clinic, Elevance Health team members have demonstrated that they hold the same values.

Jamie DiFalco

Quality Improvement Coordinator, Pendleton Community Care Franklin, West Virginia

Guiding Patients, Strengthening Outcomes

Case management changes the way patients interact with the healthcare system from something done for them into something done with them. By connecting patients to their own care and supporting them along the way, our case management program helps turn guidance into action and information into empowerment. When patients feel supported, they stay engaged — and that engagement leads to healthier outcomes, lower costs, and stronger relationships between patients and care providers.

1 Elevance Health Commercial Complex Case Management Survey, 2024.
2 Elevance Health internal program evaluation, 2023.
3 Elevance Health Condition Care and Case Management Provider Experience Survey, June 2024.

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