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 reduced avoidable costs, strengthening outcomes and supporting affordability for patients.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.

Dr. Tiffany Inglis:

From 2018 to 2020, we saw a significant rise in maternal mortality rates. But they rose more for Black women and Hispanic women and people of color. We did a study with the Elevance Health programs in three different markets that were early doula programs. And what we found was they were less likely to need inpatient services during their pregnancy. They were less likely to have a pre-term birth. And not only does it work for people as a whole, it seems to very much positively impact people of color.

Nicky Dawkins:

I'm Nicky Dawkins. I've been a certified doula going on six years now. As a doula, I help people who are pregnant with advocacy, education, and just general support. I think the beautiful thing about doula care is that it's continuous care for the parents. So, we're not just there when they birth, but we're also there for them after they birth and before they birth, and pretty much all the things that come in between. Today we're hosting an event for the moms so they can actually connect with each other. Because after you have a baby, you tend to lose touch with the world.

Dr. Tiffany Inglis:

Doulas themselves are non-clinical. They're really there to be that support structure and to help be the voice and help the member or the person find their voice within their healthcare experience. And also, I think they help build community. And anyone who's had a child knows that you need it.

Nicky Dawkins:

Getting them on a path with somebody who is supportive of what they wanted to do made such a huge difference for them, like literal change in their personality of how much more supported they feel.

Program participant:

I felt supported as a woman. I felt supported as going through it as a first time mom.

Dr. Tiffany Inglis:

What this research has proven to us is that we do need to share it broadly and make sure that everyone understands the value of having access to doulas, whether that's through local access with training and certification, but also through policy around supporting doulas and having doulas be a part of this workforce.

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 non-acute 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 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 multi-state 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.

“

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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