CM program keeps high utilizers out of hospital.

The University of Michigan Hospitals and Health Centers has reduced its overall readmission rate to 17.4% with a multi-pronged program that concentrates on patients who are under age 65 but high utilizers of healthcare services. Case managers provide high-intensity care coordination for about 25 patients at a time with complex medical and psychosocial needs. They visit them in the hospital and often accompany them to primary care visits. Non-clinical patient care associates make follow-up calls to less acute patients after a hospital discharge.