Case Management
Nurse-led support balancing compassionate care with responsible cost management
Personalized Case Management for Complex Care Needs
Innovative Care Management’s Case Management program provides personalized, nurse-led support for members with complex, high-risk, or resource-intensive healthcare needs. Case management helps ensure care is coordinated, appropriate, and aligned with the member’s clinical goals—while supporting plans in managing and mitigating avoidable utilization and cost.
By addressing both clinical and non-clinical barriers to care, case management improves continuity, reduces preventable complications, and supports better long-term outcomes for members and plans alike.
How We Do It
Clinically focused, integrated, and member-centered.
Key elements of our approach include:
Nurse-led assessment and care planning for complex or high-risk cases
Member education to support understanding, engagement, and self- management
Integration with utilization management, clinical navigation and transitions of care
Coordination across providers, settings and services
Identification of barriers to care, including social and psychosocial factors
Timeline and thorough updates to the Plan on potential high costs
Nurse-led assessment and care planning for complex or high-risk cases
Coordination across providers, settings, and services
Member education to support understanding, engagement, and self-management
Identification of barriers to care, including social and psychosocial factors
Integration with utilization management, clinical navigation, and transitions of care
Timely and thorough updates to the Plan on potential high costs
Why Is Case Management Important?
Imagine a member is diagnosed with a life-threatening form of cancer and recommended a course of care that includes chemotherapy and high-cost medications. In addition to clinical complexity, the case presents significant financial exposure for the plan, with multiple treatment options, coverage considerations, and potential variation in cost and outcomes.
ICM’s Case Management services provide critical and compassionate guidance. It’s not just about cost control. It’s about making healthcare more human.
At the same time, cost control is important. The majority of plan costs are typically driven by a small number of members. For example, the AARP says the average cost of cancer treatments runs around $150,000, and the out-of-pocket share can add to a cancer patient’s stress and health problems. An organ transplant is even more expensive, running around $446,800 in billed charges for a kidney transplant and around $1,918,700 in billed charges for a heart transplant, according to Milliman.
As medical advances lead to better treatments and outcomes, costs can surge. According to the American Association for Cancer Research, the cost of cancer care is expected to increase by more than 30% by 2030, reaching $245 billion.
How Much Can One Medication Cost?
Keytruda (pembrolizumab) is an established immunotherapy medication used to treat certain types of cancers. It is administered by infusion.
When given every three weeks, the list price per dose exceeds $12,000 as of September 2025.*
For a participant who remains on therapy for two years, total drug costs can exceed $408,000.
*Source: Keytruda
Case Management Case Studies
Case Study1
Supporting Recovery Through Complex Care Transitions
Case Study2
Supporting Access to Specialized Cancer Care
A member was recently diagnosed with a rare form of breast cancer and faced uncertainty about treatment options and where to seek specialized care.
An ICM case management nurse worked closely with the member to understand the diagnosis and identify facilities with expertise and emerging research specific to this cancer type. The nurse helped the member engage with a leading treatment center offering a newer therapy that had demonstrated improved outcomes for this rare diagnosis. Throughout the process, the nurse supported coordination of care and helped the member navigate next steps.
As a result, the member was able to access specialized care aligned with the latest clinical advancements without adding greater costs to the plan, supporting an informed treatment decision, better outcomes and a more confident care journey.
Additional Services to Consider
Utilization Management
Prior authorization processes protect members from unexpected costs while ensuring that care is safe, effective and medically necessary.
Chronic Condition Management
This program helps members navigate and coordinate care for chronic conditions.
Healthy Mother Baby Management
This maternity management program gives expecting mothers the education and support needed to promote healthy pregnancies and deliveries.
Frequently Asked Questions
Will members work with a single, dedicated case manager?
Yes. ICM pairs each member enrolled in the program with a dedicated Registered Nurse case manager. This arrangement supports continuity of care and fosters trust between the member and the nurse. This also allows for the formation of the strong, supportive relationships that members need when facing complex medical conditions.