Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats

Jeffrey Swanson
William G. Weissert
Journal Article
August 2017

This resource reviews the literature on case management programs published over the past 17 years, arguing that application of two theories (agency and street-level bureaucratic theory) can help improve performance of case management programs.

  • Case management is generally of interest to health system managers because it is thought to hold the potential to reduce the costs of care for individuals with complex needs.
  • This review suggests that this goal is rarely achieved. No studies incorporated explicit payment incentives into their design, none rewarded efficiency or penalized waste, and very few studies made use of risk algorithms to direct intensity of care.
  • Cost results might be improved if additional ideas of agency and street-level theory were adopted, specifically incentives, clear rules, guidelines, and algorithms relating to resource allocation among patients.
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Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What does the evidence indicate about the effect of case management on health care costs?
  • What strategies might improve the effectiveness of case management programs?
Level of Evidence
What does this mean?