I've noticed quite recently, within the last 6 months, more insurers employing clinical care case managers for some patients with chronic, complex medical or mental health issues. I've been pleasantly surprised in the few dealings I have had with these case managers. They work with patients to improve compliance with treatment, insure that conditions are being closely monitored so that interventions can occur before hospitalization is needed, etc. Keeping up with doctor appointments, medications, physical therapy, occupational therapy, etc., is a complex and energy consuming endeaver, and people need support and advocacy to manage their health when they have significant chronic illness.

A community health facility in my area is participating in a grant-funded research project in which I know a couple of people who are involved. (both have congestive heart failure.) Every morning they weigh themselves, and check pulse, temperature and blood pressure on equipment that transmits the data to the physician's office. If the physician's office does not receive the data for a couple of days, they call the patient to remind them and to check in. If the physician is concerned about the readings, they contact the patient. There may be medication adjustments that can be made based on the phone call, or the patient may be asked to come into the office, immediately if the readings indicate the need, or at least within 2 days. Or, if readings are very critical, they can direct the patient to go to the ER, or even summons an ambulance. For both people I know involved with the project, the quick feedback has kept them much more stable over the past year, probably prevented visits to the ER and hospitalization on occasion, and resulted in rapid hospitalization and stabilization in one instance that very likely would have resulted in death otherwise.