How a Michigan Health System Strengthened Case Management Performance Through Targeted Optimization

Facing a complex patient population, a rise in long length-of-stay (LOS) cases, a high proportion of observation patients, and several leadership transitions, the Case Management (CM) team at University of Michigan Health-Sparrow Lansing identified the need for a structured operational reset. The organization sought targeted support to optimize performance while maintaining care quality and patient satisfaction.

Working closely with hospital leadership, association corporate affiliate member FTI Consulting reviewed current practices and partnered with the CM team to implement sustainable improvements across structure, processes, and performance management. The improvements aimed to decrease length of stay for patients who no longer required an inpatient level of care and to alleviate difficult discharge barriers.

Setting the Stage: Mounting Pressure on Case Management and Utilization Review

UM Health-Sparrow Lansing's Patient Support Services department includes both CM and Utilization Review (UR) teams. Before the initiative, the department faced several operational headwinds:

• Growing population of complex and long-LOS patients
• Elevated observation rates
• Inconsistent workflows and clinical documentation routines
• Variation in approaches to care progression management among individual physicians
• Differing levels of hospitalist group oversight of care progression activities
• Suboptimal staffing with costly reliance on agency staff

These challenges strained patient throughput, staff capacity, and performance visibility.

Three Steps to a More Effective CM/UR Function

A detailed organizational and workflow assessment identified three critical priorities to improve performance:

1. Strengthen organizational structure and staff competency.
2. Standardize core CM/UR workflows and guidelines.
3. Implement transparent performance monitoring.

Building the Foundation: Structure and Capability

FTI Consulting evaluated the department's organizational design and staffing model and made recommendations to better align roles, reporting relationships, and workforce coverage. Key actions included:

• Refining the CM department structure and job descriptions to enhance the use of RN case managers, realign social work resources, and use fewer agency staff
• Assessing staff competencies and recommending targeted training
• Optimizing workforce schedules, including expanded weekend coverage

These changes established clearer accountability and improved resource deployment.

Standardizing High-Impact Workflows

To drive consistency and efficiency, the team developed leading practice guidelines and educational materials across several core processes, including:

• Multidisciplinary rounds structure, roles, and workflows
• Concurrent front-end denials management process
• Avoidable nights documentation and tracking
• Discharge consult and testing workflows
• UR and level-of-care designation guidelines
• Long LOS meeting structure and responsibilities

FTI Consulting partnered with UM Health-Sparrow Lansing leadership to develop best practices for the guardianship program that were leveraged across the organization. The team also recommended implementing the CarePort Community Resource Network to strengthen care coordination, improve visibility of post-acute care resources, and better inform discharge planning across the continuum of care. In addition, comprehensive education sessions helped drive accurate and timely patient status determinations. FTI provided training on utilization management and the Two-Midnight Rule, a Medicare payment policy that directs hospitals to classify patients as inpatients if their medically necessary care is expected to span at least two midnights.

Enabling Data-Driven Performance

In partnership with CM leadership, the FTI team developed a CM/UR dashboard featuring key performance indicators to monitor department performance and trends. This tool improved outcome visibility and supported more proactive operational management.

Results: Improved Flow, Accuracy and Workforce Stability

Since implementing the redesigned structure, workflows, and reporting tools, UM Health-Sparrow Lansing has achieved measurable improvements:

• Improved patient flow and capacity through optimized multidisciplinary rounds processes
• Reduced observation rate by 4.2%
• Clearer role alignment via refined job descriptions
• Reduced agency dependence through optimized workforce scheduling
• More efficient and accurate status assignments following targeted education
• Enhanced performance visibility through the new CM/UR dashboard

UM Health-Sparrow Lansing sustains LOS reductions through a focused and standardized approach that combines process discipline, care coordination, and cultural alignment. The organization is further optimizing its multidisciplinary rounds to recognize potential barriers earlier and ensure clearer accountability and more proactive discharge planning. In parallel, leadership has emphasized a robust guardianship program to accelerate patient access to durable power of attorney when needed, removing a common administrative barrier that can delay discharge for complex patients.

Beyond discrete process improvements, UM Health-Sparrow Lansing is also tackling the cultural and operational factors that lead to avoidable days. Upcoming initiatives aim to streamline nursing workflows and therapy utilization, reinforcing shared ownership of throughput and discharge readiness. Together, these efforts reflect a deliberate shift from episodic LOS management to a continuous, enterprise-focused performance model that improves patient flow, reduces unnecessary days, and sustains long-term operational efficiency.

Four Takeaways for Essential Hospitals

UM Health-Sparrow Lansing's experience highlights how focused operational discipline can strengthen case management performance. Peer organizations can consider:

1. Aligning structure and staffing to patient complexity and volume
2. Strengthening multidisciplinary round structure and processes to surface and resolve discharge barriers early
3. Using transparent, real-time metrics to drive accountability and sustain improvement
4. Level setting by providing the same educational content to physician and nursing staff.

To learn more, reach out to FTI Consulting's health care business transformation experts, Chris Sdao and Leisa Maddoux.

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