Measuring the ROI of Care Management — A Coffee-Chat Conversation with Darcie Goodman

If you ask three different leaders to define Care Management ROI, you’ll probably get three different answers. For some, it’s all about reduced readmissions and lower total cost of care. For others, it’s quality scores, patient engagement, or simply fewer fires to put out on a Tuesday.

At Medix, we see Care Management ROI a little differently: it’s what happens when you put the right people in the right roles and build systems that actually support patients in the real world, not just on paper. It’s clinical outcomes, yes, but also fewer missed appointments, better documentation, lighter provider workloads, and patients who finally feel like someone is in their corner.

To dig into what that looks like day-to-day, I grabbed a virtual coffee with Darcie Goodman, RN, MPA, a Medix Care Management consultant and the founder of Slingshot Healthcare Consulting. After years as a trauma nurse and clinical leader, Darcie now helps health plans and provider groups build programs that are sustainable, human-centered, and impact-driven.

In this Q&A, Darcie breaks down how she thinks about Care Management ROI — from quick-hit wins to long-term value, and why it matters more than you think.

Q: To start us off, how did you get into care management?

Darcie: I grew up in my career as an emergency room and trauma nurse. I worked in urban hospitals, rural hospitals — pretty much everywhere — and across every role you can imagine: utilization and case management, long-term care, school nursing, leadership, and strategy.

From my experience, I noticed that a constant gap across all of those environments was the difference between the plan outlined with the provider and the reality for many patients once they are left to manage the complexity of healthcare systems independently.

There’s a huge need to better connect care, support patients, and make providers’ time as meaningful and impactful as possible. Care management became an obvious area of focus, which eventually pulled me into consulting. Now I have the opportunity to design systems that fix those gaps, center on the patients and providers, and create sustainable ROI that organizations can actually measure.

Q: In your consulting role today, what does your day-to-day look like?

Darcie: It really depends on the client — which is what I love. But, the theme is always the same: there’s a problem to solve.

When focusing on care management, one day, I may be looking at utilization patterns and digging into why ED visits appear to spike early on Monday mornings. Another day, I might be simplifying transitions-of-care (TOC) workflows or helping a provider group better integrate different kinds of roles into their daily operations to enhance their documentation and quality.

Care management is a specialized lever, but it affects the entire care ecosystem — providers, nurses, community-based teams, front desk, IT, etc. My job is to help streamline disparate aspects in a way that makes patient care more effective and programs more sustainable.

Q: “ROI” is a loaded term in healthcare. How do you define care management ROI?

Darcie: Care management ROI has layers — and which one matters most depends on who you’re talking to.
Here’s how I break it down:

1. Financial ROI

• Reduction in cost from avoidable events like ED visits, readmission penalties, or extended length of stays
• Increase in additional revenue generation from programs like TCM, achievement of quality scores, and improved documentation and coding accuracy (HCC, Z codes, risk adjustment)

2. Operational ROI

• Smoother workflows delivered with a “top of license” mentality
• Effective handoffs with fewer process failures and waste
• Higher staff retention
• Less provider and team burnout
• Ability to scale/reduce without chaos

3. Patient ROI

• More satisfaction, wellness, better outcomes, and a higher quality of life
• Stronger engagement and trust with the clinical team, including PCPs and specialists
• More independence in managing chronic conditions with a slowed disease progression

4. Quality & Risk ROI

• Higher quality scores with potential for bonus dollars
• More accurate risk scoring tied to a full perspective of patient complexity
• Reduction in coding compliance issues

Different leaders latch onto different pieces — but when you can bring them together within the impact of a well-designed program and system, that’s where care management ROI tells the real story.

Q: When you talk to leaders, what care management outcomes resonate most right away?

Darcie: Leaders often think of chronic condition metrics and long-range outcomes — such as A1C and blood pressure, that demonstrate a delayed progression of illness. Those are extremely important, but they’re slow movers.

What resonates fastest are early wins with a high financial value:

• Reduction of hospital readmissions
• Reduction of avoidable ED
• Reduction in hospital LOS and discharge failures
• Patients engagement with their PCP
• Patient adherence to high-cost medications
• High-quality scores on triple-weighted measures

Early success in these kinds of metrics demonstrate larger improvements and give organizations confidence they’re on the right path, while the longer-range metrics have the time they need to be achieved.

Q: Can you share an example of care management ROI you’ve seen in real time?

Darcie: Transitions-of-care is my favorite example because the ROI is immediate and measurable for everyone involved, including the patients.

Strong TOC programs can deliver:

• Fewer readmissions (penalty avoidance and higher quality scores/bonus revenue)
• Less unnecessary utilization
• Higher patient satisfaction
• Lower length of stay and risk for nosocomial infection, delirium, etc.
• Revenue from TCM visits
• Safer medication management
• Better follow-up engagement with PCP and specialists
• Reduction in post-acute care spend

When you build more upstream workflows that integrate teams and support patients throughout their journey, the impact is almost instant.

Q: What misconceptions do organizations have about the cost vs. value of care management?

Darcie: One that I see all the time is this assumption that you need to stand up a large and expensive program in order to see ROI.

You don’t.

Often, it’s small tweaks. At a practice, it could be adding a front desk script, a follow-up scheduling workflow at checkout, or a weekend access point that creates a massive change.

If needed, you could hire one or two people and make meaningful progress that you scale against, as you see results.

Another misconception is expecting ROI overnight. Some benefits show up quickly, but others require patience. For chronic care programs, I often say to leaders:

“It’s time to put on your Teflon underpants.”

You need to balance revenue-generating programming with cost-saving programs that may have a longer time horizon for certain outcomes.

Q: Beyond financial metrics, how else should organizations measure care management success?

Darcie: Look at:

• Progression of illness: Are we slowing it down?
• Integrated view: Are we combining medical, behavioral, and social data to understand a well-rounded cost impact?
• Continuity: Does the patient have a consistent provider relationship with someone they trust?
• Engagement: Are the patients activated in their care, responding, showing up, and following through?

You can tell a lot about program impact before the finance team closes a single book.

Q: Care management is as human as it is clinical. How do care managers build trust that leads to better outcomes?

Darcie: Trust is the whole ballgame.

If my first conversation with a patient is, “You need to take your medications,” we’re probably not going to make it very far. They don’t know me, and I haven’t earned the right to direct very much or build any trust. They are not going to listen.

Care managers are trained in very specific skills and expertise to build trust by:

• Meeting people where they are and removing bias
• Being consistent with the membership they are working with
• Listening to what actually matters to the patient and what goals they have, through techniques such as motivational interviewing
• Utilizing a multi-disciplinary team to ensure that the approach matches the need
• Providing actionable support and helping remove real-life barriers (transportation, meds, child care, food access)

That additional level of trust and support can become the bridge between the provider’s plan and the patient’s daily life. It’s nuanced, but that is where care management ROI starts to take hold.

Q: What about interdisciplinary collaboration — how does that factor into care management ROI?

Darcie: It’s everything.

I’m a nurse, so I used to be biased about this, thinking that care management nurses could do it all, but that is not the case. Nurses can be essential, but are often NOT the best positioned to resonate with a patient. The truth is, the strongest teams are woven like fabric.

That fabric can include many roles:

• Social workers
• Community health workers
• Peer support specialists
• Front desk staff
• Pharmacists
• Care navigators and coordinators
• Trusted individuals from the community who understand its rhythms
• And, nurses

Often, the most impactful person is the one who speaks the language, lives in the neighborhood, knows the bus routes, or understands the cultural context.

When those team members collaborate and the patient trusts them, that’s when real impact is made.

Q: Technology is changing fast. What enhances or hinders care management ROI?

Darcie: Technology is essential in supporting care management, and should be leveraged to enhance our work and build trust and engagement.

Helps:

• Secure texting with care team members
• Predictive analytics and risk stratification
• Tools that make access easier, such as self-scheduling and video chats with providers
• AI tools that can support the effectiveness of our work

Hurts:

• Non-transparent bots pretending to be human and creating confusion or frustration
• Over-automation that erodes trust and reduces engagement
• A reliance on perfect data at the expense of clinical intuition and decision-making

As long as technology strengthens connections and refines how we focus and target our efforts, it can improve ROI. When it is set up to replace the human component in care management, it often backfires and leaves you further behind.

Q: For leaders looking to build or expand a care management program, where should they start in calculating ROI?

Darcie: Start with the problem — not the program.

Then:

• Look at the data you have and use it to understand what is driving cost or utilization
• Ensure you look for trends; annualize your data to see patterns over time and establish a baseline to measure against
• Focus on levers you can actually control
• Start your work with areas you expect to see a more immediate impact
• Capture some form of measurement from day one (even if it’s a temporary spreadsheet)

The clearer the baseline of a finite set of metrics that are within your control, the clearer the ROI picture will be.

Q: What pitfalls or blind spots should leaders be aware of?

Darcie:

• Unrealistic expectations about time horizons
• Not establishing programs that link or tie quality or documentation revenue back to the care team
• Only looking at medical data to explain utilization, rather than including behavioral and social drivers that often play a large role
• Missing provider coding opportunities (whole person perspective in capturing the patient complexity)
• Not collecting early process metrics that help them pivot quickly

Q: And finally — what’s the “secret ingredient” that makes care management worth the investment?

Darcie: In my opinion, the role of care management is to enhance the role of the provider by curating the right team who can support the trust building and engagement of the patient to support the plan of care.

Care management extends limited provider bandwidth. It supports patients in ways that providers simply don’t have time to with their limited availability and focus. Care management builds trust, connection, and continuity.

When you hire people who understand and come from within the community they serve, this resonates with patients. It’s critical that teams follow through and work hand-in-hand with providers and others within the community to create a bridge between the plan or care and the real-life reality that is the patient’s every day.

You have to invest in the right people — and when you do, the ROI shows up in all areas: finances, operations, quality, outcomes, and patients and providers’ lives.

Let’s Build the Right Team to Power the Right Outcomes

If there’s one thing Darcie made clear, it’s this: care management works best when the right people are in the right roles — supported, aligned, and connected to the communities they serve.

The right voices.
The right relationships.
The right talent supporting patients in the right moments.

Medix helps organizations build care management teams that turn care plans into results, reducing avoidable utilization, improving outcomes, and strengthening the trust that makes all of it possible.

If you’re ready to invest in the people behind the ROI, we’re here to help. Start a conversation with Medix’s Care Management experts today.