5 Trends Shaping Medical Case Management in 2025

Medical case management is evolving faster than ever, and 2025 is shaping up to be a year defined by new tools, new expectations, and new pressures on care coordination. With AI-driven predictions, telehealth expansion, value-based incentives, behavioral-health integration, and centralized scheduling, today’s case manager is working inside a system where speed, communication, and proactive intervention matter more than ever.

AI and Automation: The New Backbone of Medical Case Management

Artificial intelligence is becoming a daily tool in healthcare. By 2024, roughly two-thirds of physicians reported using some form of AI in their workflow, and more than 70% of hospitals had built AI-driven predictions into their electronic health records.

For case managers, AI shows up in practical, time-saving ways. Case managers benefit most from:

• Automated prior authorization support and lighter documentation loads.
• Risk scores that identify patients who may decline before it becomes obvious.
• Predictive routing that helps determine who needs early intervention.
• Fraud-detection flags that help coordinate with SIU teams when something looks off.

Additionally, JAMA Network Open’s 2025 findings showed that AI-supported documentation tools not only saved time but also directly reduced clinician burnout, with some organizations reporting drops of nearly 30%. That’s relevant for case management because every reduction in clinician burden means faster responses, clearer notes, and less back-and-forth to gather information or clarify care plans.

Telehealth Expansion in Modern Medical Case Management

Telehealth has become a core part of modern care delivery. Nearly three-quarters of physicians now practice in settings that offer virtual visits, and telehealth use has grown dramatically, with video visits rising from single digits in 2018 to about two-thirds of physicians by 2022. It’s now used routinely for chronic disease management, medical follow-ups, and behavioral-health visits.

For case managers, the relevance is straightforward: telehealth removes many of the barriers that traditionally delay care. It enables:

• Quicker follow-up touchpoints without waiting for in-person availability.
• Easier access for patients in rural or transportation-limited situations.
• Smoother medication reconciliation and symptom check-ins.
• Consistent behavioral-health visits, which are often the hardest appointments to secure.

Value-Based Care: The Payment Model Reshaping Medical Case Management

Value-based care continues to gain traction, and it’s reshaping how organizations think about outcomes, costs, and coordination. In 2024, more than half of physicians participated in a value-based contract, and CMS estimates that about one-third of all physician revenue now comes from alternative payment models instead of traditional fee-for-service.

These models financially reward what strong case management already drives: fewer hospitalizations, smoother transitions, timely follow-ups, and better chronic disease control. When the system shifts its incentives toward coordination and prevention, case managers become even more essential to achieving organizational quality metrics.

Value-based care changes the case-management role in subtle but meaningful ways. It pushes teams to:

• Intervene earlier with high-risk patients before issues escalate into admissions.
• Close care gaps that directly affect quality scores, such as missed specialist appointments or delayed post-op checks.
• Coordinate across multiple providers to avoid preventable ED visits and readmissions.

Example:

Humana’s multi-year analyses consistently show that members in value-based arrangements have fewer inpatient admissions and lower total medical costs than those in traditional models. This reinforces what case managers experience every day: when care is proactively coordinated, outcomes stabilize, recovery improves, and claims resolve more predictably.

Behavioral Health Integration in Medical Case Management

Behavioral health has become one of the biggest determinants of claim duration and recovery.

CMS’ Innovation in Behavioral Health model pushes providers to integrate physical, mental, and social care using expanded provider eligibility and new payment supports. This model was launched because about 25% of Medicare beneficiaries and 40% of Medicaid adults have a mental health or substance-use disorder.

Additionally, in Workers’ Compensation, NCCI data repeatedly shows that claims with behavioral-health comorbidities have significantly higher lost-time severity.

This matters for medical case management because unaddressed behavioral health needs consistently slow recovery and complicate treatment plans. When psychological factors are not identified early, cases often experience missed appointments, stalled clinical progress, higher opioid-related risks, extended modified-duty periods, and care plans that fail to gain traction. These patterns make case managers a central driver of early intervention and coordinated support, ensuring behavioral health barriers are addressed before they derail recovery.

Centralized Access and Scheduling

Centralized access is quickly emerging as one of the most effective ways organizations are reducing care delays. In 2024, nearly half of health systems reported moving to a single, system-wide scheduling number, and more than half now rely on universal call centers or digital access hubs. Many are also layering in AI-enabled slot-filling and waitlist tools, which have been linked to lower no-show rates and faster access to specialty services.

Delays in appointment-setting are one of the most persistent barriers to timely recovery. When scheduling is fragmented, case managers spend excessive time calling multiple departments, tracking down openings, and trying to move a patient into the right specialist. Centralized access solves that bottleneck.

Centralized scheduling provides:

• Real-time visibility into earlier openings, cancellations, and priority slots.
• One coordinated access point instead of navigating siloed clinics or departments.
• The ability to accelerate care by placing patients into sooner appointments, often shaving days or weeks off critical steps.

Centralized access directly speeds up care delivery, improves adherence, and helps cases progress more predictably.

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Check out our sources:

American Medical Association. 2024 AMA Physician Practice Benchmark Survey. AMA, 2024. https://www.ama-assn.org

Centers for Medicare & Medicaid Services. “Medicare Telehealth Trends Report: 2023–2024.” CMS, 2024. https://www.cms.gov

Centers for Medicare & Medicaid Services. “Innovation in Behavioral Health (IBH) Model.” CMS Innovation Center, 2024. https://innovation.cms.gov

Centers for Medicare & Medicaid Services. “Quality Payment Program: Alternative Payment Models Data.” CMS, 2024.
https://qpp.cms.gov

Humana. Value-Based Care Report: 2023 Edition. Humana Inc., 2023. https://www.humana.com/valuebasedcare

Klepper, Emily, et al. “Association of Ambient Clinical Documentation Tools With Clinician Time and Burnout.” JAMA Network Open, vol. 8, no. 1, 2025. https://jamanetwork.com

National Council on Compensation Insurance. Medical Indicators and Behavioral Health Impact on Claim Severity. NCCI, 2024.
https://www.ncci.com

Office of the National Coordinator for Health Information Technology. “Adoption of Predictive Analytics and AI Tools in U.S. Hospitals, 2024.” ONC Data Brief, 2024. https://www.healthit.gov