Case Management Corner: How AI and Technology are Transforming Discharge Planning

By Kelly Bilodeau

In an era where case managers often need to do more with less, new technologies are providing a helping hand with discharge planning. Most EMR systems now have integrated artificial intelligence (AI) and machine learning that flag patients at high risk for complications, hospital readmissions, and extended lengths of stay. However, many case management programs are not fully integrating these tools into their daily practice.

“The technology gives us the ability to identify and manage the most complex patients but we have to utilize the tools and put standard processes in place to allow case managers to focus their time where it’s needed most,” said Marie Stinebuck, COO of Phoenix Medical Management.

While technology is a valuable assistant that can identify care gaps, recommend evidence-based interventions, and guide discharge planning, it is designed to augment, not replace, people. Patients still need case managers to apply judgment and critical thinking skills to guide their progression of care, Stinebuck said.

New tools save time

When applied correctly, AI and other digital tools can reduce the administrative burden for case managers. EMR-integrated risk stratification programs such as the LACE Index or Project BOOST use criteria such as polypharmacy, comorbidities, chronic diagnoses, or a recent readmission within 30 days of discharge to identify high-risk patients. These tools allow case managers to intervene earlier and potentially prevent avoidable readmissions. This is crucial because hospitals with high readmission rates among Medicare patients with certain conditions may face penalties under the Hospital Readmissions Reduction Program. Organizations should note that CMS recently expanded this program to include Medicare Advantage patients starting in 2026.

While automated systems are helpful, case managers shouldn’t rely exclusively on these tools. Medicare conditions of participation require a licensed professional, such as a nurse or social worker, to conduct the assessment and develop the patient’s care plan. This requires clinical reasoning and human insight that AI can’t replace. “Our role is as an advocate for our patients and to identify those patients with high-risk needs,” Stinebuck said.

AI working against case managers

Although AI tools can be helpful, they’re also adding new layers of complexity for hospitals and case managers. Payers have fully joined the tech revolution, leveraging advanced AI and machine learning algorithms to review patients in near real time. These algorithms scan thousands of clinical data points to predict level-of-care recommendations. This provides an efficient means to deny post-acute placements, creating multifaceted challenges. AI tools are not always able to capture nuanced patient needs, such as social determinants of health or a lack of caregiver capacity, factors that may affect their ability to recover safely at home without additional support.

Patients often have little choice but to challenge these determinations, triggering a series of appeals and denials that can lead to excess and avoidable days. Case managers need to spend time managing these appeals, as well as coordinating post-acute placement and repeatedly adjusting discharge plans. This represents a significant, often immeasurable loss in productivity.

Looking to the Future

Technology will likely continue to play a pivotal role in discharge planning in the coming years. However, as case managers gain access to new tools, the core skills they bring to the job are still vital. Technology can’t replace clinical expertise, empathy, or the ability to determine what’s best for each patient.

Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered. Whether you're looking for industry updates, practical strategies, or real-world perspectives, we bring you valuable conversations designed to enhance your knowledge and support your professional growth. Stay tuned for expert insights straight from the field! Kelly Bilodeau has been a longtime writer for HCPro’s Case Management Monthly.