Friend or Foe? Exploring Artificial Intelligence in Case Management
BY TIFFANY FERGUSON, LMSW, CMAC, ACM, LISA SIMMONS- FIELDS, DNP, MSA, RN, CCM, CPHQ, FCM, AND THERESA LITZINGER, MSN, RN, CCM
As artificial intelligence (AI) becomes more deeply embedded in healthcare, the case management profession stands at a crossroads: Will AI be a powerful ally in improving care coordination, or a disruptive force that compromises the human touch so central to our work? In a recent roundtable discussion, I sat down with two respected leaders in the field—Lisa Simmons-Fields, National Director, System Population Health/Care Management, and Theresa Litzinger, Manager for Special Needs Care Coordination to discuss the promises, perils, and practicalities of AI integration in case management.
This conversation captured the complexity of AI as both a “friend and foe,” an innovation capable of enhancing efficiency, yet one that demands caution, oversight and ethical rigor.
The New Frontier: Virtual Nurses and Predictive Models
Tiffany Ferguson: To get us started, how would you define the role of artificial intelligence in the world of case management?
Lisa Simmons-Fields: I see AI as a connector. For example, we’ve started considering how virtual registered nurses could support high-risk patients and serve as a bridge between the care team and the individual. Predictive modeling plays a key role here, identifying patients most at risk for readmission or complications, allowing us to act earlier and more strategically.
Theresa: That makes sense. While I haven’t had direct experience deploying virtual nurses or AI tools in my organization, I do think predictive models can offer consistency. At the same time, we must make sure they don’t remove our ability to individualize care.
Tiffany Ferguson: Exactly. It’s a balance, AI can help us identify who needs our attention, but it can’t replace our clinical judgment.
Friend or Foe? A Dual Perspective
Tiffany: So, let’s get into your direct opinions, would you say AI is more friend or foe?
Theresa: I’d say both. It’s a friend when it gives us better information faster, but a foe when it’s seen as a replacement for human decision-making. It’s also scary when leadership starts asking, “Can this replace a role?” rather than “How can this enhance what we do?”
Lisa: Right. AI can’t be a standalone solution. It must operate within ethical guidelines and evidence-based practice. For example, we’ve explored tools like DAX (Dragon Ambient eXperience) to reduce documentation time and psychographic segmentation to tailor outreach strategies—both of which show promise when used appropriately.
The Ethics of Automation: Human Oversight Is Key
Tiffany: Let’s talk about ethics. What concerns should we be thinking about when using AI in patient care?
Lisa: Advocacy is critical. Case managers must stay focused on the patient’s voice, especially when dealing with complex systems like insurance authorization. AI might flag a service as non-essential, but it’s our job to say, “Wait—this person’s story matters here.”
Tiffany: I agree. AI can’t be the final word. We’ve seen cases where automated decision-making could lead to denial of care if there’s no human check. That’s dangerous. Oversight isn’t just a safety net—it’s a necessity.
Theresa: And with that comes education. Case managers need training to understand how AI algorithms work, what the data is telling us, and how to ask critical questions. Without that, we risk using tools we don’t fully understand.
Technology and Training: Is Healthcare Ready?
Tiffany: Are our organizations ready for AI? Have you seen adequate training and support?
Theresa: Honestly, no. We’re adopting things like chatbots and automated alerts, but the rollout has been uneven. Some people know how to use the tools well; others don’t. And it’s a concern for many, especially in the area of HIPAA and information sharing, where legal considerations add another layer of complexity.
Lisa: That’s true. We’re moving slowly, which can be good for safety but bad for adoption. We’ve seen success in using patient portal messaging to improve screening rates, especially when we align our methods with patients’ communication preferences. But it takes time, and trust to build new workflows.
Preserving the Human Element
Tiffany: One common concern I hear is that AI might erode the human connection. What are your thoughts?
Lisa: Technology should never replace compassion. We need to be adaptable—yes—but not robotic. A case manager’s role is inherently personal. We guide patients through fear, uncertainty and often life-changing decisions. No machine can replicate that.
Theresa: I think it’s also about respecting the patient’s preferred method of communication. Some prefer texting. Others want a phone call or face-to-face interaction. AI should support communication and engagement, not standardize responses. The individual with unique circumstances and needs will always need that human touch. Case management is all about seeing our members, patients or clients as a whole person, physical, emotional, spiritual – that nuance can’t be teased out of the system.
Patient-Centered Innovation
Tiffany: Can you share examples where technology has improved engagement?
Lisa: Absolutely. By using campaigns, bulk outreach, patient portals and text-based appointment reminders, we’ve seen a significant boost in follow-through rates, particularly for wellness screenings in underserved communities. The data showed that when you reach people in ways that fit their lives, they respond.
Tiffany: That resonates. I was part of a pilot project using a simple SMS campaign to engage patients with chronic conditions. The results were eye-opening; we reconnected with individuals who hadn’t been seen in over a year. The key wasn’t high-tech, it was right-tech.
Action Steps and Final Thoughts
As the discussion wrapped up, we reflected on what comes next.
Tiffany: What’s one action step your organization is taking to better integrate AI into case management?
Lisa: We’re exploring different ways to leverage our hospital virtual RNs for assistance with follow-up appointment scheduling. We are also working to align communication strategies based on what matters most to the patients we serve. Another strategy would be wider adoption of DAX to ease documentation burdens for our care manager and the potential use of AI summaries.
Theresa: For us, the first step is education. We need a baseline understanding across all levels before we can fully embrace these tools. I look forward to contributing to this broader conversation through follow-up discussions.
Tiffany: Thank you both. What’s clear from today is that AI in case management isn’t black or white it’s nuanced, evolving, and deeply human. Our job is to shape how it serves, not replaces our commitment to patients.
AI is not the future of case management; it is the present. But its success depends not on algorithms alone, but on the wisdom, compassion and ethical grounding of the professionals who use it. Whether friend or foe, the incorporation of AI must maintain a reflection of our case management values. As this panel shows, it’s not about choosing sides in the debate, it’s about choosing how we navigate the implementation and utilization journey.
Theresa M. Litzinger, BA, MSN, RN, CCM, has over 30 years of experience in pediatric nursing and 10 years of pediatric case management and management experience in various post-acute settings. She holds a BA in Elementary and Special Education as well as an MSN in Nursing Administration.
Tiffany Ferguson, MSW, ACM, CMAC, is CEO of Phoenix Medical Management, Inc. Tiffany serves as an adjunct professor at Northern Arizona University, Department of Social Work, and on the American College of Physician Advisors (ACPA) Observation Committee. Tiffany is co-author of The Hospital Guide to Contemporary Case Management through HcPro. She is a contributor for RACmonitor and Case Management Monthly; she also serves on the editorial board for CMSAToday and Care Management. She is a weekly correspondent on SDoH for the news podcast Talk Ten Tuesday. After practicing as a hospital social worker, she went on to serve as director of case management and quickly assumed responsibilities in system level leadership roles in health & care management, which includes CM, UR, CDI, HIM, and coding. She has held C-level responsibility for a large employed medical group which included value-based arrangements and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA.
Lisa Simmons-Fields, DNP, MSA, RN, CCM, CPHQ, FCM, has 35 years of experience in case management, utilization review, and quality. Lisa currently serves as the director, system population health/care management for Trinity Health System, a national multi-institutional Catholic health care delivery system. In this role, Lisa collaborates with leadership across clinical, business, and community health domains to improve the health and well-being of our patient populations. Lisa is known for being a visionary thinker, mentor, author, speaker, and influencer in the case management profession.
Lisa holds a Doctor of Nursing Practice, Master of Science in Administration, is a Certified Case Manager, and a Certified Professional in Health Care Quality. Lisa has been inducted into the Honor Society of Nursing, Sigma Theta Tau International and the 2024 Class of CMSA Fellows. Lisa currently serves as President for the CMSA-Detroit Chapter, on the CMSA Board of Directors and Editorial Board, CMSA Grants Taskforce, and is Co-Chair of the Epic Care Management Advisory Board.
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