An innovative case management intervention for people at high risk of permanent work disability to improve rehabilitation coverage and coordination of health services (AktiFAME)

Background: German social law provides a wide range of services from various providers, designed to maintain work ability, support return to work efforts, and prevent disability pensions. However, many individuals with health impairments who are at risk of permanent work disability often do not know where to seek advice or how to apply for these services. As a result, many of the available services remain underutilized. The model project AktiFAME developed a multimodal strategy to address this gap, targeting individuals at high risk of receiving disability pensions. This strategy consisted of four modules: initial screening and postal outreach, telephone counseling, an initial in-person consultation, and individualized case management. A key goal was to provide guidance on and facilitate access to rehabilitation services, ultimately supporting sustained work participation. Methods: The effectiveness of the approach was evaluated in a randomized controlled trial (DRKS00024648), supplemented by an observational study that accompanied individuals who participated in the case management intervention. Participants were identified using a validated risk score that combined and weighted individual administrative data from pension accounts. Individuals with high risk scores were informed by post about the option of participating in case management and encouraged to contact their regional case manager if needed. Our randomized controlled trial aimed to include 9,000 individuals, equally split into an intervention group, which received written information about the case management intervention, and a control group, which did not. The primary outcome was the use of rehabilitation services provided by the German Pension Insurance North. Additional administrative data were analyzed as secondary outcomes. All participants also received a postal questionnaire one year after assignment to either group to collect self-reported outcome data. Participants in the case management intervention completed questionnaires at the start and end of the case management. Results: A total of 10,600 individuals were enrolled—5,300 in the intervention group and 5,300 in the control group. Outreach led to 570 calls, 359 consultations, and 277 people receiving case management, which was delivered with high fidelity and received very positive feedback. On average, case management lasted 35 weeks and required 11 hours (excluding travel time) and 15 hours (including travel time) of support. After one year, the intervention group showed a modest but significant increase in approved rehabilitation services (1.5 percentage points; HR = 1.28; p = 0.001). Secondary outcomes like employment days or sickness absence benefits showed no significant group differences. However, participants reported improved knowledge about available services. Among those who actually received case management, the approval rate for rehabilitation was 35.7%, nearly eight times higher than in the control group. These participants also showed reduced use of sickness absence benefits and slight improvements in mental health indicators. Discussion: The project demonstrated that at-risk individuals can be identified early and effectively supported by a case management intervention. Our multi-modal strategy significantly increased the likelihood of accessing rehabilitation and proved especially effective for those who actively participated in the case management intervention. Standardized materials developed during the project support future dissemination and quality assurance.