Health Law and Regulation

Click here for a Free trial to Jenks Healthcare Business Report

Healthcare case managers are playing a larger role in the coordination of all phases of patient care — from management of the chronically ill in primary care to monitoring hospitalized patients from pre-admission through post-discharge to overseeing care of residents in long-term care facilities.

The December 2009 Healthcare Case Management e-survey by the Healthcare Intelligence Network captured the expanding focus, responsibilities and impact of case management in the healthcare industry, from the populations benefiting from their efforts to metrics on case loads, ROI and performance measurement. Responses provided by 187 healthcare organizations reveal a growing reliance on case management to more closely direct care for high-risk patients so that unnecessary health costs and utilization can be avoided.

Figure 1: Case Manager Case Loads

Survey Highlights:

• More than four-fifths — 84 percent — of respondents are using case managers in their organizations.
• The target population for the case management efforts of the majority of respondents — 89.1 percent — consists of individuals suffering from complex illnesses.
• Overwhelmingly, the primary duties of case managers are related to care continuity and management of care transitions, said 87.6 percent of respondents.
• More than half of respondents — 52.7 percent — said the primary work location for case managers is in the health plan office, while another quarter of respondents place case managers alongside hospital discharge coordinators.
• Almost two-fifths of respondents — 38.4 percent — said their case managers carry an average caseload of 50 to 99 individuals per month.
• The telephone is the primary method by which case managers communicate with patients and members in their charge, say 84.6 percent of respondents.
• For more than half of respondents — 58 percent — cardiovascular disease is the initial primary diagnosis for which case management is most effective.
• A case manager is most likely to be a registered nurse, say 62.8 percent of respondents.
• Almost two-thirds of respondents — 65.1 percent — say patient satisfaction is the number one factor they consider when evaluating a case manager’s performance.
• Of 32 organizations who rated the overall effect of case management on unplanned treatments or procedures such as ER visits, 75 percent said they experienced a decrease in these types of utilization.
• Of 92 organizations who shared ROI ratings, slightly more than one-third of respondents — 36.7 percent — said it was too early to measure ROI from case management programs, while another third — 34.7 percent — reported ROI from case management falling between 2:1 and 3:1.

Source: 2010 Benchmarks in Healthcare Case Management: Responsibilities, Results & ROI, April 2010