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An Introductory Guide to Case Management

Posted by The Brain on Mar 11, 2020 5:03:49 AM

 

Case management emerges as a process of systematic problem solving

_Introduction to Case Management-01

 

What is case management, exactly? Outside of the healthcare and social assistance sectors, there’s great ambiguity – the precise meaning of the term and a nuanced understanding of its underlying techniques often eluding those in other industries, such emergency and safety management, who most stand to benefit from implementing the practice. So, let’s start at the beginning.

Case management first emerged as a managed care technique, specifically in advanced healthcare and social assistance systems. The novelty it offered as a practice was simple, a more “holistic” means of handling patient care, one that more fully accounted for extra-medical factors like physical, emotional, financial, psychosocial, and behavioral needs, as well as related support systems. On this point, the academic literature is worth revisiting:

Historically, there have been many definitions of case management. Generally, it is a way of helping people identify the areas where they need help connecting them to the personal and community resources that will help them (Rubin, 1992a). It is a systematic problem-solving process that enables and facilitates individuals in their interaction with their environment. According to the National Association of Social Workers (1984; NASW), “Case management is a mechanism for ensuring comprehensive programs that will meet an individual’s need for care by coordinating and linking components of a service delivery system.” According to Dinerman (1992), “It is a function designed to arrange for, and to sequence, needed services of different sorts by various providers on behalf of a client or client family.” Case management involves the engagement of a client in a system of services by an accountable professional. According to the American Association on Mental Retardation (1994) – now the American Association of Intellectual and Developmental Disabilities – “Service coordination (case management) is an ongoing process that consists of the assessment of wants and needs, planning, locating, and securing supports and services, monitoring and follow-along” (see also Summers, 2008; Woodside & McClam, 2005). The individual or family is the defining force of the service coordination process.” In the words of the National Conference on Social Welfare (1981), “Case management is a growing, evolving process which is shaped by forces in the environment in which it exists.” NASW (1992) views case management as the link between the client and the service delivery system. Social work case management practice is built on a bio-psycho-social model that addresses strengths and challenges in systems impacting various populations (NASW, 2016). One can see from these definitions that case management is the glue that binds a fragmented array of services to the unique and changing needs of clients.[i]

Since its inception, though, case management has broken out of the narrow confines of healthcare and social assistance, making important forays to disaster, emergency, and safety management (among other sectors), as well as regulatory compliance. The question is why.

Well, at its core, case management is all about solving problems, especially gathering information (among other resources) and getting it distributed quickly. Case management can be understood as a collaborative work method (constituting multiple phases) to link people to the relevant and available resources they need to attain pre-determined goals. The problems themselves are deemed cases, representing pieces of work that deliver tangible business outcomes for a customer, employee, partner, or other stakeholder.[ii]

To business owners, that might sound like a task. But there are important distinctions between cases and tasks. Cases yield concrete business outcomes; they are the end-objects that get worked on. On the other hand, tasks are mostly fixed-term assignments that need to be completed in order to close a case. Those specific tasks might include some of the following:

  • Regulatory compliance, where case management techniques can help ensure that organizations handling cases remain compliant with laws, policies, and procedures. The flexibility of case management itself also allows for the quick adaptation (of rules and processes) to regulatory changes, as well as ensures compliance with insurance contracts and warranty fulfillment. Indeed, in certain sectors, the handling of certain classes of cases often comes under regulatory scrutiny.
  • Claims management, where case management techniques can enable the fulfillment of complex claims, involving the collection and consideration of vast quantities of information.
  • Facility management, where case management techniques can help with the efficient maintenance of complex, large-scale assets, including facilities spread across multiple locations. A key benefit of case management, here, is the improved ability to identify potential issues, then automate steps to proactively address issues, while maintaining comprehensive records and measures for risk mitigation.
  • Emergency response and disaster welfare relief, where case management techniques and capabilities can help better engage field workers about ongoing incidents, enabling the more efficient routing of those responders for faster incident resolution. The improved customer service component of case management can also help in disaster welfare relief, where disaster relief agencies must navigate complex client issues that often require multiple steps to rectify and manage long-term client relationships across at-risk populations.
  • Safety and Human Resources grievances, where case management techniques help guarantee that all incidents (e.g. return to work and worker’s compensation cases) are handled according to pre-set policies and procedures, potentially leading to more resolved disputes whose measurable outcomes can improve future incident handling. Safety and security accident investigations also stand to benefit from techniques which facilitate the gathering of information to determine causes, elicit results, and change future behavior.

The key functions of case management

Of course, the benefits of case management techniques don’t just happen, even if those benefits are applicable to diverse types of work. To be effective, case management involves multiple collaborative phases. Those phases include the following[iii]:

  1. Screening. In the clinical setting, screening helps determine whether a patient would benefit from case management services. Information is reviewed to this effect, including claims information, utilization of healthcare services, current health status and history.
  2. Assessing. Assessing involves the collection of information about a client's situation similar to those reviewed during screening, but at greater depth, with the goal of (1) identifying the client's key problems to be addressed, as well as individual needs and interests; (2) determining the expected goals and target outcomes; and (3) developing a comprehensive case management plan that addresses these problems and needs while enabling the achieving of goals outlined. The phase also involves either confirmation or update of the client’s risk category based on the information gathered.
  3. Stratifying risk. During this phase, the appropriate level of intervention is determined by classifying the client’s level of risk. In the clinical setting, health risk assessment and biomedical screening would be performed, based on these risk factors. The case manager would then review the information generated and contact the patient if appropriate.
  4. Planning. As the name suggests, planning involves determining specific objectives, goals, and actions designed to meet the client’s needs as identified through the assessment process. The resulting case management plan is action-oriented and time-bound, with both short- and long-term goals articulated.
  5. Implementing. Defined officially as the “process of executing specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan,” implementation is the stage during which care is coordinated by organizing, securing, integrating, and modifying the resources needed for the client to reach the desired outcome. Here, the case manager can act as a liaison between the client, their support system and/or caregivers, providers, and payer/insurance company.
  6. Following-up. Again, as the name suggests, the following-up phase focuses on review, evaluation, additional monitoring, and reassessment of the client. In the clinical setting, the focus is on the client’s condition and treatment. In other settings, the phase offers an opportunity to evaluate the appropriateness and effectiveness of the client’s case management plan and its effect on outcomes, i.e. gathering information from relevant resources and sharing that information with relevant stakeholders. Unsurprisingly, following-up might result in either a minor modification or a complete change to the case management plan.
  7. Transitioning. This phase is better known as transitional care, a clinical stage. Case managers typically use the stage to mitigate the risk of errors occurring when patients are transferring from care settings. They do so via education and follow-up.
  8. Communication post-transition. This post-transition phase follows an episode of care. At this time, the case manager follows up to determine how things are going. Issue and problems, such as management and compliance, are addressed to ensure resolution.
  9. Evaluation. Here, the case management plan is finally assessed, with its effect on the client measured. Metrics include cost-benefit analysis, return-on-investment, and client satisfaction – in the clinical setting, quality of life is also taken into account.
case management process

Source: Case Management Body of Knowledge

Purpose-built technology to mitigate the challenges to effective case management

In practice, the phases above rarely unfold linearly. Business owners seldom complete a phase absolutely without returning to it in some fashion. And that’s because the underlying business activity – be it disaster welfare granting, investigating safety and security incidents, or claims compensation – is so fluid and complex.

Indeed, the very unpredictable nature of the unpredictable work to which case management provides greater efficiency and transparency serves as a reminder that effective case management isn’t easy. The main challenges: resources are often limited. And when those resources are available, accessing them depends on overcoming crude information-sharing pathways.

Fortunately, digital case management technology can help better manage and improve the details of how work gets done in the context of that work’s desired outcome. By automating key facets of unpredictable work, in particular, flexible case management technology increases visibility into complex operations, improves collaborations, and facilitates better stakeholder engagement.

Though a marked improvement over the type of manual processes and systems (i.e. spreadsheets) by and in which case work typically gets done, case management systems aren’t a cure all. After all, not all technology is created equal. In fact, many systems don’t offer much more than workflows that manage the receipt, routing, and reporting of work.

Enabling the automating of the response and resolution of unpredictable works calls for much more robust functionality to manage all intelligence and case management incidents affecting a given organization. Key system capabilities to look for include:

  • Intelligence teams & cases dashboards. Robust dashboards to summarize. all incidents, team tasks and actions, and case management information
  • Configurable forms for cases, targets, subjects, or investigations. Highly configurable forms allow you to ensure the right information is always captured
  • Case event & decision logging. Easily capture case occurrences and log details and follow-up tasks and actions
  • Tasks, communications & notifications. Easily assign tasks and communicate with stakeholders and personnel about incidents and operations.
  • Investigation teams, roles & team activation. Manage your investigation teams, set back up roles, and activate & confirm teams instantly
  • Intelligence briefs & reporting. Capture intelligence briefs and related information for inclusion in reports and documents.
  • Configurable workflows for cases, investigations & report production. Create robust, configurable workflows to automate your business processes.
  • Mobile collection of intelligence, communications & field agent tracking. Comprehensive mobile app allows you to take your intel and case management operations on the go and always know where your field agents are.
  • People, capability & contact management. Track key personnel alongside their capabilities and qualifications to ensure the right people are assigned to the right tasks.
  • Event mapping & case data analysis. Robust information tracking and reporting capabilities allow you to capture and distil all incident information into actionable reports and analytics.
  • Kanban boards for tracking production of intelligence products. Inbuilt Kanban boards ensure intelligence products are produced quickly and correctly every time.

Finally, there are many definitions of case management. But at its core, case management is simply a way of helping people identify the areas where they need help and connecting them to the personal and resources that will help them.

As a systematic problem-solving process that enables and facilitates individuals in their interaction with their environment, case management offers business process owners a way to perform unpredictable work more efficiently, by gathering and distributing information quickly and effectively.

But the challenges to effective case management can’t be understated, especially resource limitations and frictions in information sharing. The right technology, like intelligence and case management software platform, Noggin, helps business process owners overcome those challenges, so as to get complex work completed quicker, with happier stakeholders.

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[i] Introduction to the Case Management Body of Knowledge. Available at https://www.cmbodyofknowledge.com/content/introduction-case-management-body-knowledge.
[ii] David Challis, University of Kent: Case management: problems and possibilities. Available at http://www.psi.org.uk/publications/archivepdfs/Care%20managers/CHALLIS.pdf.
[iii] Arthur J. Frankel et al, Oxford University: Case Management: An Introduction to Concepts and Skills.

Topics: Case management


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