Case manager workloads not uniform

A new study takes a census of patients covered but leaves unanswered the question of how many patients should be overseen by a single person.

By — Posted Sept. 19, 2012

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The number of patients a case manager is assigned to oversee varies widely, according to data released Aug. 29 by the Healthcare Intelligence Network, a company that advises executives on health care trends.

Approximately 31.1% of case managers, also known as care managers, handle one to 49 patients per month, according to data from a survey of 153 health care organizations carried out earlier in 2012. Another 42.2%, the largest group, manage 50 to 99 patients, and 15.6% are assigned 100 to 149 patients. Only 2.2% managed 150 to 199, and 3.3% have 200 to 249 patients. Approximately 2.2% manage more than 250 patients. The remaining 3.3% did not report the number.

Nineteen percent of the entities in the survey were managed care organizations, and 15% were health plans. Another 15% were hospitals, and 9% were physician organizations. The remaining participants were categorized as “other.”

Case managers coordinate care and provide patient education. They also may make referrals to community resources that can address patients’ social and financial concerns.

Some case managers are hired directly by medical practices working toward various bonuses within an accountable care organization, patient-centered medical home or some other model for improving outcomes and constraining health care costs. Others are employed by an insurer or large health system and may be embedded in a practice or work remotely. In many situations, say those who study issues related to case management, physicians will have significant input, if they don’t make the decision entirely, in determining how managers work and how many patients they handle.

The survey did not judge whether these case loads were appropriate, but researchers say this should be determined by the experience of the manager, who is usually a nurse or other health care professional, as well as the needs of the patients. For instance, a more experienced case manager may be able to handle a greater number of patients, but when patients have severe and complex illnesses, the number will be reduced.

“There’s a lot of factors that go into the decision,” said Melanie Matthews, Healthcare Intelligence Network’s executive vice president and chief operating officer. “Case managers with more experience can manage a much larger case load. It also depends on the population. For example, it’s much easier to manage the diabetic patient than one with congestive heart failure. A patient with behavioral health needs may require more care coordination.”

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