Case management is a coordinated effort between community-based, often nonprofit, organizations that work to provide quality health care solutions that are customized to a client’s specific and individual needs. This health care approach is designed to be customized to the client to best address unique needs on the client’s own timeline. In addition to traditional health services, case management can also aid with employment searches, transportation solutions, and community involvement. This collaborative process involves assessment, planning, plan implementation, and evaluation to successfully achieve the client’s desired outcome.
There are four basic levels involved with case management – intake, needs assessment, service planning, and monitoring and evaluating – which will be analyzed here. It is important to note that while these levels are numbered one through four for the purposes of this discussion, they are not necessarily linear. Case management levels can be revisited as needed depending on how well the case manager and client are navigating their plan.
Before we discuss the FOUR levels though, we should look at the role of the case manager and how these health professionals help their clients.
What does a Case Manager do?
Case managers are health service professionals who work toward the goal of bettering the life and needs of their clients. Case managers will work with clients, the client’s families, community members, and other health professionals to address their clients’ individual and specific needs. Case managers are responsible for making sure their clients have the resources they need to meet their agreed-upon goals. As health professionals, case managers must also advocate on behalf of their clients as these individuals are often not in a position to advocate for themselves.
Case managers also take into consideration the client’s values, and cultural and religious beliefs when working with them. They must take into consideration any relevant state and federal laws, current best practice guidelines, and health insurance plan requirements and obligations. Documentation is expected at every level of case management as it is in most health service environments. This creates a record for the safety, well-being, and legal protection of both the case manager and the client.
The roles and responsibilities of a case manager can be boiled down to a single word: coordination. These skilled professionals act as the intermediaries between stakeholders and health care providers to put clients in the best possible position for success.
What are the skills and attributes of a successful case manager?
High degree of empathy: Empathy is of utmost importance for anyone working as a case manager. In fact, a lack of empathy is a barrier to entry for working in the case management field. The ability to identify with the struggles of their client is critical for being able to effectively aid that client. Empathy, in addition to clarifying the needs of a client, builds a rapport and trust that cannot be replicated.
Organizational skills: Being organized and appropriately maintaining information is a trait that is common to all health care roles. Case managers are responsible for multiple clients who are all at different stages of progress and have their own individual goals and tracks. Keeping calendars, notes, and confidential client paperwork organized and secure is a must.
Advocacy skills: Advocacy is one of the key responsibilities of a case manager. They act as the contact point between their clients and health service providers. Case managers advocate on behalf of their clients to help navigate cumbersome rules, regulations, and laws associated with health care.
Communication skills: Whether it is with the client, their family, community stakeholders, or the client’s other health professionals, the case manager must be able to accurately convey the needs and status of the client both verbally and in written form. Given the diverse groups that have to be communicated with, case managers need to be able to tailor their communication style to their audience.
Patience: The job of a case manager can be trying. Patience is required not only with the clients who are often in difficult personal circumstances but also with the red tape that accompanies working in any health care profession.
Adaptation: Effective case managers must be able to adapt quickly. In addition to each client having specific needs, the environment, and resources available in each situation will vary. Being able to think quickly and adapt to these circumstances can determine how successful the manager will be in servicing the client.
Now let’s elaborate one by one on the four levels of case management.
Level One: Intake
Level Two: Needs Assessment
Level Three: Service Planning
Level Four: Monitoring and Evaluating
Level One: Intake
The first level of case management – intake – is the foundation for all other steps that follow. In this step, as much information as possible is gathered with an eye to creating an accurate picture of the client’s current situation. This information is provided by the client and at this stage, the client’s needs are made expressly clear.
Let’s dive in a bit more on what happens in this stage of case management.
Gathering of demographic information: Demographic information that is gathered at this point includes basic information such as name, address, and contact information as well as medical information including health insurance coverage, health history, prior service history, socioeconomic status, self-care capability, and any other pertinent information that can help the case manager create an effective plan of care for the client.
Identify immediate needs the client may have: In many instances, the client will have existing needs that may take precedence and should be addressed before any others. These items are identified upfront and help determine what the path going forward will be for the client.
Establish a relationship with the client: This is the first interaction between the client and the case manager and is where a relationship germinates. The road toward building trust between the two parties starts in these initial interactions of understanding where the client is and how they can best be helped.
Determine if the client can benefit from the organization: This first interaction with the client is what helps the case manager determine if their organization can be of benefit to the client. Typically, if the organization is not a natural fit for the client’s needs, the organization will suggest an alternative for the client to pursue.
Level Two: Needs Assessment
The information that is gathered at the first level, Intake, begins to organize and take form in level two – needs assessment. This is the level, the case manager assesses all of the information at their disposal and develops an understanding with the client about what their needs and goals are and what the road may look like to achieving those.
Here are some steps that are taken at this level:
Identify key problems, needs, and interests: Making sure there is a clear listing of key problems, needs, and interests for the client is critical in health services. Case management thrives on individualized, custom plans and these are only effective if there is clarity in what the client’s specific needs are.
Establishment of specific goals: It is also critical to the case management process that expected goals are established and communicated. This helps to ensure that all parties involved – the case manager, client, the client’s family, and health service stakeholders – are on the same page regarding the end goal.
Communicate potential challenges to the client: Everyone deserves to know the risks and challenges associated with their personal health and this is no different in case management. In level two, the client and their family should have a clear picture of the challenges that may be encountered along the way.
Reassess needs periodically: As clients move through the case management process, their needs will likely change. It is important to reassess periodically to make sure the agreed-upon plan is still servicing the client in a way that helps them most.
Level Three: Service Planning
In level three, very specific tasks and objectives are identified that will help the client move toward their goal. A plan is put together by the case manager that takes into account all of the information that was gathered in levels one and two. The plan is often subject to input from the client’s support system and their other health providers.
The steps involved in creating a service plan include:
Specific actions are outlined to achieve goals: An outline is put together of actionable steps to take. The most important item outside of creating this list of actions is that they are realistic and achievable. Achievability is a trait that is desirable for any action planning regardless of industry.
Development of a timeline for goals: Establishing a timeline is the other side of the same coin for service planning. Timelines help to keep all parties focused and motivated on the tasks at hand. This is equally as important as establishing the tasks to be completed.
Establish metrics to measure progress: How will a case manager know if the service plan they have created for a client is proving to be successful? Metrics. Identifying measurements creates accountability much in the same timeline does. It will keep all interested parties laser-focused on achieving their goals and will keep them in the loop as to where they are toward the goal at all times. Creating metrics can be a challenge in a social service environment however, this process will pay great dividends in the fourth level.
Level Four: Monitoring and Evaluating
The fourth level of case management is to evaluate the efficacy of the plan and to make sure that the client’s specific needs are being met by the case manager and the organization. The plan and metrics that were put into place in level three serve as the guides for monitoring and evaluating.
Monitor established metrics: We discussed in level three that establishing specific metrics in a social service environment can be a challenge however, it is in level four where that hard work pays off. The metrics can act as in-the-moment indicators of how progress is developing. The case manager can then use this information to adjust the course if need or proceed if the plan is yielding good results.
Ensure quantified data is used rather than anecdotal: In any project management environment, there is always the temptation to rely on the manager’s gut instinct for how the plan is working. While this may feel like a solid and gratifying way to assess progress, there is no substitute for actual data. This is the case with social service case management as well. Relying on anecdotes to assess progress made can have dramatic effects on the service that a client received. Stressing the importance of a single anecdote can give the impression that a client is well ahead of the plan or lagging far behind. Instead of this anecdotal approach, the case manager should be sure to rely on data gathered during the implementation of the plan with an eye toward using the metrics established in level three.
Case management software for Case Managers
Today’s case managers have a wealth of tools at their disposal for effective case management. As we discussed earlier, managing the specific needs of multiple clients and keeping their plans, personal data and notes organized and secure are basic expectations of the role. Thankfully, there is case management software that can help relieve much of this burden from the case manager leaving them with more time to spend focusing on their clients. PlanStreet’s Case Management software helps develop a workflow, manage client data, integrate data with existing systems, and configure dashboards to make the information the case manager needs readily available.
Documentation is a time-consuming aspect of a case manager’s role and utilizing case management software will result in a more organized and time-efficient case management process.
Four levels to case management success
These four-level, when fleshed out and seen through to completion, are a roadmap to success for case managers. While each client’s specific needs and goals are unique to them, these levels and processes can be applied to every client. When combined with an empathetic case manager and a solid case management software tool, success is inevitable.