Case Management Caseload Concept Paper: Proceedings of the Caseload Work Group, a Joint Collaboration of CMSA and NASW
Two nonprofit organizations – the Case Management Association of America (CMSA) and the National Association of Social Workers (NASW) – determined that combining efforts to examine the essential components of appropriately sized caseloads for case managers in health, behavioral health, and workers’ compensation settings would be beneficial. Practitioners and researchers from various case management (CM) disciplines were invited to join CMSA and NASW to form the Caseload Work Group (CLWG), bringing together years of frontline and leadership experience. The purpose of the CLWG was to respond to recurring requests from practitioners, supervisory personnel, and policy-makers regarding how to determine appropriate caseload sizes for case managers in health and behavioral health settings. In discussing the construction of a caseload calculator capable of spanning all sectors of CM, or a set of caseload calculators for a limited number of CM practice sectors, the CLWG determined that accomplishing either task would require a multiphase effort. This concept paper represents the culmination of the initial, or Phase I, work and findings of the CLWG. It identifies the purpose, mission, and history of the CLWG; includes synopses of the public comments received in 2007 and 2008 and the literature reviewed by the CLWG members; and offers for consideration the important Phase I product, a Caseload Matrix. The Caseload Matrix is a schematic chart of nonweighted elements sorted into four categories. The CLWG members assessed these elements as likely to influence caseload complexity and size. In addition to presenting the CLWG’s Phase I endeavors, research, and recommendations, this concept paper establishes a platform for future research a
Introduction For years, case managers from a variety of health and behavioral healthcare settings have complained of inconsistent and inappropriate case management (CM) caseload sizes. Some organizations have designed caseload calculators to help case managers and professional care coordinators determine the sizes of their caseloads; but these calculators have been limited in focus or application. Moreover, rapid changes in the medical management field – such as the integration of utilization management (UM) and disease management (DM) into case management (CM) functions – have made it more difficult to provide equitable benchmarks for caseload determination. Research findings regarding caseload levels, similar to the limited-focus calculators, have been confined to specific clinical areas or applicable to well-defined in-house programs. Despite the research, the complexity of factors across diverse CM settings has prevented the development of a comprehensive model for caseload calculations. Although information technology platforms have the capacity to standardize and automate caseload calculations, a multitude of complex factors must be considered if such computations are to be realistic. Mission In this collaborative endeavor, the Case Management Society of America (CMSA) and the National Association of Social Workers (NASW) seek to identify the issues for determining acceptable caseload sizes in a wide variety of CM practice areas. The mission of the CLWG is threefold: 1. To compile a comprehensive list of elements that can impact potential caseload determinations in complex and diverse CM settings; 2. To organize these identified elements into a schematic matrix useful for preliminary evaluation of factors that impact caseloads; and 3. To enhance professional CM practice, thereby promoting quality care outcomes for clients and patients. The purpose of the CLWG project is to determine a matrix of elements that can be used to calculate CM caseloads in a wide array of settings. Although the Caseload Matrix presented in this paper is designed for use in health, behavioral health, and workers’ compensation settings, the CLWG encourages its adaptation for use in other market segments such as child welfare, immigrant resettlement, and corrections. In Phase I, the CLWG aimed to identify all factors that could affect caseload calculations, promote quality client and patient care outcomes, and maximize professional CM practice. After the conclusion of Phase I, the CLWG may begin to assess and evaluate
included the knowledge that the increasing complexity and interdisciplinary integration of client-centered interventions have made the establishment and maintenance of CM caseloads a more complicated task. Recently, many healthcare leaders observed that nurses, social workers, and other case managers often were frustrated with the uneven application of cases in their clinical or workplace settings. With the endorsement of the CMSA Board, Mr. Carneal and Ms. Lattimer were named co-chairs of the joint task force entitled the Caseload Work Group (CLWG). CMSA also invited NASW to join the CLWG in this collaboration. Next, experts