What Is Case Management?
Growing organizations will always benefit from workflow and process automation to streamline repetitive tasks. These tasks include day-to-day business activities such as document routing, invoice approval and data entry.
But what happens when the steps needed to complete a business process demand flexibility? Dynamic decisions need to be made, for example, when insurance firms must evaluate whether a patient’s medical claim can be approved, Human Resources (HR) departments must solve an employee dispute and other non-routine tasks that require human intervention.
With the help of ISSI, organizations can deploy efficiency-driven case management strategies to support their decision-makers and case managers.
Case Management: What Does It Mean?
Case management is a procedure for managing data relationships, documents and processes for unique cases, like service requests, investigations or incidents that require action and resolution.
This encompasses the recording, monitoring and analysis involved in processing the data, procedures and related content that comprise a case.
Unlike business process management (BPM), which focuses specifically on workflows and repeatable processes, case management is a more holistic technique for managing work and processes that are not repeatable. Case management solutions are designed to improve knowledge-driven work as well as improve general processes to optimize outcomes.
Some business activities that a case management solution can improve are:
- Project management
- Compliance tracking
- Vendor management
- Contract management
- HR onboarding
- Incident resolution
- Fraud investigation
What is a Case Manager?
A case manager coordinates the entire process an incident, event, request and investigation must go through to reach its objective or resolution. They are responsible for assessing, planning, implementing, evaluating and reporting on a specific case from start to finish.
The duties of a case manager include:
- Assessing the risk levels of a specific event, customer or employee before registering it as a case
- Creating a tailored plan based on the desired outcome
- Involving other business professionals and specialists in a workflow for added guidance, or connecting individuals with external service providers
- Monitoring and tracking timelines, milestones and overall status updates of a case
- Evaluating the outcome of a case and producing reports for the business
The Different Models of Case Management
There are four main case management models to consider based on your organization’s unique requirements. Each has a different focus, which can be either modified or combined to reach a specific business outcome.
In the brokerage model, case managers connect services provided by various businesses and professionals to their customers. This usually involves extending support and other resources to customers in an office-based setting.
With a brokerage model, case managers are much less involved with the people they serve on an individual level. They place less emphasis on continuous monitoring and more focus on data collection and reporting across service providers. In turn, this allows them to allocate their attention to many cases at a time.
Intensive Case Management (ICM)
An intensive case management (ICM) framework is reserved for individuals or incidents that require critical and ongoing support.
Organizations that deploy an ICM model require case managers to be consistently engaged and updated on case progress. Here, case managers must extend resources to their customers through routine evaluations, appointment follow-ups and other personalized rehabilitation services if needed.
Clinical Case Management
Clinical case management involves certified therapists or counselors assigned by clinical providers. This type of case management model is commonly reserved for organizations that offer clinical therapy, addiction recovery and crisis intervention services.
Case managers in this model work directly with their customers in an office-based atmosphere to curate specific treatment plans. Clinical case management is highly personalized and involves detailed record keeping, allowing case managers to quickly identify gaps in treatment and deliver required services with greater efficiency.
Strengths-Based Clinical Case Management
The strengths-based clinical case management model focuses on the strengths of involved individuals before developing a treatment plan. It starts by identifying their desired outcomes and personal objectives — following up with a care plan matching their unique background to a personalized route to treatment.
For case managers, this model heavily focuses on critical evaluation and reporting. The dynamic nature of a strengths-based clinical case management approach requires case managers to be supported by real-time solutions that can track a customer’s crucial documents and status updates regarding their case.
The Core Functions of Case Management
Every case management workflow consists of crucial steps to address a problem and deliver the highest standards of service. Case managers are responsible for six essential tasks as part of this process.
Every case management process starts with identifying whether the issue in question requires a higher degree of problem-solving and attention to detail. In the screening phase, case managers must determine if a case cannot be quickly resolved.
For example, if service requests require more actionable information, if customers need greater technical support or an incident requires further investigation.
In the assessment phase, case managers will start by gathering basic information about a potential customer (medical records, current financial status, etc.) or a specific incident.
In this situation, case management software is used as a single source of truth for all case managers to view and manage relevant documents in the form of personal assessments, background checks, incident reports and other collected data to move the process along.
3. Evaluating Risks
Before a solution can be proposed, an organization must understand the severity of a case. Cases can be divided into three categories; low-risk, moderate-risk or high-risk situations.
In a medical setting, patients are classified according to their risk types based on pre-existing medical conditions and the urgency of care needed. For higher education institutions, the most at-risk students are categorized based on low retention indicators or poor academic performance.
The planning stage turns collected incident reports, background information and all forms of gathered data into an actionable plan. Here, case managers are required to outline a step-by-step proposal to address desired objectives along with methods of execution.
Having an initial strategy in place helps case managers understand risks that may arise in a plan, identify the best ways to be in compliance and seek guidance from other professionals if necessary.
Case managers can move forward to the implementation and execution phase once a solid plan is finalized.
Legal departments, for example, might require case managers to launch negotiation talks, start settlement processes or continue to a trial with the parties involved in a case. HR departments could assign a specific case manager to multiple new hires at a time, ensuring that all employees have access to their training materials, business laptops, access cards and other resources to get started with a new position.
6. Following Up
How do organizations and case managers subsequently determine the efficacy of a plan? The follow-up phase monitors if all implemented solutions, services and processes can successfully resolve a problem or reach a specific business objective.
If the desired outcome cannot be achieved according to the timeline or in line with expectations, case managers are able to intervene and suggest a new course of action or work to optimize the case management strategy.
The final step of the case management process is the data collection and reporting phase. The evaluation stage considers metrics like customer satisfaction, objectives reached, overall costs, case duration, ROI for your organization and other results that can determine how well a process was carried out.
Organizations are then able to compound these detailed case records in one place and continue to make continuous improvements to case management efficiency in the future.
Why Should Case Managers Use Case Management Solutions?
Case management software allows your case managers to effectively manage customer relationships, documents and processes on a single platform. This solution streamlines claim submission, complaint management, contract collaboration and other activities that require a combination of automated workflows and manual intervention.
Case managers can improve the quality of their work and customer satisfaction through a case management solution. The right provider will:
- Increase productivity and ensure continuity with a complete view of information: Rather than having to toggle between systems or manage spreadsheets, staff remain within the same intuitive interface, logging activities, adding notes and updates, delegating tasks, and scheduling events
- Improve visibility and control: Reporting dashboards and audit trails of all activities increase transparency, support compliance and help organizations identify opportunities for improvement
- Ensure smooth handoffs and effective collaboration: Organizations can support effective collaboration by having critical information and supporting content instantly accessible to all authorized employees throughout a case
The Differences between Cloud & On-Premise Case Management Solutions
The decision to deploy a case management solution in the cloud or on-premises depends on what your organization needs.
Hosting in the cloud is becoming the go-to option for today’s businesses due to its superior security, business continuity and scalability.
However, some organizations still choose to go with on-premises deployment, especially if they have the capital, expertise and infrastructure to support it.
Organizations that choose to host in the cloud have the added advantages of:
- Solid security measures: Data is protected with multiple layers of security on top of protocols like physical security, perimeter data defense and cloud host security that protect against hackers, technology failures, disasters or misuse
- Reliable infrastructure: Reliable, available and resilient cloud infrastructure is made possible by failover exercises, replication, incident response protocols and resource utilization monitoring
- Scalable technology: A cloud case management solution evolves with your organization’s changing business needs, scaling to accommodate additional infrastructure and document storage needs. Upgrades and expansions take place as smoothly as possible with automatic updates
- Better compliance: The right cloud solution will have the requisite security and compliant infrastructure that accommodates demanding SLAs and a range of industry-specific and location-based compliance initiatives
If your organization already has the infrastructure, then it might make sense to deploy on-premises so you can avoid paying annual hosting charges, lowering the total cost of ownership.
Get Started with ISSI
With ISSI, you can use software solutions to meet your case management needs and streamline processes that require both automated workflows and manual intervention. Contact an expert today to get started.