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© 2011, Healthcare Intelligence Network — http://www.hin.com

Note: This is an authorized excerpt from 2011 Benchmarks in Healthcare Case Management: Responsibilities, Results & ROI. To download the entire report, go to http://store.hin.com/product.asp?itemid=4153 or call 888-446-3530.

2011 Benchmarks in Healthcare Case Management

Responsibilities, Results & ROI

This special report is based on results from the second annual Healthcare Case Management Benchmark Survey administered in January 2011 by the Healthcare Intelligence Network and includes excerpts from recent webinars on healthcare case management.

Contributors:Toni Cesta, PhD, RN, FAAN, senior vice president of operational efficiency and capacity management at Lutheran Medical Center in Brooklyn, New YorkRebecca Ramsay, BSN, MPH, senior manager of care support and clinical programs at CareOregon Jan Van Der Mei, RN, MS, ACM, continuum case management director at Sutter Health Sacramento Sierra Region

Executive EditorMelanie MatthewsHIN executive vice president and chief operating officer

Project EditorPatricia Donovan

Cover DesignJane Salmon

© 2011, Healthcare Intelligence Network — http://www.hin.com Page �

Table of Contents

About the Healthcare Intelligence Network ............................................................. 6

Executive Summary ................................................................................................. 6

Survey Highlights ��7

Key Findings ............................................................................................................ 7

Program Prevalence, Content and Delivery ��7

Case Management Responsibilities, Training and Performance ��8

Impact and ROI �� 8

Methodology ........................................................................................................... 9

Analysis of Responses ............................................................................................. 9

Overview of Survey ��9

Respondent Demographics ��9

Comparing 2009 and 2011 Responses ��9

Program Challenges and Barriers ��10

The Health Plan Perspective ��11

The Hospital Perspective ��12

Respondents in Their Own Words ......................................................................... 15

Key Case Manager Responsibility ��15

Successful Interventions and Partnerships ��17

Program Success Factors ��18

Key Contribution of the Case Manager ��18

Planned Program Expansions ��19

Conclusion ............................................................................................................. 21

Responses to Questions ........................................................................................ 22

Part I: Overall Survey Responses ��22

1:01: Utilizing Case Managers ��22

1:02: Adding Case Managers in the Next 12 Months ��23

1:03: Populations Targeted by Case Managers ��23

1:04: Case Manager Work Locations ��24

1:05: Participant Referral Methods ��24

1:06: Average Monthly Case Load ��25

1:07: Case Manager Duties ��25

1:08: Case Manager Communication Tools ��26

1:09: Case Manager Educational Background ��26

1:10: Evaluating Case Manager Performance ��27

1:11: Diagnosis Most Impacted by Case Management ��27

1:12: Impact of Case Management ��28

1:13: Case Management ROI ��28

1:14: Respondent Organization Type ��29

© 2011, Healthcare Intelligence Network — http://www.hin.com Page �

Part II: Responses from Health Plans ��29

1:15: Health Plans: Utilizing Case Managers ��29

1:16: Health Plans: Populations Targeted by Case Managers ��30

1:17: Health Plans - Case Manager Work Locations ��30

1:18: Health Plans - Participant Referral Methods ��31

1:19: Health Plans - Average Monthly Case Load ��31

1:20: Health Plans - Case Manager Duties ��32

1:21: Health Plans - Case Manager Communication Tools ��32

1:22: Health Plans - Case Manager Educational Background ��33

1:23: Health Plans - Evaluating Case Manager Performance ��33

1:24: Health Plans - Diagnosis Most Impacted by Case Management ��34

1:25: Health Plans - Impact of Case Management ��34

1:26: Health Plans - Case Management ROI ��35

Part III: Responses from Hospitals ��35

1:27: Hospitals - Utilizing Case Managers ��35

1:28: Hospitals - Populations Targeted by Case Managers ��36

1:29: Hospitals - Case Manager Work Locations ��36

1:30: Hospitals - Participant Referral Methods ��37

1:31: Hospitals - Average Monthly Case Load ��37

1:32: Hospitals - Case Manager Duties ��38

1:33: Hospitals - Case Manager Communication Tools ��38

1:34: Hospitals - Case Manager Educational Background ��39

1:35: Hospitals - Evaluating Case Manager Performance ��39

1:36: Hospitals - Diagnosis Most Impacted by Case Management ��40

1:37: Hospitals - Impact of Case Management ��40

1:38: Hospitals - Case Management ROI ��41

Glossary ................................................................................................................ �2

Appendix A: Healthcare Case Management Benchmark Survey Tool ..................... ��

About the Contributors ......................................................................................... �7

© 2011, Healthcare Intelligence Network — http://www.hin.com Page 5


About the Healthcare Intelligence Network

The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare� In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care�

Executive Summary

Targeted case management interventions across the health continuum are resulting in more efficient and appropriate care coordination and utilization of healthcare resources�

In its second annual Healthcare Case Management e-survey, conducted in January 2011, the Healthcare Intelligence Network captured the details of contemporary case management and the evolving responsibilities of today’s case manager� Responses provided by 201 healthcare organizations to 24 multiple choice and open-ended questions indicate that not only are more organizations utilizing case managers, but the practice of embedding case managers at the point of care is becoming de rigueur� For example, the number of case managers working in hospital admissions offices doubled from 2010 to 2011�

Additionally, the contemporary case manager’s job description is much more likely to include home visits, crisis management and quality improvement responsibilities in 2011 than it was in 2010� New this year: metrics on case managers’ health coaching duties�

2011 Survey Highlights

Ninety-one percent of responding organizations use case managers, up from 84 percent in 2010�

Care coordination and patient education continue to be the top case manager duties in 2011, closely followed by discharge planning� Health coaching by case managers — a new area explored by this year’s survey — was reported by 48 percent of respondents�

The average case manager

case load is 50-99, say 35

percent of respondents.

Page 6


By which methods do your case managers interact with patients and members?

What is the preferred educational background of a case manager?

Source: HIN Case Management SurveyJanuary, 2011

1:08: Case Manager Communication Tools

Source: HIN Case Management SurveyJanuary, 2011

1:09: Case Manager Educational Background

©2011

©2011

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Post-reform redesign of clinical care delivery and supporting reimbursement models reflects the healthcare case manager’s dual roles as care coordinator and utilization manager. Case manager work locations, job focus and caseloads are evolving in response to these shifts in the healthcare landscape. 2011 Benchmarks in Healthcare Case Management: Responsibilities, Results & ROI provides actionable information from 201 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-driven results in healthcare utilization, cost and compliance.

Includes:

Current and planned healthcare case management programs;

Populations and conditions targeted by case management efforts;

The top five responsibilities of the healthcare case manager;

Work locations and average case manager case loads;

Tools and strategies to identify patients most in need of case management;

Tactics to evaluate a case manager’s performance and program impact;

Overcoming barriers to case management; andCase management’s impact on healthcare

utilization, member/patient satisfaction and ROI.

Yes, I need benchmark data on the placement and responsibilities of case managers and the impact case management has on healthcare utilization, cost and compliance. Please reserve my copy of 2011 Benchmarks in Healthcare Case Management: Responsibilities, Results & ROI, today for $139.

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