Case management is a coordinated effort between community-based, often nonprofit, organizations that work to provide quality healthcare solutions that are customized to a client’s specific and individual needs. This healthcare approach is designed to be customized to the client to best address unique needs on the client’s timeline.
In addition to traditional health services, successful 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 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.
Now let’s elaborate one by one on the four stages 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 to create an accurate picture of the client’s current situation and present problem . 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.
Common Issues With Intake
One of the common difficulties with intake is getting enough of the right amount of information to understand how to move forward with a needs assessment. No two clients are the same, and one with a history of a mental health disorder will need different intake questions than one with substance abuse issues.
Case management software allows for customized intake forms, so a case manager can create different questions based on the problems understood about the client even before intake. This also allows for all this information to be stored online for easy reference for the next stage of the case management process.
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. Here, the case manager assesses all of the information at their disposal and develops an understanding with the client about their needs and goals and what the road may look like to achieve them. Here are some case management steps 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 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 the most.
Common Issues With Needs Assessment
Data-driven decisions are a key factor in a needs assessment, yet the information needed may not be readily available. Case management software keeps all the analytics from each client in one place. This allows case managers to look to real-time data to see how needs assessments were handled in the past and which services led to success for various needs.
Level Three: Service Planning
In level three, very specific tasks and objectives are identified that will help the client move toward their goal. A case management service 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 an effective case management 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.
Common Issues With Service Planning
Communication is key with service planning, and clients must be properly informed of case management services scheduled and expected goals within their case. A client portal in case management software simplifies service planning by allowing for streamlined communication between non-profits and clients. Services can be scheduled directly in the system, and clients can choose the times to meet with their case managers that are most convenient for them.
Level Four: Monitoring and Evaluating
The fourth level of case management is to evaluate the efficacy of the plan, monitor milestones , and 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 needed 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 receives. 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 to use the metrics established in level three.
Common Issues With Monitoring and Evaluating
It’s not simply enough to set up the services, case managers need solutions to easily track how services are going and restructure goals as needed. Case management software includes customizable case boards with columns covering each goal area. This makes it easy for case managers to make changes, check the status of a service, and see the overall picture of client case management.
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.
Case management software simplifies the four-step process discussed, giving case managers more time to spend focusing on their clients. PlanStreet’s case management software guides case managers through every step of the process in the case management lifecycle, with
- Customizable intake forms to streamline data collection.
- Improved needs assessment tools, including power BI analytics to better understand what has worked for clients in the past.
- Comprehensive service planning with a shared calendar with clients and direct messaging to communicate easily.
- Robust monitoring and evaluation, with case boards to view the whole picture of a case and an easy system to enroll for programs and track client attendance.
PlanStreet automates workflows and processes, integrating data with existing systems with customizable dashboards so the information the case manager needs is readily available. Skip the time-consuming paperwork and book a demo to learn how PlanStreet’s case management software can be tailored to meet your organization’s needs.
Four Levels to Case Management Success
These four levels, 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