what is the max case load for disease specific case managers.

  1. Without putting you to sleep...can you give me an idea for TOTAL patient load per month or year for the following situation:

    -disease specific case manager
    -high complexity/acuity (cancer patients on active therapy or hospice)
    -need to provide monthly reports including patient status, medical update, cost savings, education,
    -every patient requires monthly reports
    -we are in constant communication with pt -educating, sx management
    -you have to get claims or other UR/payment/charge info from TPA (no access to system)

    50 active patients with this above (abridged version of what we do)..seems like more than enough (in fact it is a difficult load at 50)...what are your thoughts?
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  2. 15 Comments

  3. by   tgb1966
    Wow, 50 is a lot. I carry between 40 and 45, although during our busiest times I have had as many as 52. The only upside is that some of mine were quarterly reports. There is a great article in Lippincotts Case management journal about quantifying case management workloads. It is the Nov/Dec 2006 issue. The title is "Quantifying CAse Management Workloads: Development of the PACE Tool," by Amy Balstad and Pam Springer. I hope that this helps! You can find it on www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=680743

    Good Luck!

    Tamara

    Quote from sassy3
    Without putting you to sleep...can you give me an idea for TOTAL patient load per month or year for the following situation:

    -disease specific case manager
    -high complexity/acuity (cancer patients on active therapy or hospice)
    -need to provide monthly reports including patient status, medical update, cost savings, education,
    -every patient requires monthly reports
    -we are in constant communication with pt -educating, sx management
    -you have to get claims or other UR/payment/charge info from TPA (no access to system)

    50 active patients with this above (abridged version of what we do)..seems like more than enough (in fact it is a difficult load at 50)...what are your thoughts?
  4. by   sassy3
    Thank you Tamara for your reply. I thought 50 patients plus about 10 patients that are on quarterly reports was a big load. I was just curious if that was high, low or average. I work with seasoned CM/DM and some of us are new to this area and we all feel it's high. Just nice to hear from someone else. THanks for taking the time to respond....i will def. check out the article!
  5. by   Renaylor
    I work at a Long Term Care facility were there are approximately 800 residents and about 125-150 have managed care policies, the rest are Medicare/Medicaid. Of those 125-150 I actively follow 30-40/wk which vary from month to month-sometimes more,sometimes less(and about 10-15 residents are monthly(Guildnet) spread out over different days during the month.
  6. by   wincha
    I work disease management and we are supposed to have 350 in our caseload however many of these I have never contacted and it will be quite awhile before I will be able to. I think I talk to around 50 a week max and I make around 3-5 calls per person every 2-4 weeks.
  7. by   Mijourney
    I'm a case manager doing disease management and we have anywhere from 30-50 patients. I wonder if some of us who are doing disease management are disease managers that don't have dedicated cases? How does that work as far as disease management vs. case management?
  8. by   wincha
    I talk to my members usually 3-5 times and close the case however if they have any issues they can call me back and I will open the case. Some of us have case management certification and do some case management but our focus is disease management.
  9. by   wincha
    Quote from sassy3
    Without putting you to sleep...can you give me an idea for TOTAL patient load per month or year for the following situation:

    -disease specific case manager-YES I DO SPECIFIC DISEASE MANAGEMENT
    -high complexity/acuity (cancer patients on active therapy or hospice)-NO I REFER THEM TO OTHER CASE MANAGERS WHO SPECIALIZE IN THESE AREAS HOWEVER I WILL FOLLOW THEM AFTER DISCHARGE IF THEY ARE ONE OF MY CASES
    -need to provide monthly reports including patient status, medical update, cost savings, education, -I PROVIDE REPORTS EVERY TIME I TALK TO SOMEONE WHICH INCLUDE COST SAVINGS AND EDUCATION, MORE OF A SPREADSHEET TO FILL IN
    -every patient requires monthly reports- NO ONLY A SPREADSHEET AFTER I TALK TO SOMEONE
    -we are in constant communication with pt -educating, sx management- 3-5 CALLS THEN CASE IS CLOSED, CAN BE REOPENED
    -you have to get claims or other UR/payment/charge info from TPA (no access to system)-I DON'T HANDLE CLAIMS OR CHARGES-I REFER THEM FOR THIS

    50 active patients with this above (abridged version of what we do)..seems like more than enough (in fact it is a difficult load at 50)...what are your thoughts?
    I do specific case management and am educating and providing cost savings. How many disease managers focus on metrics and ROI?
  10. by   kTIE
    As a hospital base case manager, I have had anywhere from 14-28 patients case load.
  11. by   Katie82
    It has been my experience that 50 is the magic number, although many case managers carry more. I always had a difficult time closing cases. Once you develop a rapport with patients, many tend to cling, long after their acute needs have been met. Do you have a good data tool? That can mean the difference between calm and frenzy when reporting. I have a good program that, after a little tweaking to make it serve my needs, pretty much writes my reports for me.
  12. by   dria
    Quote from wincha
    i do specific case management and am educating and providing cost savings. how many disease managers focus on metrics and roi?

    a self-employed one who wants to keep working?

    seems odd to me too....would think that this could be handled more cost effectively with non-clinical staff.
  13. by   charna
    Hi all,
    I worked in disease management and my caseloads were much higher. I've had caseloads that fluctuated between 700 - 1000 and even went higher at certain points. Is this a lot? OMG it is most certainly a lot and there was no way that I could possibly touch base with all clients. The company I worked for was just a bit too ambitious.

    The diseases that I worked with were diabetes, CHF, and depression. If the clients are stratified and classified correctly you can handle higher caseloads but nothing like the amount that i was given. I assume the caseload is also determined by the number of clients your organization has in ratio to the amount of nurses they employ. The nursing shortage results in us having to carry a much higher workload.

    The frequency that we touch based with the clients was determined by their level of stability. For example, let's say client A is a type II diabetic and has a HgbA1c of 6.5 or lower, her BP has been consistently stable at or below 120/70 and she is compliant with her med regimen and MD appts. This is a client that would be considered low priority and we would probably reach out to her once every 2-3 months.

    However, let's see client B is a type II diabetic with a HgbA1c of 10.5%, and uncontrolled BP. This is someone that we would probably reach out to a couple of times of week to provide ongoing education, monitor their glucose and BP and ensure that they're taking their meds as prescribed.

    I found disease management to be exciting. I appreciated the autonomy it allowed me. You really have to be able to think out of the box. Another aspect of I liked was how you were able to realize the results of your actions almost immediately. It gave a wonderful sense of satisfaction to assist a client and prevent them from requiring hospitalization.
  14. by   wincha
    700-1000 is IMPOSSIBLE! I work with high intensity members whose a1c's should be above normal thats why they are in our workload. For a member who needs to be called back at least monthly or sooner the max that you can handle would be around 200 members while spending 15-20 minutes on each call. You must have a very limited amount of time you spend with these folks or you never even talk to them.

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