[dria]

Originally Posted by 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.

[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.

[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.

[charna]

You couldn't be more correct. There were so many clients that I was unable to even attempt to reach. In addition to communicating with them via telephone, I also saw them face to face in our centers and performed a disease specific assessment. Because the organization was for profit, they really pushed the concept of increasing numbers, meaning, it was more important how many clients we contacted vs quality of outcome. However, when clients had a less than favorable outcome, which we often could not avoid as most of them had been on a very slippery slope at the onset of the program, we were slammed for it.
It was very unrealistic and quite stressful. I certainly tried to do my best but with the workload it became increasingly difficult to maintain the quality of work I pride myself on. I eventually left the position for managed care case management. You live and learn...

[introspectiveRN]

Hello,

I currently work as an RN, CM in hospice. My previous job was a caseload of 16-22 (pts that must be seen a min of Qweek and sometimes Qday). Current caseload is between 10-14 with pts split between home care and SNFs. Since hospice is becoming more and more open access, the opportunity to work with pts longer and earlier in the disease process is rewarding as well.

I am on this particular board because I am considering segueing into other pt populations of CM.

[Bengle49]

I am reading with interest the responses to the question about max. case loads for disease specific case managers. I am currently in an administrative position with a small IPA offering a Medicare Advantage and managed medicaid to about 15k people. I have a young disease management program for 5 common diseases. I am trying to determine if I should build in-house for my DM/CM staff or outsource all or part of my Disease management efforts.
I would enjoy any conversation with someone who can discuss the pros and cons of these options, cost for a vendor based program, case loads etc.
Please respond,
Ben