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

[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?

[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. :uhoh21: 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