Note: This is an authorized excerpt from 2017 Healthcare Benchmarks: Case Management. To download the entire report, go to

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1 Note: This is an authorized excerpt from 2017 Healthcare Benchmarks: Case Management. To download the entire report, go to or call

2 2017 Healthcare Benchmarks: Case Management In this comprehensive analysis of Healthcare Case Management, 78 healthcare organizations weigh in on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to case management hiring and evaluation standards, via responses to a July 2017 survey by the Healthcare Intelligence Network. Advice for newly hired case managers: Don t become overwhelmed by all that needs to be learned. Strive for sure and steady progress in gaining the knowledge needed. > Hospital/Health System [My most rewarding interaction was] seeing a patient s face when I was able to successfully acquire their medications for them at no cost. It was a look of astonishment and disbelief. They were brought to tears. > Health Plan More time to resolve social issues, improve compliance and reduce ED utilization [are advantages of embedded case management]. > Hospital/Health System Case managers get better results when they are able to connect with members face to face. The connection is better between the two. > Health Plan 2017, Healthcare Intelligence Network 2

3 2017 Healthcare Benchmarks: Case Management This special report, based on results from the Healthcare Intelligence Network s industry survey on Case Management conducted in July 2017, is the latest installment in HIN S Healthcare Benchmarks series. Executive Editor Melanie Matthews HIN executive vice president and chief operating officer Project Editor Patricia Donovan Document Design Jane Salmon 2017, Healthcare Intelligence Network 3

4 Table of Contents About the Healthcare Intelligence Network... 6 Executive Summary... 6 Survey Highlights... 7 Key Findings... 7 Program Components... 7 Results and ROI...8 Most Rewarding Case Manager-Patient Interactions...8 About the Survey... 8 Respondent Demographics... 9 Using This Report... 9 Responses by Sector...10 The Hospital/Health System Perspective The Health Plan Perspective...15 Respondents in Their Own Words...16 Most Rewarding CM-Patient Interactions Improvements and Innovations from Colocated Case Management Advice for Newly Hired CMs...20 Most Effective Tools, Protocols and Workflows Most Important CM Program Component Final CM Comments...24 Conclusion...25 Responses to Questions Figure 1: All - Case Manager Utilization Figure 2: All - Future CM Utilization Figure 3: All - Targeted Populations...28 Figure 4: All - Targeted Conditions...28 Figure 5: All - Patient Identification for CM...29 Figure 6: All - Colocated Case Management...29 Figure 7: All - Future Colocated Case Management...30 Figure 8: All - Care Sites for Colocated CM...30 Figure 9: All - Top Colocated CM Challenges Figure 10: All - Top Colocated CM Benefits Figure 11: All - Typical CM Duties Figure 12: All - Top CM-Patient Interactions Figure 13: All - Average CM Caseload Figure 14: All - Preferred CM Education Level Figure 15: All - Additional CM Certifications...34 Figure 16: All - Factors in CM Performance...34 Figure 17: All - CM Impact Figure 18: All - CM ROI Figure 19: All - CM ROI from Wearables , Healthcare Intelligence Network 4

5 Figure 20: All - Organization Type Figure 21: Hospitals - Case Manager Utilization Figure 22: Hospitals - Future CM Utilization Figure 23: Hospitals - Targeted Populations Figure 24: Hospitals - Targeted Conditions Figure 25: Hospitals - Patient Identification for CM Figure 26: Hospitals - Colocated Case Management Figure 27: Hospitals - Future Colocated Case Management Figure 28: Hospitals - Care Sites for Colocated CM Figure 29: Hospitals - Top Colocated CM Challenges Figure 30: Hospitals - Top Colocated CM Benefits Figure 31: Hospitals - Typical CM Duties Figure 32: Hospitals - Top CM-Patient Interactions Figure 33: Hospitals - Average CM Caseload Figure 34: Hospitals - Preferred CM Education Level Figure 35: Hospitals - Additional CM Certifications Figure 36: Hospitals - Factors in CM Performance Figure 37: Hospitals - CM Impact Figure 38: Hospitals - CM ROI Figure 39: Hospitals - CM ROI from Wearables Figure 40: Health Plans - Case Manager Utilization Figure 41: Health Plans - Future CM Utilization Figure 42: Health Plans - Targeted Populations Figure 43: Health Plans - Targeted Conditions Figure 44: Health Plans - Patient Identification for CM Figure 45: Health Plans - Colocated Case Management Figure 46: Health Plans - Future Colocated Case Management Figure 47: Health Plans - Care Sites for Colocated CM Figure 48: Health Plans - Top Colocated CM Challenges Figure 49: Health Plans - Top Colocated CM Benefits Figure 50: Health Plans - Typical CM Duties Figure 51: Health Plans - Top CM-Patient Interactions Figure 52: Health Plans - Average CM Caseload Figure 53: Health Plans - Preferred CM Education Level Figure 54: Health Plans - Additional CM Certifications Figure 55: Health Plans - Factors in CM Performance Figure 56: Health Plans - CM Impact Figure 57: Health Plans - CM ROI Figure 58: Health Plans - CM ROI from Wearables Appendix A: 2017 Healthcare Case Management Survey Tool , Healthcare Intelligence Network 5

6 Healthcare Intelligence Network Benchmark Members Received This Report for FREE! Sign up today for $695 for a year of Healthcare Benchmark Data Fax Form to: Learn more about why you should become a HIN Benchmark Series Member, scan with your smart phone QR reader to view HIN s Benchmark Series Membership Infographic. Thank You For Your Order! Five easy ways to order: 1. Online: 2. Phone: Fax: info@hin.com Tax ID No Mail to: Healthcare Intelligence Network PO Box 1442, Wall, NJ TT Check Enclosed - payable to Healthcare Intelligence Network in U.S. dollars - NJ residents, please add 6.875% sales tax Name & Title Company Address City State Phone The Healthcare Intelligence Network s Healthcare Benchmarking Series provides continuous qualitative data on industry trends to empower healthcare companies to assess strengths, weaknesses and opportunities to improve by comparing organizational performance to reported metrics. As a HIN Benchmarks Member you will have access to ALL of our benchmark reports published during your membership year. Sign up today for just $695 per year, a savings of over $500. You ll get: Feedback from 1,000 respondents annually; Thousands of sector-specific data points, sorted by hospital, health plan and provider; Year-over-year data analysis; 8 to 10 trending topics annually; Upcoming topics include: Healthcare Case Management; Patient Engagement; and Other key topics of interest to healthcare executives. As a subscriber, you will also have direct access to: TT Auto-delivery of new benchmarks to your box; Preview copy of the latest executive summaries - even before respondents; e-newsletters of your choice; Healthcare infographics; White papers and case studies; Educational videos; e-books; and Healthcare podcasts. Yes, I need actionable healthcare metrics on the industry s top trends. Please sign me up for HIN s Benchmark Series Membership, today for $695. Zip Fax Charge my Visa MC AMX Account No. Exp. Date Signature Security Code IPF

7 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 94% of 2017 survey respondents currently use healthcare case managers. With each year, a larger swath of the healthcare industry comes to rely upon the skills of healthcare case managers to influence clinical, quality and financial outcomes. According to the 2017 Case Management Survey by the Healthcare Intelligence Network, the percentage of healthcare organizations enlisting case managers in care management rose from 88 percent in 2013 to 94 percent in Further, patients are much more likely to encounter a case manager in a provider s office this year than they might have been four years ago. Two-thirds of 2017 respondents embed or colocate case managers alongside care teams today, versus 54 percent in However, this jump in embedded case management has created more concern about integrating case managers into the care team; 28 percent of this year s respondents reported integration as a CM challenge, versus 15 percent in Healthcare case managers in 2017 have larger workloads, managing monthly averages of 50 to 99 cases, according to 41 percent. In 2013, only 28 percent of case managers carried a workload of that size; juggling up to 49 cases was more the norm, said 31 percent at that time. What hasn t changed in four years is return on investment from case management, with ROI holding steady between 2:1 and 3:1 for 18 percent of respondents in 2017 and back in Case management rewards frequently exceed the financial, the survey found. Helping individuals identify and attain their health goals counts as one of the most fulfilling events in a case manager s career, according to 2017 respondents. Seeing a patient s face when I was able to successfully acquire their medications for them at no cost was one notable highlight, shared one. It was a look of astonishment and disbelief. They were brought to tears. Every case needs to be independently addressed. There is no formula for success. 2017, Healthcare Intelligence Network 6

8 Respondent Demographics Responses to the July 2017 survey on Case Management were submitted by 78 organizations. Of 53 respondents identifying their organization type, 34 percent were hospitals or health systems, 15 percent were health plans, 8 percent were physician-hospital organizations (PHOs), 8 percent were home health, and 17 percent categorized their organization type as Other. Using This Report This benchmarking report is intended as a resource for healthcare organizations searching for comparable data and means to measure implementation and progress. It is also a helpful planning tool for organizations readying initiatives in this area. 85% target case management interventions at populations with multiple chronic morbidities. The initial charts and graphs presented here represent results from all respondents; images in subsequent sections depict data from high-responding sectors. (Figure titles include the segment they represent: for example, All, Health Plans, Hospitals, etc.) Often, one of the largest responding sectors is composed of respondents identifying their organization type as Other. In general, we do not depict results from this segment because it represents a wide range of organization types, including consultants and product vendors. However, you will always find a graph indicating the demographics of respondents. Here are some additional tips for using this report: 99 See how you measure up: Scan this report for your sector, and see how your program compares to others. Note where you lead and where you lag. 99 Evaluate your efforts: Think about where you have been focusing your efforts in this area. Look for trends in the data in this report. Look for benchmarks set by your sector and others. 99 Set new goals: Use the data in this report to set new goals for your organization, or to raise the bar on existing efforts. 99 Use it as a reference book: Keep this report accessible so you can refer to it in your work. Use these data to support your efforts in this area. If you have questions about the data in this report, or have feedback for our team, don t hesitate to contact us at info@hin.com or Advice for new CM hires: Develop a trust bond, almost as a family member, and your medicalfocused concerns will be that much easier to handle. 2017, Healthcare Intelligence Network 9

9 Figure 7: All - Future Colocated Case Management Will you embed or co-locate case managers in the next 12 months? 38.10% Yes No 61.90% 2017 HIN Case Management Survey July, 2017 Figure 8: All - Care Sites for Colocated CM At which care sites are case managers embedded or colocated? Hospital ER Primary care 47.50% 47.50% Hospital admissions 30.00% Hybrid Community clinic SNF/LTC Other Employer site 22.50% 20.00% 17.50% 12.50% 7.50% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 2017 HIN Case Management Survey July, , Healthcare Intelligence Network 30

10 Healthcare Intelligence Network Benchmark Members Received This Report for FREE! Sign up today for $695 for a year of Healthcare Benchmark Data Fax Form to: Learn more about why you should become a HIN Benchmark Series Member, scan with your smart phone QR reader to view HIN s Benchmark Series Membership Infographic. Thank You For Your Order! Five easy ways to order: 1. Online: 2. Phone: Fax: info@hin.com Tax ID No Mail to: Healthcare Intelligence Network PO Box 1442, Wall, NJ TT Check Enclosed - payable to Healthcare Intelligence Network in U.S. dollars - NJ residents, please add 6.875% sales tax Name & Title Company Address City State Phone The Healthcare Intelligence Network s Healthcare Benchmarking Series provides continuous qualitative data on industry trends to empower healthcare companies to assess strengths, weaknesses and opportunities to improve by comparing organizational performance to reported metrics. As a HIN Benchmarks Member you will have access to ALL of our benchmark reports published during your membership year. Sign up today for just $695 per year, a savings of over $500. You ll get: Feedback from 1,000 respondents annually; Thousands of sector-specific data points, sorted by hospital, health plan and provider; Year-over-year data analysis; 8 to 10 trending topics annually; Upcoming topics include: Patient Engagement; Community Health Partnerships; and Other key topics of interest to healthcare executives. As a subscriber, you will also have direct access to: TT Auto-delivery of new benchmarks to your box; Preview copy of the latest executive summaries - even before respondents; e-newsletters of your choice; Healthcare infographics; White papers and case studies; Educational videos; e-books; and Healthcare podcasts. Yes, I need actionable healthcare metrics on the industry s top trends. Please sign me up for HIN s Benchmark Series Membership, today for $695. Zip Fax Charge my Visa MC AMX Account No. Exp. Date Signature Security Code IPF