Launching the Case Load Capacity Calculator

by Pat Stricker, RN, MEd
Senior Vice President, Clinical Services
TCS Healthcare Technologies

Last month, CMSA launched a new tool for case managers – the Case Load Capacity Calculator (CLCC)! For many of us, this represents an exciting opportunity to begin laying the foundation for evidence-based case loads for a variety of clinical settings.

For years, case management programs have struggled with trying to determine realistic case loads. We often hear -- "What is an average case load?" Sounds simple, right? People are looking for "a number" that defines the average case load. But in reality, there isn’t a magic number and the question is very difficult to answer without evaluating all the variables that affect the "average" case load. A few examples include: business and/or regulatory environment; type of program; services offered; practice setting; skill level and experience of the case manager; availability of "CM extenders;" additional responsibilities of CMs that take them away from working directly with the patient; paper vs. computerized processes; etc. The addition of integrated care management interventions and complex condition management programs only add to the dynamic nature of determining what the "right" case load is in any given situation.

Due to these challenges, a special workgroup was formed in 2007 to study the case load issue nationally and to identify potential solutions, or at least determine the next steps in finding a solution. This effort was sponsored by CMSA and the National Association of Social Workers (NASW). A review of existing peer-reviewed articles on case loads found that average case loads per CM ranged from 2 to 365! Obviously, there was no empirical approach to calculating case loads. After 18 months of study and meetings, the workgroup published a white paper that highlighted the reasons for significant variations in case loads from one program to the next. Click here to view the white paper – "Case Management Case Load Concept Paper: Proceedings of the Work Group."

The workgroup analysis gave us a better understanding of what the problems and challenges are and provided us with a matrix of independent variables that can impact case loads. CMSA has continued to lead efforts to further study this issue by holding town hall meetings, convening focus groups, sponsoring public comment periods, and conducting several surveys. Their ultimate goal – to improve patient care and improve case manager job performance and satisfaction by establishing a more empirical basis for determining appropriate case loads.

CMSA is now taking the next step in meeting this goal by supporting the development of a cloud-based software application that can begin to collect information on how case loads should be established. This initiative is being supported through the sponsorship of Consulting Management Innovators (CMI) and several dozen volunteers.

The Case Load Capacity Calculator is available free of charge to all case managers through December 31, 2011. Think of this new online tool as an information-exchange platform that allows case managers to track their case loads and see how they compare to their peers in similar settings and conditions.

Starting in 2012, the tool will remain free only to CMSA and NASW members. This initail version of the CLCC is designed for health plan and inpatient acute settings. As additional data are collected, CMSA and CMI hope to expand the scope of the clinical and program features for the future.

This initiative is a prime example of how information technology can aid in the day-to-day practice of case managers. It will be exciting to see how a new knowledge-base of case load levels will be documented through the CLCC. This information should promote a discussion among case management professionals as to what constitutes a ‘best practice’ for staffing levels in a given situation and help us develop new evidenced-based criteria that all case managers, along with their patients, can benefit from.

CMI and CMSA have given us a great start by providing this tool and I think we can define an "average" case load if we all work together! So I encourage all of you to try the tool. Inputting your data will help you see how the various factors affect your case load, as well as help contribute to the overall empirical data that is needed to determine the appropriate "average" case load.

To try out the calculator, visit http://clcc.cm-innovators.com. And stay tuned – this isn’t over yet. It is going to be an exciting ride!

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