Nick Goodwin introduces our new paper on case management, evaluating practical examples and considering how it can help establish integrated health and social care.

1. Case management
What it is and how can it be implemented?
Dr Nick Goodwin
Senior Fellow, The King’s Fund
with thanks to Shilpa Ross and Natasha Curry

2. What is it?
An approach to caring for people with long-term
conditions (LTC)
Usually nurse-led community-based programmes
Components include:
– case finding
– assessment
– care planning
– care co-ordination
– case closure

3. Why is it important?
Share of budget for people with LTCs
Co-ordinates and integrates services
Enhances the patient experience
Improves care outcomes
Reduces expensive care service utilisation

4. The benefits
Impact − ‘promising but mixed’
Works best when part of a wider programme of
care

5. Case example: Guided care
Specially trained nurses integrated into primary
care practices
Predictive modelling techniques identify at-risk
patients
Nurse undertakes assessment of patient and
carer needs and co-designs an action plan
Nurse supports case load of 50-60 patients,
provides self-management support and co-
ordinates care across agencies
Secure web-based electronic health record
supports real-time decision-making

6. Case example: Guided care 2
Positive outcomes:
– high levels of satisfaction amongst patients,
carers and professionals
– significant improvements in quality of care
– reduction in total health care costs of 11%
See: www.guidedcare.org/index.asp

7. Key factors for success
Appropriate roles and skills of the case manager
– assigned accountability
– clarity of responsibilities
– a range of skills
– relationship building
Getting the programme design right
– targeting and eligibility
– manageable caseload
– single point of access
– continuity of care
– effective use of data/IT

8. Support from the wider system
Shared vision and objectives
Close links between health and social care
Stakeholder engagement
Provision of services in the community

9. Conclusions
Potential to deliver better care for patients and
reduce costs
But, evidence shows it has not always worked
Good case managers and care teams needed in a
co-ordinated, care provision system
Must be delivered as part of a wider programme
approach