Q&A: Case management department reporting structures
Q: Who should the case management department report to?
A: Plocher and Metzger (2001) correctly state that “[t]here is no single structure that works universally for all case management programs. However, there are some basic premises to be considered during the decision-making process:
- To promote an enterprise-wide approach to care [case] management, an organizational integration of care functions is optimal
- To set strategy, accelerate decision-making, and minimize duplication, a centralized reporting structure is optimal
- To establish the accountability and responsibility for achieving results, a centralized reporting structure is optimal
- To achieve the centralized reporting structure, select personnel and resources may need to be reallocated and/or realigned
- Case management touches all levels in the organization; accordingly, the relationships and communication lines are linked from people to results
- Physician alignment with case management and organizational goals is critical, and the structure must reflect reporting lines in which the physicians feel that their interests are protected ... When the structure aligns the case management function more closely to physician leaders in the organization, and to administration, the readiness of physicians to embrace the concept of case management increases incrementally
- To realize cost savings and service improvement objectives, operations executives will need to be linked to case management in order to address capacity management, financial management, and quality improvement issues.”
Directors of case management services generally report to people in one of the positions on the executive team.
At times of huge political upheaval in the hospital, or a looming financial deadline or Centers for Medicare & Medicaid Services (CMS) investigation, the CEO may decide that case management temporarily reports to him or her.
Reference: Plocher, D., and Metzger, P. (2001). The Case Manager’s Training Manual. Gaithersburg, MD: Aspen Publishers.
Editor's note: For more information, see Case Management Models: Best Practices for Health Systems and ACOs. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.