May 23, 2017

Private Case Management vs. Public Case Management Services


This article discusses the introduction of privatized case management in addition to case management provided by public agencies.


For years people with mental health and intellectual disabilities have relied on public agencies and community services boards to provide case management services. However, there has been a push in many states to privatize case management services. This push is largely due to a significant increase in state regulations and requirements of case managers. Consumer choice has also played a part in the move toward private case management services.

In the last 10-12 years case management has changed significantly. Times have changed from hand-written notes and reports from decades ago. The introduction of electronic health records and mobile technology has allowed case management to be more productive. However, the increase in the use of technology has also lead to increased responsibilities. The expectations have increased tremendously and case managers are now expected to have more detailed reports and assessments. Each year there seems to be a new requirement or a new report that just adds to the workload that is already overwhelming.

The increase in responsibilities has made it more difficult to manage large caseloads. A full time case manager can have a caseload that can range anywhere from 25 cases to up to 60 cases in some situations. Large caseloads often bring up concerns about the quality of services. A caseload of 40-50 makes it extremely difficult to complete basic activities such as monthly phone contacts, site/home visits, completing progress notes, completing quarterly reports, and updating treatment plans.

In an effort to improve the overall quality of services, privatized case management has been considered as an option in addition to the case management services provided by the local city or county. In some cases, contracting services out to private companies are more cost effective and can give families the opportunity to receive services faster. Some private agencies feel that they can provide case management services that are equal to or better than public agencies.

More private companies have become interested in providing case management services along with the traditional services such as residential services and day support services. The main reason private agencies have become interested is because of the revenue that case management generates. In Virginia, Medicaid reimburses agencies $326.50 per month (per client) for case management services. These reimbursement rates can create millions of dollars in annual revenue.


Gross Income Potential From Just One Case Manager (Sample)
Current Monthly Rate in VA
Average Caseload
Monthly Gross Income
Annual Gross Income
$326.50
25
$8,162.50
$97,950






Total Gross Income Potential (Sample)
Number of Case Managers
Total Number of Cases Based on a Caseload of 25
Monthly Gross Income
Annual Gross Income
25
625
$204,062.50
$2,448,750





Private Case Management

Advantages
1. More Consumer Choice- The privatization of case management services will create more agencies available to provide services. The consumer can choose to remain with the public agency or a number of private agencies.
2. More Efficient Services- Public agencies often require several levels of authorization for even simple requests. This is primarily due to the use of taxpayer money. Department managers need to ensure that all expenditures are documented and determined to be appropriate for the situation.
3. Limited Wait Times- Private case management decreases the dependency on public agencies to provide services. More agencies available to provide case management should reduce waiting times for services.
4. Smaller Caseloads- Private providers have more control over case load size. Private agencies have the option to turn down case referrals which can keep caseloads at a more manageable level. Public agencies typically do not turn down referrals as long as they meet the criteria for services.

Disadvantages
1. Less Regulation- The creation of more case management agencies will be more difficult to regulate. There are approximately 40 Community Services Boards in Virginia. Private case management could create over 100 agencies trying to provide case management services.
2. Decrease in Quality- New agencies and agencies providing a new service will naturally have a learning curve. The level of service quality will likely be lower than a public agency in the beginning stages. Private agencies will need more training and oversight in order to understand a new set of state regulations. Many private agencies don’t have a full understanding of case management. They may see case managers visiting their clients at the group home or day support program but have limited knowledge of all the coordination and work that goes on behind the scenes.
3. Adjustment Period- New case management providers will require more oversight from state regulatory agencies. More staff at the state level will be needed to accommodate the
4. Focus on Profit- Private agencies are more focused on profit will not likely serve people who don’t have Medicaid. People without Medicaid will probably have to use the public agency, which limits consumer choice. Private agencies are less likely to accept people on a sliding scale if there is a client with Medicaid that they can charge the full fee.

Public Case Management

Advantages
1. Experience- Case managers at a public agency will initially have more experience and more knowledge of regulations than a private agency. As I mentioned earlier, the learning curve may limit the quality of services until they become more comfortable providing the new service.
2. Additional Resources- Public agencies have additional resources to help families in need. Individuals sometimes need more than just case management services. Public case management agencies have additional resources allocated by city government to assist with other services such as utility/rent payment, food, and emergency services not covered by Medicaid. Private agencies are not in the business of giving money away.
3. Less Dependent on Profit- Public agencies are less dependent on profit due to support from taxpayer dollars. City council or another governing body allocates annual funds to the local department of human services to assist with programs for the disabled. Private agencies do not have this luxury and will likely be reluctant to serve clients who cannot generate money from insurance. Public agencies can afford to provide services regardless of ability to pay.
Disadvantages
1. Longer Wait Times- Wait times for services may be longer if the local public agencies are the only providers of case management services. Staff turnover also contributes to longer wait times.
2. Longer Processing Times- Public agencies often have to take longer to process simple requests. Public agencies are careful to be good stewards of tax payer dollars. This sometimes means going through a lengthy chain of command to complete funding requests.
3. Limited Consumer Choice- Consumers have no choice but to choose the public agency in some states. There is no other choice even when they are dissatisfied with the services. They have the option to choose another public agency in another city but there is no other private vendor for case management services.
  
In summary, the inclusion of private case management will open up more choices for services. Private case management will create more competition and eliminate the monopoly that many public agencies enjoy. However, some caution should be taken if the private agency is the choice for services. I would recommend doing as much research as possible on the private agencies. There are some good private providers that can perhaps provide services just as well as a public agency. There will also be some private agencies that will offer this service simply as a revenue source. It’s been my experience that when money is the number one driving force in providing human services, quality is often pushed to the side.

Related: The Differences Between Public Sector and Private Sector Employment

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