This article discusses the introduction of privatized
case management in addition to case management provided by public agencies.
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
|
Related: The Differences Between Public Sector and Private Sector Employment
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.
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.
