Decoding the What, Why, and How of the Case Management Process for Effective and Efficient Case Management

Business processes are usually carried out as per preset rules and conditions. Bringing flexibility into such workflows can be challenging. Making decisions on a case-to-case basis requires a case management solution that is flexible and scalable. In situations where the steps needed to complete a process require flexibility, case management comes into play. This blog explores the case management process in great detail and also compares case management with workflow automation. 

Understanding Case Management

Before getting into case management, let us first understand what qualifies as a case. Any event or problem or incident that occurs once may be termed as a case. The type of the case depends on the product or service provided by the organization. The following are examples of a case in an organization –

• Support tickets
• Customer complaints
• Customer onboarding
• Fraudulent incidents

Case management may be considered as one of the ways to build a process. Case management is made up of a series of steps that resolve a case. The case management process is used by organizations to turn a complex problem into a manageable workflow.

A case management process uses replicable workflows to simplify a complex process. Case management software is used for creating, implementing, and evaluating case management workflows. A case management workflow provides specific instructions on how a case will proceed from start to finish.

In the absence of an established case management system workflow, organizations are bound to struggle with resolving and tracking cases in a process, achieving predictable outcomes, making costly errors, and experiencing high operational costs. Gathering, organizing, and storing data are crucial steps in the case management process.

Another way of defining the case management process would be coordinating steps, services, and tools for handling an individual’s situation (case). The primary industries that require a case management process are healthcare, social services, law, and insurance.

Unlike business process management (BPM) which focuses specifically on workflows and repeatable processes, case management is a more holistic approach towards managing work and processes that are not repetitive. The primary focus of case management workflows is to improve knowledge-driven work and to improve general processes for optimized outcomes.

However, not all business activities can be improved with a case management workflow system. The following list of business activities can benefit from implementing a case management solution –

• Project management
• Compliance tracking
• HR onboarding
• contract management
• Incident Resolution
• Fraud investigation
• Contract Management
• Process tickets
• Bug tracking
• Screening candidates
• Claims processing

A case manager plays a crucial role in the case management process by coordinating the entire process an incident, event, request, or investigation must go through to reach its objective or resolution. The manager is tasked with the assessment, planning, implementation, evaluation, and reporting of the specific case from beginning to end.

Here is what a case manager is required to do –

1. Assess the risk levels of a specific event, customer, or employee before registering it as a case
2. Creating a custom plan based on the desired outcome
3. Involve other business professionals in the workflow for added guidance and connecting specific individuals with external service providers
4. Monitoring and tracking process timelines, milestones, and overall status of a case
5. Evaluating the outcome of a case and producing reports for the business

A comprehensive case management workflow provides a holistic view of a case from start to finish. Businesses run the risk of forgotten or unsolved issues when they do not have a case management process in place.

Features of Case Management System

The features of a case management system vary across industries and depend on the type of products and services being delivered. General features that a case management system must include are –

1. Information gathering and management

A case management system must help the organization gather complete information on the case in discussion. Not just gathering information, but the system must extract important information from the gathered data, and organize it in a centralized database. Easy access to important case information helps in effective assessment of risk, and in designing and implementing a plan to improve the process.

2. Decision making

Information should be easily accessible so that key decision-makers can make simple and consistent decisions based on the established criteria. The decision-making process can be fully automated or can help humans in making the right data-driven decisions.

3. Shared interface

Information on the case must be accessible to key stakeholders via a user-friendly dashboard. A shared interface facilitates the sharing of information both within the organization and with relevant third parties and customers.

4. Retain compliance information

A case management system must provide a way to track case history and retain copies of notes, communications, and important documentation. The system must also help create an audit trail to increase compliance and provide easy and transparent follow-up opportunities.

How Automated Case Management Works?

Case management tools focus on providing users with all the information required to arrive at quick, and informed decisions. The dynamic nature of a case management workflow allows you to stay updated on task statuses, checklists, and processes. Not just that, it also provides the flexibility to navigate through each casework differently each time.

Case management allows you to dive into your business process and the sequence in which tasks are completed. Take the HR Onboarding process for example, there are many mandatory tasks and processes involved in employee onboarding. Case management solution allows you to manage the tasks and checklists associated with setting up the workplace, IT access, and accounts to other systems like Benefits and Payroll. Case management allows for centralization of information collected and managed from disparate systems, for better management of processes.

A case management solution can create an employee folder that allows you to manage their records electronically. Automating the employee onboarding process enables HR to send employment documents to the new employee before their first day of work. This way they can focus on making the right first impressions of the company, rather than signing paperwork. Adding things like annual reviews and acknowledgment of policies and procedures could be added to the employee folder.

7 Steps to Effective Case Management

The case management process is made up of 7 phases in all. The 7 steps of case management are not linear and are not meant to provide a comprehensive approach to the process from start to finish. Such an approach provides flexibility, allowing a case manager to return to earlier phases as needed. Let us look at the case management steps –

1. Screening

This is the first phase in the case management process that is designed to eliminate those cases that do not require immediate resolution or do not require resolution at all. The case management process is used to solve complex issues at scale. By weeding out issues that do not warrant further action, it saves the organization precious resources by boosting efficiency.

Screening cases does not imply that issues are disregarded or that the organization has poor customer service practices. This phase is more about an organization’s timely response to each individual’s request for assistance, informing them about the process and the decisions they make, and advising them of the alternative available options.

2. Assessing

The assessment phase is similar to the screening phase in which a case manager reviews the information provided. The purpose of assessing is to thoroughly understand the issue to come up with a solution, and not to determine whether the problem is eligible for the case management process.

The case manager gathers additional information by interviewing the customers or employees. When case managers interact with customers, it makes them feel appreciated and is an important part of the case management process. To gather relevant information, managers must craft questionnaires and use them as guides.

3. Determining the risk

In this phase, case managers are tasked with determining the case’s risks and prioritizing their resolution with other cases. While determining the risk, a measure of some measure of prespecified risk is assigned to each risk factor. The overall efficiency of the case management process depends on an accurate assessment of the risks.

Prioritizing risks allows organizations to allocate resources to solving the most pressing issues. Consider this scenario – the fraud department at a bank receives a ticket from a customer disputing a small charge on his credit card, and simultaneously, an unauthorized wire transfer that wipes out another customer’s savings accounts it also received. The second ticket takes priority. Once the case manager gets a grasp of the risks of each case, he/she can begin planning a case management solution.

4. Planning

The case manager clarifies goals and objectives and identifies actions necessary to achieve them in the planning phase. Breaking broad goals into smaller steps makes it easy to achieve them. The goals must be achievable and specific. The case manager must choose the resources for achieving the objectives. Having established workflows that are readily accessible and easy to follow helps case managers choose the correct course of action.

Workflows ensure consistency across cases and the organization as a whole. It must be borne in mind that the planning phase will not always yield possible or practical solutions. A case management workflow diagram gives case managers a clearer idea of case workflows. Whenever case managers face roadblocks in identifying and setting objectives, it is important to return to prior phases for gathering additional information.

5. Implementing

At the implementation phase of the case management process, the case manager is required to execute the plan he or she created in the planning phase. For example, a customer files a support ticket for a technical issue with some piece of hardware like a laptop or television. Implementing the case management plan involves contacting and scheduling an appointment with a technician in the field, or arranging return shipping of the defective item.

The implementation phase of the case management process presents an invaluable opportunity to gather data. It is important to take notes during the implementation process so that the information can be used to improve the handling of future cases and improve the efficiency of the case management system.

6. Following-up

The effectiveness of the implemented solution requires a follow-up by the case manager. In the follow-up phase, the case manager needs to gather feedback from the customer on whether the resolution was carried out as per their expectations.

In the example discussed above, the case manager may follow up with the customer after the technician’s visit to determine if he/she repaired it successfully. The outcome of the follow-up could be one of these 2 situations – the issue was fully resolved as per the plan or the issue was not fully resolved and requires further action. The latter outcome requires the manager to revisit the plan and come up with a new plan of action. Once the new plan is implemented, the manager must again follow up to determine if the case is resolved.

7. Evaluating

This is the last phase of the case management process which involves gathering data and feedback by the case manager. The data that should be gathered must include results, costs, and duration of the case. The organization utilizes the information for generating reports and evaluating the case management process from both ROI and cost perspectives.

These reports help in making necessary improvements to improve efficiency. The detailed records of methods and successful resolutions help the organization look at what worked and what did not. Stakeholders are required to collaborate on alternative solutions that can be implemented in future cases.

Benefits of Case Management

The case management process offers a wide range of benefits at the organizational level. One of the most important benefits of implementing a case management solution is the ability to make complex issues manageable by implementing efficient workflows. When you have established workflows in place, case managers and other stakeholders can devise and implement effective plans consistently. Some of the other benefits of the case management process are –

1. Faster resolution of cases

Case management solutions streamline the handling of an organization’s cases. Team members can use one solution to communicate, track, and improve cases. A streamlined process increases the efficiency of the process and employee productivity.

2. Accurate record keeping

Case management solutions help organizations retain all case-relevant information in one easy-to-access database. Solutions with advanced document management features simplify the gathering, extraction, categorization, and storage of important data.

3. Seamless collaboration

Communication while handling cases is streamlined with a case management process that allows stakeholders to access information and communicate through a single interface. Streamlined communication helps managers and other representatives to provide customers with updates in real-time.

4. Ready access to Information

Data and information about the case are organized and stored by the document management features in the case management solution. Proper organization of information makes it easy to access information regarding a particular case. Easy access to information greatly expedites their resolution.

5. Elimination of the manual effort

Manual gathering of documents from customers and other parties wastes time and effort and delays the successful resolution of cases. Automated case management solutions eliminate the need for voluminous paperwork, and facilitate documentation to be gathered and stored electronically.

6. Top-notch customer service –

A case management solution elevates the customer experience by several notches by facilitating seamless customer communication and enabling the timely resolution of their concerns. A clear plan of how customer issues need to be tackled is provided by the case management solution.

7. Understanding Customer’s better –

The data gathered by the case management system is analyzed to spot trends, focus on key performance indicators, and identify opportunities to better serve customers. Gathering data and analyzing it is important for the evaluation phase of the case management process. Without proper access to data, it is difficult for organizations to improve their processes.

Different Models of Case Management

The case management model to consider should be based on the unique requirements of the organization. Each model has a different focus, which can be customized to achieve a specific business outcome. The 4 main types of case management models are –

Brokerage

In this model, case managers connect services provided by various businesses and professionals to their customers. In the brokerage model, case managers extend support and other resources to customers in an office-based setting. Case managers are much less involved with the people they serve at an individual level, and less emphasis is placed on continuous monitoring and more focus is on data collection and reporting across service providers. This approach allows case managers to allocate their attention to many cases at a time.

Intensive case management (ICM)

An intensive case management model is specifically reserved for individuals or incidents that require critical and ongoing support. When organizations choose the ICM model, case managers are required to be consistently engaged and updated on case progress. Case managers must extend resources to their customers through routine evaluations, appointment follow-ups, and other personalized rehabilitation services.

Clinical case management

In the clinical case management model, certified therapists or counselors are assigned by clinical providers. This case management model is reserved for organizations that offer clinical therapy, addiction recovery, and crisis intervention services. In this model, case managers work directly with their customers to curate custom treatment plans. Clinical case management is highly personalized and involves detailed recordkeeping, which allows case managers to quickly identify gaps in treatment and deliver required services more efficiently.

Strengths-based Clinical Case Management

This model focuses on the strengths of involved individuals before developing a treatment plan. The first step in this model is to identify the desired outcomes and personal objectives. The care plan must match the unique background that is revealed by evaluating outcomes and objectives. For case managers, this model focuses heavily on critical evaluation and reporting. The strengths-based approach is dynamic in nature and requires case managers to be supported by real-time solutions that can track crucial documents and task status updates.

Workflow versus Case Management

The approach that workflow automation and case management solutions take towards building processes is similar. Both methods are highly effective at process improvement, but they have their differences and similarities. Workflow automation is suitable for linear processes that can be defined, while case management is more effective for convoluted, complex processes.

Conclusion

As businesses grow, their operations expand proportionally. Managing processes requires flexibility around the rules and conditions that govern the process. Case management helps businesses flexibly navigate the casework differently each time. The case management process allows you to dive into your business process in the order in which tasks are completed. A workflow management solution like Cflow provides businesses with the flexibility to build custom solutions for each case. To explore Cflow, simply sign up for the free trial.