What is case management and which metrics are commonly monitored?

• A. Case management coordinates care for high-need patients; metrics include readmission rates, care plan adherence, utilization, and patient satisfaction.
• B. Case management schedules staff shifts and payroll.
• C. Case management designs marketing strategies for plans.
• D. Case management monitors nurse staffing ratios only.

Answer: (A)

Case management coordinates care for patients with complex or high-need conditions, bringing together medical, social, and support services to improve outcomes and prevent fragmentation of care. Because it aims to ensure appropriate, efficient, and patient-centered care, professionals in this role monitor metrics that reflect quality, effectiveness, and efficiency. Readmission rates indicate how well transitions from hospital to home are managed and whether follow‑up care reduces the need to return to the hospital. Care plan adherence shows whether patients and providers are following the agreed plan, signaling engagement and coordination. Utilization examines the volume and cost of services used, helping to assess if resources are being used appropriately. Patient satisfaction captures the patient’s experience and perceived quality of care, informing improvements in service delivery. The other activities listed—scheduling staff shifts and payroll, marketing strategy for plans, or monitoring nurse staffing ratios—are outside the typical focus of case management and relate more to operations, marketing, or workforce management.