Is Complex Case Management Complicated?

Is Complex Case Management Complicated?

Complex Case Management

Let’s face it… complex case management sounds… well, complex. But with the right tools and systems, case management even for individuals with the most complex diagnoses can be handled with ease.

Read on to learn more about complex case management and how your organization can effectively serve individuals with complex needs.

What constitutes complex?

Complex case management is a term used primarily in the medical field in reference to managing the multiple providers that are often involved when an individual has a complex diagnosis or multiple competing needs. Complex case management is essentially the same as all other forms of case management except it generally refers to situations where the individual uses an extensive amount of varied services, making the care coordination that much more difficult.

Who needs complex case management?

Here are some examples of individuals whose needs might require a case management that is more rigorous that the average person:

  • Individuals with multiple chronic illnesses
  • Transplant cases
  • High risk newborns
  • Individuals with disabilities or diseases requiring multiple practitioners, such as speech therapists, occupational therapists, physical therapists, and doctors
  • The elderly, especially in nursing homes or assisted living facilities

Will my case management solution work for complex cases?

One of the beautiful things about today’s case management software solutions is that they are scalable and can meet the needs of individuals with complex cases in addition to more straightforward ones. The integration of these programs into the medical field is revolutionizing our ability to deliver appropriate care solutions which are directed targeted to each individual, thereby maximizing outcomes.

What are the challenges for complex cases?

As organizations continue to move towards evidenced based practices, it is important that data from complex cases does not get lost in the shuffle. The data from these cases may not match up with data from more straightforward cases and can look like an anomaly. However, the right software solution can help make this apparent, allowing your organization to make evidenced based decisions that are right for all of your clients.

Furthermore, the right software solution means that individuals managing complex cases will have a much easier job. Because they are able to more easily keep track of the needs of their clients and patients, they will experience a greatly increased capacity. This allows organizations and providers to serve more individuals and expand the scope of their work, to the benefit of all.

Where can I find help?

Many hospitals, health providers and other social service organizations have special programs to help handle complex cases. For example, Gunderson Lutheran Health Plan, Neighborhood Health Plan of Rhode Island, Sanford Health Plan and MedStar Family Choice are all health care providers that now have specific programs designed to address complex case management.


Although complex case management was complicated at one time, the advent of outcomes management software and tools has changed the whole landscape. Now patients and individuals with complex medical needs will find that their care coordination can be managed effectively with the right system. This is a benefit both to the individuals and the providers as it enables a better standard of care with less complication.

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