Caseload Guidance Given to Veterans Health Administration

NASW offered insight on the factors in determining case management caseloads for a Veterans Health Administration workgroup that is evaluating staffing ratios for care management with veterans of the war in Iraq.

NASW Senior Practice Associate Chris Herman participated in a teleconference with the VHA Case Management Caseload Ratio Work Group recently and discussed a caseload concept paper and matrix that NASW helped develop as part of a separate caseload workgroup in 2008.

The workgroup is coordinating its efforts with the VHA’s version of the Patient-Centered Medical Home: Patient-Aligned Care Team, said Peggy Kennedy, program manager for VHA Operations Enduring Freedom and Iraqi Freedom Care Management.

“This is a new, primary care model where a veteran works with a single interdisciplinary team to promote optimal health and well-being,” Kennedy said. “Social workers and nurses practicing case management are key members of the interdisciplinary team.”

She noted that the workgroup also is seeking insight and material for review from the Case Management Society of America, which also participated in the earlier caseload workgroup. “As a result of this project, we are hosting several meetings to further define the role of case manager within the Patient-Aligned Care Team,” Kennedy said.

The new concept encourages all the participants of the health care delivery team to work as a cohesive unit, Kennedy added. “NASW’s input was helpful in that we learned that determining case management ratios is an ongoing and complicated process,” Kennedy explained. “Both NASW and CMSA provided a national context for the VHA’s efforts.”

Carol Sheets, national director of social work in care management and social work service for the VHA, said Herman helped highlight the many variables that need to be considered when developing a case management ratio.

Sheets said it is vital that participants in a veteran’s care team have the same goals and work together.

Sheets said the VHA is placing a greater emphasis on a “veterancentric” care system.

She also noted that it is important that the workgroup seek information from NASW, as more than 8,000 social workers are employed by the VHA and many hold a certified advanced social work case manager credential from the association.

Herman said the question of what constitutes an appropriate caseload is frequently posed to NASW. “Case management is a primary function for social workers,” she said. “NASW’s 2004 workforce study found that a significant number of licensed social workers in the U.S. spend more than half their work time on case management.”

Kennedy said that she and the workgroup appreciate Herman’s contributions in considering case management ratios and will seek NASW’s input as the project moves forward.

“It’s important,” Kennedy said, “that all the players are on the same team.”