Table 1. Models of case management for analyzing costs.

Dimensions	Broker	Purchase authority	Capitated	Insurance	Fee for service
Service features
Extent of integration:
Case management only				x	x
Case management and community-based long-term care	x	x
Case management, community-based long-term care, and institutional care			x
Case management functions:
Assessment, care planning, and monitoring					1x
Full spectrum case management	x	x
Full spectrum case management and utilization review			x	x
Goals2
Minimize nursing home use	x
Minimize nursing home use and efficient community-based long-term care use		x
Minimize cost of case management, community-based long-term care, and institutional care			x	x
Maximize profits and revenues					x
Reimbursement mechanisms
Fixed budget	x	x
Annual capitation			x
Administrative cost				3x
Fee-for-service and billable hours					x
Constraints
Process that relates case management time to cost of community-based long-term care	x	x	x	x
Process that relates community based long-term care use to institutional care use	x	x	x	x
Fixed budget for case management	x	x
Per client cap on community-based long-term care costs		x
Private demand for case management					x

¹Private case manager may not do monitoring if client does not want to pay for that service feature.

²All goals are qualified by implicit standards of care.

³If case management is contracted out by insurance company, it may be a fee-for-service or capitated arrangement.

SOURCE: Kane, R.A., Penrod, J.D., Davidson, G.B. Moscovice, I., and Rich, E.: Case Management Costs: Conceptual Models and Program Descriptions. Prepared for Health Care Financing Administration. Minneapolis Minnesota. University of Minnesota Health Policy Center, June 1989.