Case Management Models in the Acute Care Setting, Including Roles and Staffing Ratios

Product Id : HLT9101
Instructor : Toni G. Cesta
Oct 18, 2023 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 90 Minutes


The Centers for Medicare and Medicaid Services (CMS) has instituted linkages between cost and quality through value-based purchasing and other cost-saving measures such as payment penalties for high readmission rates. These changes  have created the first links between the cost and quality of health care. These factors now require that case management models begin to change and adapt. The early case management models no longer meet the needs of the changing healthcare landscape! It is for this reason that hospitals and health care systems must look thoughtfully and carefully at the design of their case management models, the roles used, and staffing ratios of their case management departments.

No hospital can afford to remain stagnant in an environment that seems to be changing at a lightning pace. While the Medicare programs had remained fairly constant for many years, CMS now routinely changes the penalty and reimbursement structure in addition to adding new expectations such as the Two-Midnight Rule, and other similar rules and measures. Nevertheless, it seems that the case management department often seems to be the last department to be up-dated or enhanced to meet the new challenges imposed by the Affordable Care Act and Value-Based Purchasing.

Selection of the most appropriate model will depend on the needs of the organization, the available resources, and the expected goals and outcomes. Each case management department should ensure that they have correct roles, functions and staffing ratios. This program will provide you with the tools that you will need to identify the changes or upgrades you may need to make in your own case management department.

This program will review contemporary, best practice, case management roles and models. The program will begin with the contemporary case management roles used in hospitals today. This will be followed by a model review which will include descriptions of the two most commonly used models, the key differences between the models, as well as how they should be designed and structured. This will be followed by the pros and cons of each model and how the department might be designed to accommodate each model.  The best practice staffing ratios for each model will be discussed as they apply to the roles of the RN case manager and the social worker as well as strategies for optimizing existing resources.

The program will conclude with a discussion of the steps needed to re-engineer a case management department and tips for identifying the best model for your organization.


  • Review contemporary roles and functions for RN case managers.
  • Describe the contemporary roles and functions for social work case managers.
  • Understand the best practice case management models in the acute care setting.
  • Discuss access point case management.
  • Review the pros and cons of each model.
  • Apply your knowledge in selecting a model that works for your hospital.
  • Understand how to plan for model changes.

Areas Covered in the Session:

  • Why change your structure now
  • Model of care definition
  • Contemporary case management roles
  • Comparison of two models
  • Integrated model
  • Access point case management in the integrated model
  • Collaborative / Triad Model
  • Departmental structure
  • Staffing ratios in both models
  • Key differences between models
  • Similarities between models
  • Advantages and disadvantages of each model
  • Key planning and implementation steps
  • Live Q&A Session

Suggested Attendees:

RN Case Managers

Social Workers

Vice Presidents of Operations

Director of Case Management

Case Managers

Directors and Vice Presidents of Nursing

Directors of Patient Flow

Director of Revenue Cycle

Chief Financial Officers

Chief Operations Officers

Chief Medical Officer


Director of Quality Management

Nursing Home Directors

Director of Home Care

Director of Finance

Case Managers

Social Workers

Vice President of Case Management


Physician Advisors

Directors of Social Work

Speaker Profile:

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, with an eye on structure, process and outcome measures for nurse case managers and social workers.

The author of nine books on case management, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Among her books are included the “The Case Managers Survival Guide” and “Core Skills for Hospital Case Managers”.

Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.  She is a past commissioner for the Commission for Case Management Certification. She has held positions as Senior Vice President, Corporate Vice President, Director of Case Management and professor of case management.

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