Case Management
Case management is a collaborative, client-centered process that assesses, plans, facilitates, and advocates for services to meet an individual's health and human service needs across multiple providers and systems[^c3]. The joint ACMA/The Commission 2022 definition frames it as "a dynamic process that assesses, plans, implements, coordinates, monitors, and evaluates to improve outcomes, experiences, and value," with explicit priorities around health equity, social determinants of health, and safe care transitions[^c1][^c7]. Approximately 10% of patients account for roughly 70% of all healthcare expenditures, and case management serves as a key strategy for improving outcomes while containing costs for this high-need population[^c4]. A comprehensive scoping review of the literature identified 22 distinct definitions and 69 discrete activities mapped to 17 core components, confirming the breadth of the practice while also highlighting the need for greater terminological consistency across settings and health conditions[^c9].
Case management has a heritage spanning more than a century, originating in nineteenth-century charity organization and settlement house movements and evolving through the deinstitutionalization era, the rise of managed care, and contemporary population health approaches. The Case Management Society of America (CMSA), formally incorporated in 1990, has driven the professionalization of the field through standards of practice, certification programs, and policy advocacy[^c5]. The CCMC's 2025 national Role and Functions study, based on survey responses from 2,145 practicing case managers, confirmed a six-domain blueprint for the CCM certification examination, reflecting the continued evolution of professional case management practice[^c8]. In October 2024, CMSA added Standard Q on Diversity, Equity, Inclusion, and Belonging (DEIB) and Health Equity, reflecting the profession's commitment to dismantling health disparities[^c6].
The practice is grounded in a structured process of client identification, comprehensive assessment, collaborative care planning, implementation and coordination of services, ongoing monitoring and reassessment, and planned closure. Different models have been developed to meet the needs of specific populations, from brokerage models focused on service coordination to clinical case management models that integrate direct therapeutic intervention with environmental support. In English mental health services, the Care Programme Approach — introduced in 1990 to formalize care coordination for people with mental illness — has been replaced for community services by the Community Mental Health Framework, which centres on a named key worker within a multidisciplinary team and on intervention-based care rather than generic care coordination[^c10][^c13]. The CPA remains in force only in secure and forensic services, inpatient eating disorder services, and inpatient perinatal mental health services.
Case management is practiced across diverse settings including hospitals, community mental health centers, primary care clinics, child welfare agencies, aging and long-term care programs, criminal justice reentry services, and managed care organizations. The field continues to evolve in response to changes in healthcare financing — including value-based payment models, outcomes-based reimbursement through CMS Innovation Center programs, and state-level bundled case management rates — as well as technological innovation. Clinical and care management is transitioning from fragmented, labor-intensive workflows to AI-enabled, platform-led operating models that orchestrate continuous, longitudinal care[^c11], with payers deploying agentic AI tools embedded directly into health insurance workflows to support members and case managers[^c12]. Demographic shifts and growing attention to health equity and the social determinants of health further shape the field's trajectory.