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What is Case Management?

Case management helps organizations gain speed and agility as they provide services to a client. Get advice on how to solve top problems and improve automation strategy using case management software.

Case management is a specific type of knowledge work in which processes are less structured, interactions are more ad hoc, and events and milestones are difficult to predict. It is often a core operational element of an organization. Getting the building blocks of case management right is critical to helping organizations deliver a continuum of products and services to customers, stakeholders, and constituents.

What is case management software?

Case management software helps organizations gain speed and agility in the knowledge work associated with that continuum of service. Such case work presents thorny challenges because it involves data from different sources that must be collected, parsed, summarized for decision making, and acted upon—often without prescribed process steps. 

[Want an in-depth look at case management? Get the Case Management Guide.]

Why case management matters: Real-world examples.

Case management involves assigning a dedicated worker to provide a range of services to clients. But the term “case management”—and your use case for it—means different things depending on your profession. 

Doctors and lawyers are familiar with medical cases and legal cases—the sum-total of a patient’s or client’s experience over time in a given situation or combination of situations. But for IT professionals, help desk tickets are cases. In federal agencies, government teams acquiring goods and services create procurement cases, to ensure they’re buying wisely and following regulations. Pharmaceutical companies, meanwhile, work with cases that track drug compliance. In short, a “case” can be a person, a physical object, or sometimes just a collection of data.

What do these types of case work have in common? Management requires ongoing communication and collaboration between the case manager and the client. It also involves evaluation activities and documentation for long-term goals and compliance with regulatory standards. 

Let’s examine a few additional examples that illustrate why case management work is important to positive outcomes:

  • Healthcare providers use case management to help patients suffering from chronic illnesses coordinate a plan of care, including scheduling appointments, managing referrals, or providing information on medications or research studies. 
  • Social workers use case management to implement programs aimed at understanding vulnerabilities in a population and provide people with resources like education, housing, or mental health interventions.
  • Police departments use case management tools to track details about a crime and the accused, such as conversations or case details. 
  • Banking and financial services firms use case management systems to manage customer service, support inquiries and gather feedback, to improve customer experience and boost retention rates. 

Over the years, case management has evolved from old paper-and-pen and filing processes into an increasingly digitized realm. Today, case management plays a key role in wider, end-to-end process automation. A modern process automation platform enables organizations to not only manage cases, but also improve the speed, agility, and efficiency of an entire business process.

A modern process automation platform enables organizations to not only manage cases, but also improve the efficiency of an entire business process.

[ Learn how to successfully implement end-to-end process automation strategies. Get the Process Automation Guide. ]

How case management works and its role in automation strategy.

Case management almost always involves a complex collection of tasks. However, most case management work falls into four categories. These range from highly structured tasks to ad hoc requests.

The 4 types of case management, examined:

1. Process to decision.

The “process to decision” type of case management work uses structured rules and processes to work clients through a system. 

Decisions are made based on a high degree of context, and this work typically follows a predictable path. Following rules, policies, and procedures is paramount. 

For example, a case manager helping state government run health inspections would follow specific checklists and guidelines to ensure that facilities meet the proper standards for cleanliness and health. Depending on how well a facility complies, the health inspector might decide to either shut the place down or give it a passing score. 

Another example might be a loan provider deciding whether to provide a mortgage loan to a new applicant. They may check a series of rules related to credit scores, credit payment histories, home insurance requirements, zoning, and other factors. These complex decisions result in a specific outcome— whether or not a loan is approved. 

2. Service requests.

This type of case involves decisions around providing services, such as approving requests, running maintenance on machines or fleets, performing customer service, or executing consulting contracts with respect to specific obligations. 

These types of cases are often highly structured, can lack context (especially early in a case), and can easily evolve or escalate. 

Let’s take an example of a bank. Banks have to comply with regulations related to identifying, preventing, and reporting money laundering issues. This often requires responding to requests by regulatory agencies for information on irregularities. It’s a high-risk and time-sensitive process involving significant intervention, centralized information, audit trails, and more. 

With a process automation platform, the bank can build out their case management process in a way that would automate actions and provide visibility across case information, documentation, and collaboration with outside parties. When the bank needs to provide anti-money laundering (AML) services as requested by law enforcement for criminal investigations, having a strong case management solution in place could make the difference between strong compliance and potentially hefty fines. 

3. Incident management.

Incident management refers to the ability to reduce risk and deal with problems that could harm an organization or a population. 

This type of case is typically proactive, but it can be reactive as well. In both scenarios, there’s usually a general high-level process, with some flexibility for rare and special incidents that require unique workflows. Incident management also relies on heavy collaboration between teams and organizations and usually must accommodate fieldwork and mobility.

For example, a human resources (HR) department has a duty to protect both employees and the company and ensure a fair, equitable work environment for everyone involved. The company can proactively avoid incidents by running employee trainings and requiring employees to read the company’s handbook and acknowledge its policies. If an incident arises that HR representatives must address, they gather information from all parties involved, document their findings, and ensure everything and everyone follows written company policies. HR representatives then work to resolve the dispute in a fair and equitable manner for all involved. They may also update policies to prevent recurrence of an incident. The result is both a better workplace and far less risk to the employer. 

4. Investigations.

Investigative case management focuses on reactions to a specific event or circumstance. It involves collecting and processing evidence from documents, research, interactions, and other information sources. 

This form of case management is typically unstructured, reactive, takes place over a long time, and involves dynamic business goals. 

Let’s take the example of an automotive insurer working with a company that provides accident insurance. In the event of an accident, the insurers will need to gather information such as police reports and photos to understand which party is at fault and which insurance company will have to pay for the damage. They may need to get quotes from auto retailers to understand the full nature of the damage to ensure the proper payout for the party at fault. Finally, they will need to have methods for communicating results with their client and any other interested parties. 

Problems that case management solves.

As these examples show, the varied nature of case management requires an extremely flexible approach to process management. This is where choosing the right type of process automation platform becomes important. For an overview of the problems that case management software solves, watch this video:

Top benefits of case management.

A strong case management solution offers:

1. Centralized information.

Dealing with individual cases requires a lot of information from disparate sources. A case management solution—especially one purpose-built to support specific end-to-end processes—provides employees with a single source of truth for each case, with all the information they need on the case history to make the right decisions.

2. Enforced rules.

Case management requires everyone involved in a case to follow specific rules, guidelines, and policies. A case management solution enables enforcement of these rules and policies, ensuring more effective governance and compliance.

3. Improved decision making.

With manual, paper-based case management, cases can easily fall through the cracks. Employees get overloaded and mistakes occur. A case management solution that automates a lot of the process ensures that employees have the right information at the right time and can make the right decisions based on relevant policies and information.

4. Enhanced communication.

Employees often need to communicate across departments and organizations to solve a specific case. A case management solution can help improve transparency for everyone involved. Even better, a process automation platform with workflow orchestration capabilities supports decision rules to route communications to the appropriate people, saving time and money.

5. Audit trails.

When you use a case management solution, it creates a log of all activities on a given case. This provides a digital paper trail that can be useful in demonstrating compliance with regulators or understanding where case management processes or policies can be improved.

6. Reporting.

How well is your organization doing on its casework? With the right case management solution tailored to your processes, you’ll be able to create reports that answer this question. This can help you course correct if teams are overloaded, too many errors crop up, or if something else must be done to meet organizational objectives. 

It’s important to realize that process automation and case management go hand in hand and that case management is often part of a wider, end-to-end business process. A unified process automation platform lets you connect software programs and data sets and apply multiple automation tools, like intelligent document processing (IDP) and robotic process automation (RPA), to improve the performance of your case management activities. 

Case management software in federal agencies: 7 key criteria.

Federal government agencies have especially demanding case management needs. By adopting case management software, they can achieve greater levels of efficiency, compliance, and adaptability for their agencies and their missions. 

[ Read the related article: Legacy Modernization and Case Management: Advice for Government Agencies. ] 

Case management solutions can play a critical role in modernizing federal agencies. Consider these seven areas of improvement:

  • Organizing and structuring case information: Case management takes a significant amount of time, especially in ad-hoc case management processes. Case management software allows federal agencies to centralize information so employees have access to all the information they need and everyone has an audit trail to prove compliance and ensure strict adherence to guidelines. 
  • Improving collaboration: Federal agency case work requires coordination from team members across departments and cooperation between agencies. Case management solutions provide a centralized place for keeping track of information across agencies and contractors at both the federal and state levels. Plus, if you use a process automation platform, you can automate communications between agencies and employees, further improving collaboration and increasing visibility. 
  • Integration with existing systems: Federal agencies often have to work with a complex IT infrastructure involving integration and communication across legacy systems, civilian contractors, and other agencies, and case management requires complex interactions as well. Being able to integrate with other systems using advanced technologies like API connectors or data fabrics is critical to smoother operations.
  • Improving governance and compliance: Federal agencies must follow a large swath of changing policies and guidelines to remain in compliance with federal regulations. A good case management solution enables agencies to enforce these rules as they accomplish their missions. 
  • Better data analysis leading to better outcomes: Accomplishing goals for your agency—whether conforming to environmental regulations, running law enforcement investigations, or making advancements in space technology—is critical to demonstrating commitment to the mission and maintaining funding levels. Case management solutions offer the ability to analyze data and processes to ensure the best outcomes, whether that’s for constituents or just other agencies.
  • Automating critical processes: Agencies often have to stretch their budgets to get their work done efficiently. A process automation platform that offers built-in case management features allows you to orchestrate and automate key processes between digital workers and humans so the two groups work better together and complete work faster. 
  • Enhanced security and privacy: Modern case management solutions, especially cloud solutions with the certifications and security infrastructure that agencies require, can improve the security and privacy of federal data. Given the amount of sensitive and private information federal agencies handle, security is paramount. 

[ Learn how to enhance your agency’s efficiency. Get the eBook: The Secret to a Streamlined Government. ]

How to choose case management software: 4 takeaways.

When evaluating case management software, keep these four priorities in mind:

1. Understand your specific needs and goals.

Before choosing a case management system, you’ll want to gather the requirements for your organization. For example, will the solution be used by only one department, used across the organization, or shared with contractors? Are typical cases highly structured or more ad hoc in nature? How much customization will you need? What IT systems do you already have in place, and how will this solution fit into your ecosystem? 

It’s important to have a North Star goal that guides your major decisions. For example, if you’re focused primarily on efficiency and the number of cases solved, then you should combine your case management solution with automation features that can take some rote, manual tasks off your employees’ workload. 

2. Prioritize the features and capabilities you need.

Based on the requirements you gathered in step one, you’ll want to make a list of features and capabilities for your case management solution. Consider the needs of your teams—you may want to prioritize features including:

  • Task management
  • Workflow customization
  • Time tracking
  • Billing and invoicing 
  • Reporting 
  • Integration with other software tools
  • Communication tools such as email integration
  • Security and privacy capabilities 

Consider how to cover the gamut of your organization’s case management types. You may need a solution that enforces strict workflows or you may need something that can cover more ad hoc case management. But most likely, you’ll need something that can handle the full range of case management types. 

3. Ensure flexibility for the future.

Your organization will grow and evolve. The types of cases you handle, compliance requirements, and the organizations you work with will all change. So choose a solution that’s flexible enough to change with you. 

One of the best ways to do this involves choosing a unified process automation platform that includes low-code development tools, a data fabric architecture, and multiple automation tools to make your team even more efficient.

  • Low-code development allows you to build out workflows with business process modeling diagrams. Often, teams can build a full workflow for case management across an enterprise-organization in as little as a few weeks. 
  • Data fabric architecture is a powerful engine that makes faster software development possible. Data fabrics allow developers to work with data in a virtual layer, sidestepping a lot of extensive database programming and maintenance work. 
  • Process automation tools like artificial intelligence, machine learning, and robotic process automation can help you automate manual, repetitive tasks. Look for a solution with workflow orchestration capabilities to coordinate handoffs between tools, people, and RPA bots.

4. Consider the total cost of ownership.

Make sure to consider the total cost of ownership of any case management solution. For example, factor in licensing or subscription, IT infrastructure requirements, and training requirements. Initial costs shouldn’t be your only measure—long-term costs can make or break your success. Make sure to evaluate your expected return on investment. 

Case management is a complex, mission-critical issue for many organizations, so it’s essential to get this right. Choose a solution that accommodates the full spectrum of your case management needs, from ad hoc requests and investigations to highly structured work. With a process automation platform that offers growth and flexibility, you’ll not only gain benefits like centralized information, enhanced compliance and governance, and better decision-making, you’ll also significantly improve the efficiency and effectiveness of your workforce. 

[ Want to learn more about platforms for process automation that help you streamline operations? Download the Everest Group Process Orchestration PEAK Matrix® Assessment 2023. ]