The trade-offs of developing a case management model for chronically mentally ill people.

This article addresses the role of case management in the care of chronically mentally ill people. Trade-offs often occur because case management is frequently used to achieve the conflicting goals of reducing service use costs and raising the quality of life for clients. Despite these trade-offs, case management can be effective if it is designed so that services match client needs and the costs of services are measured accurately. Case management for chronically mentally ill people is particularly difficult to design because their level of functioning and need for intensive services are such that the cost to deliver the appropriate services is great. The profit-maximizing nature of the U.S. health care system makes some form of capitation likely in the design of case management services for this population.