Example Conflict-Free Case Management Policies

One of the three structural change requirements Balancing Incentive States must implement is a conflict-free case management system. “Conflict of interest” is defined as a “real or seeming incompatibility between one’s private interests and one’s public or fiduciary duties.” Some State social services systems allow the agent that conducts the functional assessment and/or case management to also provide services to that individual. These systems have assessors and case managers performing quality oversight activities over their own agency and their own employers. “Self-policing” puts assessors and case managers in the position of evaluating the performance of co-workers, supervisors and leadership within the very organization that employs them. Problems arise because assessors and case managers are typically not the direct line supervisors of the other workers and therefore do not have the authority to require changes.

This structure can lead to obvious conflicts, such as:

  • Incentives for either over- or under-utilization of services.
  • Interest in retaining the individual as a client rather than promoting independence. Agents may also be reluctant to suggest providers outside their agency because the agency may lose revenue.
  • Issues that focus on the convenience of the agent or service provider rather than being person-centered.

 

Many of these conflicts of interest may not be conscious decisions on the part of agents; rather, in many cases, they are outgrowths of inherent incentives or disincentives built into the system that may or may not promote the interests of the individual receiving services.

Find below the policies states have in place to ensure their case management systems are conflict-free.