Intensive case management (ICM) is traditionally targeted at patients with complex needs and exists within a wider service context. Targeting is integral to the efficiency of the service. A process and outcome evaluation of case management was conducted in a large urban area in England between 2007 and 2008. Data from a postal questionnaire, interviews, and resource utilization data of patients within the service are used to explore issues associated with targeting. The study identified various approaches to select appropriate patients. A lack of standardization in assessment was apparent. Reported policies on case allocation, caseload size, and frequency of visiting patients varied. There was little evidence of ICM. Not all patients in receipt of case management admitted to hospital were diagnosed with a specific disease or condition. Few patients were recorded as discharged and transferred to another service. We conclude that measures of targeting often focus only on admission to a service and specific outcomes and suggest that targeting be considered as a series of interconnected processes rather than static indicators.