EXECUTIVE SUMMARY
Case managers and others will head to Capitol Hill to meet with lawmakers in September to explain how case management adds value to the healthcare delivery system.
- The first goal is to show policymakers who professional case managers are.
- The Case Management Society of America will focus on its Standards of Practice for Case Management and the Case Management Model Act.
- Another focus will be helping lawmakers understand the importance of case management in the care continuum — particularly as they debate any new healthcare legislation
Every time there is a new Congress and a new president, there are big opportunities and challenges for educating lawmakers about the need to include professional case managers in important healthcare bills or regulations.
This year, that mission is especially important as Congress debates repealing and replacing the Affordable Care Act (ACA).
The Case Management Society of America (CMSA) will meet and talk to members of Congress during the upcoming CMSA Hill Day 2017, Sept. 13-14, on Capitol Hill in Washington, DC.
“Every time we visit Capitol Hill and our CMSA leadership and members meet with Congressional leaders, our goal is to educate policymakers first and foremost on who we are as professional case managers,” says Patricia Noonan, RN, MBA, CCM, director of Network Care Management with Lahey Clinical Performance Network in Beverly, MA. Noonan is the chair of the CMSA public policy committee.
Congressional representatives might not be aware that case management is provided by an interprofessional team that can include lay navigators, community health workers, pharmacists, physicians, allied health professionals, and case managers, says Cheri Lattimer, RN, BSN, executive director of the National Transitions of Care Coalition (NTOCC) in Prescott, AZ. The NTOCC includes pharmacy professional organizations, case management, veterans affairs, hospitals, and other transitions of care stakeholders.
“The challenge is that various professional organizations and academic leaders need to come to a consensus so we can share the same information with legislators,” Lattimer says. “Consensus is needed on what are the services, who can deliver the services, and what do we actually mean when we say we’re achieving outcomes.”
From CMSA’s perspective, Hill Day 2017 is a big opportunity to create a lasting effect.
“Our goal is to have 200 professional case managers attend our Capitol Hill day, so we can all deliver an important message to Congress that we are professional case managers, adding value to our healthcare system and to healthcare consumers,” Noonan says.
“We are licensed, qualified healthcare professionals. We are guided by the standards of practice for case management. We are guided by our professional certifications,” she adds. “That clearly, in and of itself, is an important message to deliver to congressional leaders that are thinking about developing or drafting new legislation that includes case management services.”
Having CMSA members share their stories of how they are adding value to patients and clients is what resonates, Noonan adds.
CMSA recently updated its Standards of Practice for Case Management and supports the Case Management Model Act that promotes case management program standards. (See story about Case Management Model Act in this issue.)
The 2016 revised Standards of Practice for Case Management focus on recent changes in the healthcare industry, including minimizing the healthcare system’s fragmentation and expanding and maximizing the contribution of the interprofessional collaborative healthcare team to plan care and services for patients. More information about the revised standards is available at: http://bit.ly/2q35bRU.
CMSA’s chief message is that the organization is nonpartisan and would like any newly introduced healthcare legislation to include professional case managers in order to reach broader healthcare populations and to increase case management’s contribution to quality care, safety, and outcomes, Noonan says.
“From the standpoint of both private insurance and healthcare reform, we all realize that the ability to be able to work with and manage this healthcare coordination is key,” Lattimer says. “There is a tremendous amount of duplication of resources and, sometimes, not the best use of time and money in our healthcare system.”
The goal is a unified healthcare system in which teams work to support patients through the continuum of care, Lattimer adds.
“Over the years, many providers say the laws are made and they don’t look at what they’ll actually mean to patients and caregivers,” Lattimer says. “We’re trying to take a look at that.”
Outreach and education are CMSA’s chief objectives for 2017. The Case Management Model Act is one possibility.
“It would be helpful to hand [lawmakers] talking points on a case management model act to demonstrate how case management works and how it is structured, regardless of where case management happens,” says Chriss Wheeler, RN, MSN, CCM, owner of Innovative Care Consultants in Independence, MO. Wheeler also is the vice-chair of the national CMSA public policy committee.
“I think our leaders are really looking for good information to be able to restructure whatever the ACA becomes,” Wheeler says. “It gives me hope that Congress realizes we can’t go back to what we were before, because we can’t sustain it economically.”
Congress changes every two years after all U.S. representatives and one-third of the Senate go through the election process. Any legislation that was left languishing in a committee right before the new Congress takes office is gone, and would have to be reintroduced. Advocacy groups like CMSA have about two years to meet with legislators to convince them of the importance of bills that address their concerns.
“Each time you go knock on their doors to build that relationship, you have a better opportunity to get things done,” Wheeler says.
“Sometimes change comes very, very slowly. After research comes out, it takes 17 years to change that behavior to support the research,” Wheeler says. “Our political world also takes time to bring things about.”
CMSA stresses its nonpartisan nature and focuses on how case management helps patients.
“Since the ACA was enacted, we share the stories of how we are working with chronic and complex individuals and how we’re making a difference each day,” Noonan says. “The cost savings is significant, and we’re playing a role in not only contributing to achieving national quality goals, but also in reducing inefficiencies and readmissions.”
One of the challenges case managers face is that the regulations that provide funding for care management services do not define who is qualified to provide those services. Case managers need to be licensed professionals who can conduct an assessment independently.
So, while having coding now that pays for chronic care management services is a positive thing, it’s not clear that organizations will put resources into professional case managers.
“In today’s world, you can have non-licensed personnel do the work,” Wheeler says. “When you look at most physician offices, they have medical assistants who finished nine-month certificate programs, and those are the folks doing medical case management.”
What the coding lacks is an understanding that professional case management has better outcomes. CMSA’s standards of practice define a professional case manager as someone who has at least a bachelor’s degree and a professional license, or, in some states, a certificate. “The caveat is that, within your scope of practice and licensure, you have to be able to do an assessment independently,” Wheeler says.
As healthcare evolves away from fee-for-service and toward population health goals and focus, there likely will be such a huge demand for case management that healthcare organizations will need to fill some of these jobs with case manager extenders. But those roles also need to be well-defined, she says.
“That’s something our model act will do — defining the role of the professional case manager and defining what a non-clinical person does when helping to support the case management process,” Wheeler explains.
For instance, case management extenders could arrange patients’ transportation to medical appointments. But the chief oversight and organization should be the professional case manager’s job.
“We have to make sure we are getting the professional case manager to assist,” Wheeler says. “Your outcomes are going to be better. They just are.”
Case managers and others will head to Capitol Hill to meet with lawmakers in September to explain how case management adds value to the healthcare delivery system.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content