Opportunities are opening up in new practice settings
Medical homes, ACOs want case managers
EXECUTIVE SUMMARY
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Physician practices need case managers to work with their patients and make sure they are following their treatment plans.
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Transition case managers, who coordinate care through the continuum, are a new trend.
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The downside is that some people are being called case managers when they don't have the education, skills, or experience for the job.
As the healthcare industry shifts its focus to coordinating care and improving transitions, new opportunities are opening up for case managers in emerging practice settings.
"Case managers can be a great asset at every point in the continuum of care — physician offices, long-term care, subacute facilities, home health. There should be a case manager to tie all the pieces together at any place a patient enters the healthcare system for care," says Marcia Diane Ward, RN, CCM, PMP, a case management consultant based in Columbus, OH.
Case managers are going to have new opportunities in the community in medical homes and accountable care organizations, adds Toni Cesta, RN, PhD, FAAN, partner and consultant, Case Management Concepts, LLC, North Bellmore, NY.
"We've been talking about case management in the community for 25 years and it's finally starting to happen. Case managers in the community help patients navigate the healthcare system and support them in doing what they need to do to stay well. It's very exciting," she says.
Patient-centered medical homes offer new opportunities for case managers, says Brenda Keeling, RN, CPHQ, CCM, president Patient Response, Inc., a Durant, OK, healthcare consulting firm. "These case managers see the patients in the physician offices, visit them when they go to the emergency department or are admitted to the hospital, and follow up by telephone to make sure they are following their treatment plan. Places that are truly doing case management versus just utilization review are going to be far ahead of the pack in the future," she says.
Physician offices and group medical practices are continuing to present opportunities, adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.
"This position gives case managers autonomy and flexibility as well as an opportunity to do what they went to nursing school for — work closely with patients and make a difference in their lives. Working with patients one-to-one over an extended period of time is rewarding, and case managers can make a great impact," she says.
Case managers who work in physician offices as part of Cigna's Collaborative Accountable Care model report that they enjoy their jobs because it enables them to deliver care and help patients improve their health, says Harriet Wallsh, director of Cigna collaborative care clinical operations. (For details on Cigna's initiative, see related article on page 17.)
Case managers who are embedded in a physician office develop a relationship with patients and get to see patients take accountability for their future help, something that doesn't necessarily happen in the hospital setting, says Maria Strohmeyer, RN, MSN, CCM, director of clinical services for Taconic Professional Resources, who oversees all of the case managers within the Fishkill, NY-based organization. (For details on Taconic's embedded case management program, see related article on page 15.)
"The biggest advantage of working as an embedded case manager is that you can make an impact on a patient's life, either starting with them when they are first diagnosed or even if they have had an illness for a while. Case management provides a nurse the opportunity to empower the patient with the skills for immediate and long-term self care," Strohmeyer says.
Many times, patients leave their physician's office with a feeling of uncertainty about what to do next, she says. "They have no knowledge of the road ahead and are afraid to ask a lot of questions of their physician. The case managers can support the patients where the physicians left off and assist them with adherence to the treatment plan as well as help them meet their short-term and long-term goals toward health," she says.
Specialty clinics are also hiring case managers for disease-specific care coordination, says Keeling. "This is a new trend that can be expected to continue," she says.
Transitional case management is another trend that's just getting started, Keeling says.
"With the changes Medicare has made in reimbursement and the emphasis on preventing readmissions, there are going to be additional opportunities for transition case managers. Case management throughout the continuum, from entry in the hospital through discharge and beyond, is slow to catch on but it represents the future of case management," she says.
Today's emphasis on care coordination means that people realize there are gaps in care but they don't always recognize where the safety net will be, Ward says.
That's because many people in the healthcare industry still do not understand what case managers do and the value they provide, Keeling adds.
"The spotlight is shining on care coordination and care transitions, but that brings up concerns about what could be the erosion of the profession because there is no definition around the role and function of case managers," says Patrice Sminkey, chief executive officer for the Commission on Case Manager Certification.
"We need to be very vocal regarding the role and function of case management. There are people being called case managers who don't have the education and experience and who aren't practicing case management," she adds.
Some organizations see no problem with calling everyone in the case management department a "case manager" regardless of his or her training, experience or credentials, Mullahy says.
For instance, some physician offices are hiring medical assistants to perform pre-authorizations and are calling them case managers, Keeling says.
In other situations, organizations use other titles such as navigator, care manager, advocate, coordinator, and coach, Mullahy adds.
"These have served to undermine and diminish the profession and create confusion. However, when one looks at each of those titles, each is, in fact, part of the role and function of the case manager and the case management process," she says.
