CCMA works to define accountability concept
Series of papers will explore CM outcomes
This month, the Case Management Society of America’s (CMSA) Center for Case Management Accountability (CCMA) will publish its first white paper. The paper will explain the framework for CCMA’s plans for the next year and start case managers down the road to defining what it means to practice accountable case management.
"Case management outcomes used to be based on cost-benefit analysis. Now that we have moved into the managed care world, that is no longer applicable. The job of CCMA is to help define what outcomes case managers can reasonably be held accountable for and help case managers find the tools to measure those outcomes," says Marlys Severson, RN, CCM, president of SCM Associates, a case management firm in Cypress, CA, and immediate past president of CMSA in Little Rock, AR.
CCMA sent two surveys to case managers in April. The first listed areas of case management practice and asked case managers to score them in order of importance. The second listed more than 20 areas that case management affects and asked case managers to score those in order of importance.
Case management outcomes on the survey included:
• appropriateness of care;
• clinical outcomes;
• coordination of care;
• functional status of patient;
• patient involvement in treatment;
• payer satisfaction;
• physician satisfaction;
• patient productivity.
Is it fair?’
"We know what case managers do thanks to the CMSA Standards of Practice. We also know that case managers impact three big areas of health care outcomes: clinical outcomes, clinical and functional satisfaction, and cost savings," says Severson, who also chaired the CCMA Outcomes Project Committee.
"However, case managers are not solely responsible for those big three outcomes. Providers and patients also affect them," she says. "Is it fair for case managers to be respon-sible or accountable for those three outcomes, if we are not directly responsible for them?"
CCMA used the survey responses to narrow case management outcomes to three areas in which case managers have a direct impact. Those include:
• patient knowledge, involvement in care, and empowerment;
• patient adherence to the care plan;
• coordination of care.
Filling the holes
"Our plan for the next year is to publish three additional white papers to address each one of those outcomes in turn," Severson says. "We will conduct a thorough literature search on each area and identify tools that case managers can use to measure each of the three outcomes. Where no tools exist, we will identify the holes and look to the academic setting, managed care organizations, or CMSA to decide whether they want to step forward and fill the holes."
"We are starting the process to give this industry the tools to measure what we do. Frankly, if we don’t start measuring them ourselves, we won’t be here in the future," she concludes.
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