Certification, education, membership: To succeed, you need them all!
Here’s what industry leaders say the successful CM should have
Case management is evolving rapidly due to driving forces in the health care industry such as e-health, the graying of America, and managed care. Case managers are working in an increasingly intense and demanding environment. To survive, industry leaders agree case managers must gather the necessary tools: professional association membership, certification, and education.
There is little doubt that case management has firmly established its place in health care and is expanding rapidly. The evidence that case management has evolved from a fledgling specialty practice to a maturing profession is clear. Consider the following facts:
• The Case Management Society of America (CMSA) in Little Rock, AR, has entered its 11th year.
• Nearly 20,000 case managers have earned the certified case manager (CCM) credential from the Commission for Case Manager Certification (CCMC) in Rolling Meadows, IL, since that board began case management certification in 1993.
• A group of case management pioneers has launched the Academy of Certified Case Managers (ACCM) in Fairfield, CT, to meet the educational needs of more advanced case managers.
• The Centers for Disease Control and Prevention in Atlanta has adapted the CMSA "Standards of Practice for Case Management" into its own case management models.
• The Health Care Financing Administration in Baltimore has asked CMSA to provide several reviewers for proposals for Medicare’s upcoming demonstration project on care coordination.
• The final Health Insurance Portability and Accountability Act’s rules for transactions and code identifiers list case management under "atypical services."
With responsibility comes accountability. Accountability means that to succeed, case managers must have the credentials, education, skills, and experience necessary to survive in a competitive market.
"As the future of health care evolves, any and all players will be scrutinized regarding the value that they bring. Case management will not be exempt from this process," says Sandra L. Lowery, BSN, CRRN, CCM, president of Consultants in Case Management Intervention in Francestown, NH, and national president of the CMSA.
"I personally feel that after almost 15 years of case management practice in a wide variety of practice settings, case management provides a unique role that will prove to be a necessary component of the future health care delivery model. However, if there isn’t a concerted and unified effort toward demonstrating the value of case management, there is a great risk of losing the ground we’ve gained," she says.
Only CCMs need apply
Industry leaders say case managers who want to remain marketable and advance their careers must continue to educate themselves and develop the skills necessary to keep pace with the rapid changes in the health care industry. "The full package would include relevant clinical experience, experience in discharge planning and/or utilization management, certification in case management, and an advanced practice degree, preferably in case management. That’s no small order," notes Toni Cesta, PhD, RN, FAAN, director of case management for St. Vincent’s Hospital and Medical Center in New York City.
"I feel that case managers should obtain certification as well as an advanced degree, particularly if they work in the hospital setting," Cesta says. "I believe that each — certification and advanced degrees — represents a different skill set. Certification represents a national standard, and an advanced degree represents advanced education in a specialty area. Experience and credentials are important when recruiting a case manager in a hospital setting."
"To pursue advancement in case management, it is important to be certified," agrees Mindy Owen, RN, CRRN, CCM, corporate director of complex care management with Coordinated Care Solutions in Coral Springs, FL, a member of the ACCM membership council, and past president of CMSA. "No certification will deem you an expert, but it will distinguish you as a knowledgeable professional to an often confused public, which is where I believe the question really should be placed. Ask yourself, Who am I doing this for?’ My own belief is that it is more important to the consumer that you are an ethical, knowledgeable, caring professional than the number of letters after your name," she says.
"Every initial I have after my name was obtained because it was needed for job growth or a way to show competence and validation for what I have done," notes Anne Llewellyn, RNC, BPSHA, CCM, CRRN, CEAC, owner of Professional Resources in Management Education, a case management consulting and education company in Miramar, FL. "I am not one for obtaining initials because they are new or they look good. Certification is expensive to obtain and maintain. I have sought certifications that make sense for me at this time in my professional life."
Certification is a mark of personal pride and professional excellence, says Deborah Smith, MN, RN, Cm, CNAA, a consultant with American Medical Systems in Los Angeles and chair of the ACCM leadership council. "It is attained after one has become an expert in the field. Case managers should choose that certification which best matches their practice and the populations they serve. I am certified by the American Nurses Credentialing Commission in Washington, DC, because the scope of their examination fits more closely with what I do than any of the others," she explains. "As a consultant, I probably wouldn’t get much work without certification. And, some jobs require certification — that speaks for itself."
"As buyers of our services become more savvy, they are going to require some kind of certification and/or accreditation for their subcontractors as a way of protecting themselves and the consumer," adds Carrie Engen, RN, BSN, CCM, director of Advocare in Naperville, IL, and chair of the CCMC.
Llewellyn cautions that for case managers looking into certification, research is important. "The public is demanding to know what gives us as case managers the right to make decisions for them," she says. "Certification gives validation to our experience and expertise in a given area. Today, the CCM is the gold standard for most case managers. There are other certifications that may meet an individual case manager’s needs. The point is to choose which one works best for you and what will give you the opportunity for professional growth."
While industry leaders agree on the necessity of case management certification, there appears to be no clear consensus about education for case managers. "I am pleased to see the development of academic programs focused on case management on the bachelor’s and master’s level. This is a good thing. Thank goodness there is preparation available and the days of apprenticeship are gone," Smith says.
"However, I think good preparation is a combination of prior clinical experience, class work, case simulations or exercises, and some sort of practicum, orientation/mentoring process. We must recognize also that there are many competent case managers in the field without bachelor’s level or above academic preparation. The [certifying and accreditation boards] for case managers and case management recognize this by offering several sets of eligibility criteria. I do think we will see a natural evolution toward higher education for case managers in the future," she says.
"We have seen a number of academic institutions develop case management degrees or certificates of continuing education courses in the last few years. I think that what we’re moving toward is delineation of core competencies and a core curriculum for case management. This is a necessary and important step for case management," says Gary S. Wolfe, RN, CCM, CNA, a consultant from San Francisco, past president of CMSA, and executive vice president of the ACCM.
For case managers planning a return to school to further their formal education, Llewellyn says there are several majors to consider. "I really feel that advanced education is needed for case management today. A bachelor of science should be the basic requirement, if we are to continue to move case management toward a profession. I would certainly look into a bachelor of science program in health services, health care administration, or nursing, if a case manager is already a RN and wants to go that route," she notes. "If you already have a BS and want to continue, a master’s in public health or a master’s in health care administration will give you a new focus. In addition, many MSN programs are adding a focus on case management to their programs." (For more on education for case managers, see Case Management Advisor, January 1998, pp. 1-7.)
Llewellyn says the growing number of degree programs and course offerings in case management at the university level is proof that case management is "here to stay." However, she adds that the field will not continue its current growth if case managers don’t learn to measure outcomes and share their findings with others. "Every case manager working on a master’s degree should send thesis papers to CMSA so that we can begin as an industry to build the body of research the government, employers, payers, and consumers are requesting," she says.
In addition to formal education, industry leaders argue that case managers must educate themselves on new products and technology. "System advancements in health care technology are changing the way patient care is delivered," says Mary Gambosh, RN, CDMS, CCM, a case management consultant in Henderson, NV, and developer of www.mcaremall.com, a case management Web site. "Case managers who don’t stretch themselves to learn to use the Internet will be left behind. Every excuse in the world has been made for why more case managers don’t learn how to function on the Internet. This is an investment in your future. You can’t afford not to learn. Your patients are out there. You need to be, too."
Finally, after weighing the benefits of certification and education and making some personal choices, leaders agree that case managers must work together through professional associations to influence policy-makers and take steps to advance the practice of case management.
"I feel that membership in professional associations is the only way we can join together to . . . publicize case management as an integral component of health care delivery in America," says Nancy Skinner, RN, CCM, a case management consultant with Riverside HealthCare Consulting in Whitewell, TN, and past president of CMSA.
"CMSA has a mission of advancing the practice of case management," she says. "I applaud all the past and current leaders of CMSA and their efforts . . . . That said, the vast majority of case managers do not belong to any organizations. Some do not seek or obtain the information necessary to advance their knowledge and skills as a case management professional. We must encourage association membership with all case managers, for that is the only path to achieving professional recognition and political influence."
Skinner adds that case managers have different needs. "It is unreasonable to state that there is only one organization that meets the needs of all case management professionals," she notes. "Some case managers will join organizations based on their practice setting or health care discipline. Some will join organizations to expand networking opportunities. Others will join based on educational opportunities. The importance of seeking and joining an association far outweighs the significance of which association you join as long as the association you select meets your needs."
If you join, don’t be a passive member, Owen stresses. "Get involved! CMSA and the other organizations and commissions are only as good and as strong as the people who volunteer their time and energy [to them]," she says. "The organizations need dedicated practitioners to go forward. The self-learning that takes place within professional organizations through program offerings, conferences, and networking is invaluable. I cannot stress enough how important it is to get involved for the strength of the practice and for the knowledge you gain that helps you become a better practitioner.
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