Case Management Is The Critical Connection To Optimal Health Care

It’s a remarkable time to be in healthcare, especially as a case management professional. Changes in health care are happening at an unprecedented rate and include:

• Far-reaching health care reform efforts;

• Innovative new models of health care delivery and reimbursement;

• Public policy mandates to reduce spending while assuring quality outcomes; and

• Significant advancements in implementing patient-centered models of health care.

 

Case managers have often been the unrecognized voice in the health care industry, and the impact of case management has historically been underappreciated. However, with the passage of the Patient Protection and Accountable Care Act (PPACA), case management has taken a giant leap forward. This is because the concepts of care coordination and case management are key components woven throughout the PPACA. At last, case management is being acknowledged for what it is: the “glue” that carefully, creatively, thoughtfully, and successfully holds together the multiple parts and pieces of health care, regardless of the setting or where the patient is along the care continuum.

 

As a direct result of the PPACA¸ we can expect to see more opportunities and more demand for case management. The role of case management will become more highly visible and will be seen as pivotal in effective implementation of new models of care. For example, case managers can step up to leadership roles within Accountable Care Organizations (ACOs) to help design and implement care coordination programs and evaluate the outcomes. Case managers are ready, willing, and able to take on this challenge to help coordinate patient-centered care and ensure successful outcomes in health care quality and practice improvement efforts underway.

 

Health care reform efforts and a renewed focus on improving quality outcomes mean that there will be an increased utilization of case manager professionals throughout a variety of care settings. For example, case management is a central component of the patient-centered medical home (PCMH) model of care delivery. Case managers will be working with health care consumers along all points of the health/illness continuum—from wellness and prevention to complex acute medical care to chronic care self-management.

 

However, as the need for case managers across care settings grows, so too does the responsibility to maintain tight linkages between and among case managers along the various points of the care continuum. It is essential that case managers recognize when silos of care exist and work together to break down these barriers—because successful case management depends on shared efforts united by an ever-present focus on the patient as the center of the total health care experience.

 

Topping the list of public policy and accreditation mandates faced by hospitals is the directive to reduce hospital readmissions and improve patient safety. Case managers offer a significant contribution to meeting these quality goals by focusing on effective care transitions. Care transition programs aim to ensure that care is well-coordinated, well-communicated, continuous, safe, and timely as patients move across care settings, or across levels of care within a setting. Case managers know that improving communication, coordination, and collaboration throughout the care transition process results in better identification and elimination of gaps in care, improved medication adherence, better self-care management and self-care efficacy, and more effective utilization of patient support systems and resources.

 

No one can deny we work in an industry that is ever-changing and being driven by reform efforts aimed at reducing costs, improving access, and assuring quality. Case managers provide the common denominator and the key to success to dealing effectively with these forces of change because:

• Case managers use a patient-centered process of care coordination that includes meaningful, goal-directed communication and interaction with all key stakeholders—the patient, their family and support system, physicians, social workers, other members of the multidisciplinary care team—with the goals of promoting quality, cost-effective outcomes.

• Case managers work hard to promote effective communication across care settings to ensure smooth, coordinated delivery of care and services.

• Case managers believe in the power of advocacy, collaboration, shared-decision-making and education to promote effective patient engagement and adherence with evidence-based care and treatment plans.

 

For these reasons and more, case management truly IS the critical connection to optimal health care. There has never been a time where this has been truer. As we celebrate National Case Management week, let’s take a moment to really recognize and appreciate case managers for the vital role they play in optimizing health care as we journey ahead.