It’s really quite simple. To succeed in the 2010s, all a case manager must do is expand her practice to encompass the kinds of patients — millions of them — who will gain coverage under health-care reform. Integrate into her care plans and their execution the ever-growing range of services that today’s patients require. Coordinate care across the full range of psychosocial contexts. And perform wizardry with patient data to drive optimal care decisions and meet ever-tighter fiscal and regulatory standards.
Yes, the job of the 21st century case manager is much more complex and challenging than it was just a few decades ago. But the opportunity is greater as well.
“Case managers are working in new situations, in ways that will improve outcomes for patients and the bottom line,” says Margaret Leonard, MS, RN-BC, senior vice president for clinical services at Hudson Health Plan, a managed care provider in New York.
Health-Care Reform Expands Role of Case Manager.
Even given the legal uncertainties swirling around The Patient Protection and Affordable Care Act, health-care reform will drive many changes for leading-edge case managers in the 2010s.
“Health reform has care coordination written all over it,” says Sheilah McGlone, RN, CCM, CPUM, director of case management and utilization review for Hudson. Bundled payments, for example, are already motivating forward-looking hospitals to give a more prominent role to case managers. With courses of treatment for certain conditions reimbursed by a fixed, bundled payment, hospitals are likely to give case managers more resources and clout to coordinate care as efficiently and effectively as possible.
Meanwhile, given the demographics of patients to be newly covered by 2014, care coordination itself will require more advanced skills. “Under health-care reform we’re anticipating more people with coverage, and more people with pre-existing conditions that will require extensive treatment — some very complicated cases,” says Alan Boardman, an account manager for Beacon Health Strategies, a Boston-area provider of behavorial health-care management services. “So case managers need to coordinate comprehensive care.”
In addition, in the coming years the case manager will take on a much more challenging client-mentoring role. With patients who long lacked insurance, “we’ll have to do more patient education about what primary care is, and more health-care coaching,” Boardman says.
Forward-Looking Case Managers Integrate Services.
Case managers who seek to excel in these times are expanding the scope of their work, both within the health-care system and beyond.
First, the case manager will be responsible for creating and implementing a more tightly synchronized care plan that crosses the boundaries of specialties and institutions. “The trend in case management is integrating behavioral health with medical services,” says Boardman.
Says McGlone: “One case manager handles all care coordination of the patient whether behavioral or physical; there’s no handoff.” Case managers are also forging a greater role for themselves in patient transitions.
Overall, case management, according to the 2010 revision of the CMSA Standards of Practice for Case Management, now means “expanding the interdisciplinary team to include clients and their identified support system, and health-care providers including community-based and facility-based professionals.”
Coordinating Care in Context.
To serve their clients’ diverse needs, leading-edge case managers now must venture beyond clinical settings into the community, to create care plans that contemplate the social, psychological and educational milieus of their clients. “One of our intensive case managers is a licensed clinical social worker with experience in schools, so she knows resources in the school system and attends meetings to create individualized education plans,” says Boardman.
“We may need to meet the patient where she is; this is the new skill set,” Leonard says.
With increasing numbers of vulnerable patients in troubled situations, many care coordinators must also engage the human-service agencies that serve clients and their families. “Our case managers follow patients across the continuum of care and also weave in agencies such as the Department of Social Services and Child Protective Services,” says Boardman.
Data Informs Care Decisions.
Perhaps the most rapidly evolving area of expertise for care coordinators is their use of patient data. Long adept at describing their patients’ medical conditions and history, case managers who lead must now bring data to the task. “Case managers need to do more than just narrative reporting,” says Leonard. “They need to be working with fielded data, and they appreciate more and more that you can’t develop a good care plan without data mining.”
Indeed, gathering, analyzing and acting upon patient data plays a bigger part in the work of case managers than it has in the past. “I expect my case managers to analyze their patients’ data immediately,” says McGlone. “They download claims data, and that data can tell a story.”
Case managers tend to be highly organized people, and that often translates to an intuition for working with health-care IS. But not always. “In a lot of settings we hire case managers who don’t have a lot of information-systems experience,” Boardman says. “So we do a lot of training, which can be a challenge. There has to be an aptitude for technology.”
Case managers who lead in the 2010s will play a very active role in the development of the information systems that inform their practice. “Case managers can get involved in designing the systems they work with,” says Leonard. “If they don’t take the opportunity, the system may not work for them and their patients.”
What’s in store for case managers with the training, organizational skills and energy to excel in these challenging times? “Case managers now have opportunities to hone their skills in ways that are making a difference in their patients’ lives,” says Leonard. “And they’re getting opportunities to bring those achievements to the attention of their superiors.”
John Rossheim is a writer and editor who covers information technology, careers and other topics in health care.
Related Links:
> The Strategic Value of Case Management
> Case Managers, Listen Up: Empower Your Patients
