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Are We Prepared for Affordable Care Act Provisions of Care Coordination? Case Managers' Self-Assessments and Views on Physicians' Roles

Moreo, Kathleen RN-BC, BSN, BHSA, CCM, Cm, CDMS; Moreo, Natalie BS, BA; Urbano, Frank L. MD, FACP; Weeks, Matthew MA,; Greene, Laurence PhD

doi: 10.1097/NCM.0000000000000004

Purpose of Study: Care coordination, traditionally the purview of the case management field, is recognized as a national priority for improving health care delivery and patient outcomes. With reforms of the Affordable Care Act (ACA) of 2010, case managers face new challenges and opportunities in providing care coordination services. The evolving roles of case managers as members of interprofessional care teams will be influenced by new policies that enable physicians to be reimbursed for care coordination. This qualitative study aimed to evaluate case managers' self-assessed readiness for ACA reforms of care coordination and their perceptions of physicians' understanding of case management and ability to lead care coordination efforts in evolving models.

Primary Practice Settings: Provisions of care coordination in the ACA affect case managers in all practice settings. The majority of this study's participants represented hospital and managed care settings.

Methodology and Sample: An invitation to complete an 11-item online survey was sent by e-mail to 8,110 case managers in an opt-in database maintained by a health care continuing education company. Survey questions were designed to assess respondents' (1) self-reported levels of knowledge and preparation for ACA care coordination provisions and (2) beliefs about the readiness and abilities of physicians to administer care coordination services. In addition, demographic data and open-ended comments regarding physicians' roles in conducting care coordination were collected. Over a restricted 9-day period, 834 case managers representing various health care settings responded to the survey.

Results: The majority of respondents (63%) indicated that more than 50% of their day is dedicated to performing care coordination activities. However, 80% of all respondents reported being “not at all knowledgeable” or only “somewhat knowledgeable” about the new care coordination provisions in the ACA. Only 8% admitted to being “very prepared” to implement ACA changes. The majority of respondents (68%) perceive their case management departments to be at least “somewhat prepared” to implement necessary changes. Whereas 67% of respondents expect physicians to have at least a “moderate role” in implementing care coordination services, only 12% believe that physicians have more than “some” understanding of the processes of care coordination and case managers' roles.

Implications for Case Management Practice: These qualitative study findings suggest that case managers from multiple practice settings perceive a lack of preparedness, knowledge, and understanding among themselves and physicians regarding ACA reforms that may significantly affect the delivery of care coordination services. The findings call for new initiatives in interprofessional education to address the knowledge gaps and enhance understanding of the collaborative roles among case managers and physicians.

Kathleen Moreo, RN-BC, BSN, BHSA, CCM, Cm, CDMS, is President and CEO of PRIME Education, Inc., a national continuing education health care company. She is a past president of CMSA and has authored many peer-reviewed journal articles as well as online and print books in case management and care coordination.

Natalie Moreo, BS, BA, is a 4th-year medical student at Ross University School of Medicine. She has been involved in qualitative medical research as well as the development of graduate medical education supplementary curricula for residents.

Frank L. Urbano, MD, FACP, is Medical Director of Care Management at Albert Einstein Medical Center and Assistant Professor of Medicine at UMDNJ-Robert Wood Johnson Medical School. He also serves as Lead Physician Planner for PRIME Education, Inc.

Matthew Weeks, MA, is Medical Editor and Writer at PRIME Education, Inc. He is responsible for the editorial accuracy of PRIME's programs and ensuring the validity of all scientific communications. In addition to analyzing health care trends through survey research, he also develops content for various continuing education programs.

Laurence Greene, PhD, is Director of Scientific Education and Outcomes at PRIME Education, Inc. His position involves designing surveys for assessing educational outcomes and health care trends. He is a coauthor of many continuing education programs on care coordination.

Address correspondence to Kathleen Moreo, RN-BC, BSN, BHSA, CCM, Cm, CDMS, PRIME Education, Inc., 8201 W McNab Road, Tamarac, FL 33321 ( or Laurence Greene, PhD, PRIME Education, Inc., 8201 W McNab Road, Tamarac, FL 33321 (

The authors report no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.