In October 2018, the Case Management Society of America (CMSA) and the greater case management community celebrates National Case Management Week, a time to honor and recognize all professional case managers across the continuum of care in the United States. Case management has been practiced in the United States for over half of a century, and through that period we have assisted our patients and our clients in developing their plans to “move to wellness.”
This year's National Case Management Week logo reflects that movement; just as the CMSA's Standards of Practice for Case Management prescribe, we assess, plan, collaborate, implement, monitor, and evaluate our patients and clients to achieve improved outcomes. True professional case management requires a patient or client-centered approach, with influencers assisting along the way.
If someone asked you “what you do” in more detail, what would you say? What is the true value of a case manager from the perspective of the patient or family caregiver? Although we know our value, here are some facts to ponder about our very significant work.
Case Management Services
Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while utilizing available resources timely and cost-effectively to obtain optimum value for both the patient and the reimbursement source. Coordination of care, managing multidisciplinary teams, and achieving better transitions of care are the pillars of effective case management. We provide expertise and clarity to complex medical issues, including identifying obstacles to the delivery of prompt quality health care treatment and coordinating resources.
We are professionals who provide strategies to address challenges and ensure that care is patient-centered, safe, and effective. The key is in the coordination of care, with identified time frames for accomplishing appropriate care outcomes. Case management also provides a well-coordinated care experience to improve the care outcome, decrease the length of stay, and use multiple disciplines and services efficiently.
Transitions of care for people with multiple, serious chronic illnesses are critical points for promoting quality of care and reducing preventable, expensive, and debilitating hospital admissions and readmissions as well as avoidable emergency department visits. Most people with multiple chronic illnesses, which are often accompanied by functional and cognitive deficits, cannot manage their care on their own. Wherever and however they originate, care transitions are about addressing change over time and this must be addressed in health care reform, which must support reimbursements accordingly.
Case management is neither linear nor a one-way exercise, but rather a longitudinal approach across health care settings that is imperative to coordinate inpatient and postdischarge care. Facilitation, coordination, and collaboration occur throughout the client's health care encounter.
Legal and Care Reform
From a legal perspective, there is a myth and faulty belief among case managers and other experts that the standard of care is static, fixed, and permanent. The standard of care is a very important legal construct, as it is the standard against which we are judged in malpractice suits and licensing board hearings. Most broadly, the standard of care is defined as the usual and customary professional standard practice in the community. It describes the qualities and conditions that prevail, or should prevail, in a particular mental health service and that a reasonable, average, and prudent practitioner follows.
Generally, as more therapists practice in a new and unique way, this new way gradually becomes part of the standard of care. The standard of care is derived from statutes, case law, licensing board regulations, consensus of the professionals and community, and ethical codes. The standard of care is not a standard of perfection, black and white, determined by outcome, permanent, or fixed. It does not follow any particular theoretical orientation, nor is it guided by risk management principles.
Health care and case management are constantly changing, and it is our job as professionals, clinicians, and community members to make sure that we can continue to provide the highest level of care coordination possible for our citizens. We at CMSA feel that we are doing our best work to ensure the role of the professional case manager is known and respected by all health care professionals, policy makers, and consumers of health care services.
Future of Case Management
Anyone who reads the aforementioned discussion will recognize the importance, weight, and responsibility involved in being a case manager. The practice of case management is not easy, but the reward of rich relationships with clients, their families, and colleagues is immeasurable. We have come a long way in our educational endeavors, but we have more work that needs to be accomplished.
If you are not already a member of CMSA, please visit cmsa.org to learn not only about how we are celebrating National Case Management Week but also about all of the resources we make available for you to be successful throughout the year in this wonderful practice.
Truly, I am blessed to be a member and leader of CMSA and to learn from our membership each and every day. I often say that you were born caring, you worked hard to gain the experience, and with the right tools we can change the world.
Finally, when you're having a rough day, remember this phrase: “I'm not saying I'm wonderwoman, I'm just saying no one has ever seen me and wonderwoman in a room together.” We are wonderwomen and men!
During National Case Management Week 2018, we will celebrate the fabulous world of case management, right alongside you!
Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN
CMSA Executive Director