CMs, disease managers should collaborate

Work together to develop health strategies 

By Diane L. Huber, PhD, RN, FAAN, CNAA, BC
Mindy Owen, RN, CRRN, CCM
Commissioners, Commission for Case Manager Certification (CCMC)
Rolling Meadows, IL

As employers look at ways to deal with escalating health care costs, case managers likely will find themselves playing key roles. They will not, however, be the only ones in the game. Case managers complement disease managers as the two roles become integrated for more powerful care coordination.

Case managers likely will work in conjunction with disease managers as employers and their health plans launch comprehensive strategies to coordinate care, eliminate costly duplicated or unnecessary services, and promote wellness and prevention in the workplace. In addition, case managers also will find opportunities to work in disease management themselves, broadening their services from dealing with individual patients to also looking at specific groups within an employee population.

Case management and disease management do overlap at times, but these programs are distinct and different. Disease managers focus on specific groups of individuals who have been diagnosed with or who run a greater risk of having specific diseases or health conditions, such as diabetes or heart disease. The Disease Management Association of America defines disease management as "a system of coordinating health care interventions and communications for populations with conditions in which patient self-care efforts are significant."

Case managers advocate for the individual who needs coordination of care because of a serious illness, accident or flare-up of an existing condition, which may be further compounded by other health issues (known as comorbidities). The Case Management Society of America defines case management as "a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes."

As case managers and disease managers work together, there are some important considerations:

• Employees and their dependents need to experience case management and/or disease management as part of a seamless, integrated program, often with a single point of contact. Without a single point of contact, there can be confusion over whom to call and for what reason, which frustrates employees and makes these programs less effective.
• Although the employee experience may be seamless, behind-the-scenes case managers and disease managers need clear lines of demarcation for handling calls. A communication plan or map can delineate how calls from employees and their dependents are routed and referred.
• Communication and coordination among disease managers and case managers are essential, based on an understanding and appreciation of each other’s expertise.

Importantly, case management and disease management services must be administered in the right dosage. This involves the right amount and type of patient intervention, at the right time and with the right frequency.

With a foundation of cooperation, communication, and understanding, case managers and disease managers can come together under a common umbrella of "care management," as many employers are calling these integrated programs. Then as a patient’s health needs change, disease managers and case managers can work together to provide the specific services as needed in the most integrated and holistic manner.

For example, a person with diabetes may be enrolled in a disease management program, with education on diet, self-care, and wellness. Should that person suffer another health event — such as a heart attack — the case manager can step in as an advocate for the patient, coordinating care and ensuring that the right treatment is provided at the right time. When the patient is stabilized, the case manager may close the case, at which time the disease manager may take over again with education and support.

Given employers’ desire to reign in their costs for health benefits, one would expect to see more coordinated services. Clearly, this calls for case managers with their expertise as advocates for patients, and while conserving scarce and costly health care resources, to be instrumental as good stewards of resources and encourage applicable strategies. At the same time, case managers will work more closely with disease managers who focus on specific groups within a population. Together, they will promote optimal health and wellness of individuals — and better outcomes for employers looking to control costs.

[Editor’s note: Diane Huber, PhD, RN, FAAN, CNAA, BC, is the Immediate Past Chair of the Commission for Case Manager Certification (CCMC). She also is a professor at the University of Iowa College of Nursing, teaching case management courses, an investigator at the UI Center for Addictions Research, Institute for Strengthening Communities, and has a secondary appointment at the UI College of Public Health Department of Health Management and Policy.

Mindy Owen, RN, CRRN, CCM, is Chair-Elect of the Commission for Case Manager Certification (CCMC). She also is Principal of Phoenix HealthCare Assoc. LLC, a consulting firm specializing in case management, disease management, and managed care development and education.

The CCMC is the first and largest certifying body for case management professionals to be accredited by the National Commission for Certifying Agencies. URAC also has determined that the CCM credential is a recognized case management certification. For more information, contact the Commission for Case Manager Certification at (847) 818-0292 or visit the CCMC web site at www.ccmcertification.org.]