The world is our oyster,’ says CMSA Lifetime Achievement winner
Case management now is in the spotlight
When Margaret Leonard, MS, RN-BC, FNP, talks about case management and the impact case managers can have on patients and the healthcare system, her voice resonates with the passion she feels for her profession.
"The world is our oyster right now. Administrators, physicians, health plan officials, politicians, and individual patients are recognizing care coordination as a valuable service, and people are beginning to understand how the care coordination piece benefits the bottom line," says Leonard, senior vice president for clinical services at Hudson Health Plan in Tarrytown, NY, a member of MVP Health Care family of companies.
"The Affordable Care Act and other healthcare reform legislation all include the concept of care coordination as a standard of quality for healthcare. This is opening up new areas of practice for us and creating a whole world of new opportunities," she adds.
Leonard, Nurse Planner for Case Management Advisor, was recently presented the Lifetime Achievement Award by the Case Management Society of America, an organization Leonard has served as president and board member as well as chair of numerous task forces and committees. She is only the sixth recipient of the prestigious award.
Through the years, her tireless work to gain recognition for case management has earned her a national reputation as a case management advocate.
When Leonard became president of CMSA in 2009, her focus was increasing recognition of the value of case management, particularly among lawmakers and movers-and-shakers in the healthcare field.
In an interview with Case Management Advisor at the time, she commented: "We’ve gotten into the legislative game. We are working with partners who have political action arms, and they have been very generous in sharing their knowledge and their connections at the Centers for Medicare & Medicaid Services and the Office of Budget and Management."
After her term of office was up, she continued to work for recognition of case management. She was chair of the CMSA Public Policy Committee for eight years and now holds the title of chair emeritus. She also serves as chair of the National Transitions of Care Collaborative Public Policy Task Force. Both organizations are working for legislation that promotes transitions of care and care coordination, Leonard says.
Those early efforts paid off. Representatives of both organizations, including Leonard, have been invited to discussions about healthcare at the White House and at the U.S. Department of Health and Human Services.
"We are not changing the world overnight, but we are being listened to at every meeting. Policymakers are beginning to recognize and pay attention to case management and the standards we promote," she says.
It was when she was working with the Visiting Nurse Services of New York in the mid-1980s that Leonard began to recognize the value of care coordination. "When I was a nurse on the medical surgery unit and in the coronary care unit at South Nassau Community Hospital, I educated the patients using the teach-back method and thought they understood their post-discharge treatment plan. But when I became a home care nurse, I realized that patients were still confused about what to do and where to get their questions answered when they got home," she says.
Her patients were taking multiple medications and receiving services from multiple providers and had difficulty taking it all in, she recalls. As a home care nurse, she took it on herself to identify her patients’ needs, help them understand how to manage their own care, and communicate with their providers.
"The concept of coordinated care was foreign to those of us in the healthcare industry at the time. I didn’t think of what I was doing as coordinating care. It was just helping people get the services they needed, but I did observe that patients who had the best coordinated care got better quicker," she says.
At the time, the concept of managed care was just coming into play. Leonard was appointed to the New York State Senate Healthcare Task Force on Managed Care and was able to learn early on what was going to happen. "From there, I was able to make the jump into working in managed care. I knew I could make a difference if I took what I had learned about what care coordination meant to a patient and applied it to patients enrolled in a health plan. The transition from direct care to advocate care was rewarding because I could make a difference to a larger group of patients," she says.
When she started at Hudson Health Plan, Leonard had only one nurse in the clinical department. Today, she leads a 40-person team and has launched new programs for the health plan and collaborated with other organizations in the community to provide coordinated care across the continuum. Among her projects are The Westchester Cares Action Program, an award-winning Chronic Illness Demonstration Project that became a model for New York State’s Health Homes, a Special Care Program to manage special needs members who receive supplemental Social Security benefits because of disabilities and chronic disease, and the Mommy and Me Program, which provides consistent outreach and coaching by nurse case managers for members at risk for pregnancy and childbirth complications.
"If you look at many of the innovative programs that Hudson has introduced to the field of managed care, you will see Peggy’s fingerprints somewhere. She understands that patients lead complicated lives and that case managers have to find innovative ways to address both social and medical issues if they hope to make a real difference in a patient’s health," says Georganne Chapin, president and chief executive officer of Hudson Health Plan and executive vice president for corporate affairs at MVP Health Care.
Throughout her career, Leonard has been active in professional organizations and has received numerous awards and other recognition, including the CMSA Case Management Research Award, CMSA National Case Manager of the Year Award, CMSA National Award of Excellence in Adherence Management, Medicaid Managed Care Congress Medicaid Health Plan Innovation Award, Visiting Nurse Services Community Leadership Award, and New York State Nurses Association Legislative Award, to name a few.
She has served as a delegate to the Roundtable on U.S. Critical Care Policy since 2009, is vice president and a member of the board of directors of the Case Management Foundation, is a member of the Agency for Healthcare Research and Quality’s Transitions of Care Technical Expert Panel, and a member of the Quality Measurement, Research and Improvement Council and the Health Plan Council of the National Quality Forum. Her other activities include co-chair of the New York State Department of Health, Health Home Advisory Work Group; Certified Nurse at Large for the American Nurses Credentialing Center; Technical Expert Panel member for the Centers for Medicare & Medicaid Services Care Transitions Project since 2009; and is an adjunct instructor at the College of New Rochelle School of Nursing.
Her advice to case managers who want to make a difference: Volunteer to be on a committee in your department, with your local case management organization, and at a state and national level.
"Being on a committee gives case managers the opportunity to be at the same level as the senior leadership of the hospital or managed care organization. It gives you a voice and the opportunity to be seen as someone to go to for a solution," she says.