With wide variety of organizations to join, which do you choose?

Some fear that case managers are losing their voice

Case managers have a lot of choices when it comes to what professional organizations to join and which certifications to pursue. There are a wide variety of organizations on the local, state, and national levels, along with several case management certifications.

Some movers and shakers in the case management field are concerned that the proliferation of specialty organizations will dilute the power of case managers to gain acceptance as a profession among other health care providers and the public and to have an influence on the direction the health care field is taking.

"Everybody seems to be going off into special interest areas, and we are losing some of the credibility and strength that comes in numbers. As we try to move forward into professionalizing the role of the case manager, this fragmentation could hold us back," says B.K. Kizziar, RNC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.

Some leaders in the case management field believe that if you’re doing case management, you’re basically doing the same thing as your colleagues in other venues, whether you work for an occupational health company, a rehabilitation facility, a managed care company, a hospital, or have your own consulting firm.

"Case management principles of practice don’t change with the setting. There are a lot of different case managers with varied educational backgrounds and practice settings who, fundamentally, are doing the same thing while working with their clients in different settings. They’re still case managers, no matter who signs their paycheck, and based upon that, their clients are the individuals for whom they advocate," says Connie Commander, RN, CCM, ABDA, CPUR, owner and president of Commander’s Premier Consulting Corp., and national president-elect of the Case Management Society of America (CMSA).

But case managers who practice in a particular specialty disagree, feeling that they need an organization that meets their special needs, says Greg Cunningham, chief executive officer of the Little Rock, AR-based American Case Management Association, an organization for hospital and health system-based case managers.

"Hospital case managers believe their practice settings, issues, and needs for networking and education are distinct. That’s not to say they couldn’t learn from case managers in other practice settings, but they wanted an organization that is dedicated to their needs," he explains.

Belonging to a specialty organization doesn’t preclude belonging to a broader organization, such as CMSA, but it does give case managers an opportunity to network with and be educated by people who do the same thing, points out Shelly Martin, RN, BSN, MHSA, CPHQ, CCM, CMCN, who is a member of CMSA as well as serving as president of the American Association of Managed Care Nurses (AAMCN), headquartered in Glen Allen, VA.

"There are so many different jobs under the broad umbrella of case management that one organization can’t provide everything that every case manager needs. That’s what the specialty organizations provide," she adds.

Regardless of the setting in which they practice and the organizations to which they belong, case managers need to join together and market themselves and their profession, Kizziar says.

"In general, the public has no idea of what case management is or what a case manager could do for them unless they’ve been given an opportunity to utilize our services. While specializing in a particular area is certainly important if that is your calling, case managers need to remember the foundation and basis of our profession and to speak as one voice in educating the public," she adds.

Case managers have long struggled to get the public to understand exactly what their job entails, Commander points out.

"If we can’t agree among ourselves what we do, how can we get the public to understand?" she asks, adding that CMSA has tried to address the needs of all case managers with varied educational backgrounds and different work environments.

Commander tells of attending a conference of buyers of health care, intermediaries, and consumers where the focus was on health maintenance.

"No one understood what a case manager was. Some people thought the case manager was the person you called to verify the insurance. Others thought our jobs were more like risk managers. If we want to have any kind of influence, case managers must unite and speak with one voice. The more we splinter off into separate groups, the more our voice will be diluted," Commander says.

Kizziar and Mindy Owen, RN, CRRN, CCM, chair of the Commission for Case Manager Certification, expressed concern that the proliferation of specialty organizations will weaken case managers’ voices in much the same way it happened with nurses.

"We in the nursing world have shot ourselves in the foot for years. We have so many specialty organizations in nursing that we have lost our voice. I believe that had we kept together and had one strong voice, the health care system would not be in the situation we’re in today," she notes.

Case managers provide a valuable service that other health care professionals can’t provide, Owen says.

"Sometimes we lose sight of the fact that, in addition to advocating for individuals, our role is to advocate in terms of the health care system. We don’t do ourselves, our patients, or the health care system a service when we fragment ourselves, losing focus on our commonalities and our ability to influence the delivery of health care," she adds.

But case managers who specialize want to be able to network with people who do the same thing and become proficient in their specialty in addition to learning about case management in general, representatives of the specialty organizations point out.

"CMSA has great conferences and a phenomenal learning library, but what’s missing is a significant amount of information on managed care. The CCM exam is one of the hardest I’ve ever taken. It’s an excellent credential, but there’s very little managed care information on it," Martin says.

A core group of hospital case managers started the American Case Management Association in 1999, Cunningham says.

"ACM’s six-year average growth rate of 25% annually seems to validate that distinct practice setting issues can be met by an organization solely devoted to their unique needs. However, ACMA is rooted in a collaborative philosophy and has, with CMSA supported the consolidation of previously separate National Case Management Week dates," Cunningham says.

The collaborative decision indicates that ACMA has a willingness to work together as a "common voice" for case managers, he says.

"Collective influence is not decided by the solidarity of everyone having the same credential or the same association membership. It is determined by professionals who are committed to what is in the best interest of case management practice deciding to work together," he says.

The ACMA concentrates on the practice of hospital case management rather than a generic case management practice. It has developed a definition for hospital case management, standards of practice, and a code of ethics.

"We scientifically validated through a practice analysis a distinct body of knowledge for certification, the Accredited Case Manager [ACM] for hospital-based and social work case managers. We focused our educational efforts on what is relevant to the hospital practice setting," he adds.

The AAMCN was formed in part to combat the negative perception of managed care and the misunderstanding about the role of nurses who work in the managed care setting, Martin says.

"In the past, managed care nursing hasn’t been recognized as a specialty. There wasn’t a lot of education and networking available between managed care professionals. The organization offers a huge opportunity to those of us in the field," Martin says.

Multiple memberships reap many benefits

Belonging to multiple professional organizations gives case managers the ability to share information and get information from a wide variety of people in other professional fields as well as the case management field, Commander says.

"We never want to stop people from joining organizations that represent their special interests, but we would encourage them to also participate with CMSA to share information and join together to educate the public on what benefits case managers can bring to the table. Having one all-encompassing organization will unite and strengthen our voice," she adds.

Kizziar is active in the Dallas-Ft. Worth chapter CMSA as well as two Texas case management organizations — the West Texas Society for Case Management and the Case Management Society of South Texas. The organizations each have about 300 members and neither organization is affiliated with CMSA.

"These are grass-roots organizations that pull together case managers from all areas of practice to network and to offer one another support," she reports.

Kizziar worked with the Dallas-Ft. Worth chapter of CMSA to bring together leaders from nine other chapters across the country and spend two and a half days with a facilitator looking at the issues and challenges that confront case managers every day.

"The grass-roots organizations are great, but we also need a centralized organization that will speak for all case managers. Case management principles of practice do not change, regardless of the environment in which the case manager practices. They may be used differently, but the principles never change," she says.

What can the individual case manager do to ensure that case management continues to have a strong voice in the health care field?

"Case managers need to understand the issues that face their practice and consumers as well as what professional resources are available to them and the publics they serve. They should be willing to go to a variety of meetings to learn and bring forward issues involving case management and the public. This usually takes a commitment to get involved in an organization at the local, state, and national level," Owen says.