New delivery models offer opportunities

CMSA keeps case managers in spotlight

New initiatives being developed as a result of healthcare reform, such as the patient-centered medical home and the accountable care organization, are new models of care delivery, but the concepts are not new to case managers, says Mary Beth Newman, MSN, RN-BC, CMAC, CCP, MEP, CCM, program manager, case management, WellPoint Centers of Medical Excellent, based in Mason, OH, and president of the Case Management Society of America (CMSA) with headquarters in Little Rock, AR.

"Patient-centered care has always been a core element of care management, but now, with healthcare reform, new eyes and ears are open to it," Newman says. "There are a lot of new partnerships and collaborative efforts under way to improve the care that patients receive, and care coordination is the key to all of them. Case managers are the ones who know what this is all about, and we have an opportunity to provide input and direction on key issues."

One of Newman's goals as president of CMSA is to ensure that the organization has a direct effect on the transformation to the new models so that the case management efforts are led by appropriate licensed and qualified professionals. "Although there's room for people with different levels of education in the new care coordination models, case managers have a responsibility to make sure that true case management, as defined by case management standards of practice, is provided by professional case managers. Non-clinicians cannot be a substitute for licensed case managers," she adds.

CMSA is educating members through its web site and local chapters about the evolving healthcare system and what it will mean to them. "A lot of opportunities have fallen in our laps with healthcare reform and all the new models of patient care, but case managers can't take advantage of them if they don't understand them," Newman says.

CMSA is working on partnerships with key organizations in the healthcare arena, professional associations, accrediting bodies, and government and regulatory agencies to provide input, she says. CMSA leaders are providing information and feedback on the new innovative models proposed by the Centers for Medicare and Medicaid Services (CMS) through its new Innovation Center (http://innovations.CMS.gov) and met with CMS officials last November to discuss the current proposals. The organization nominated Hussein Tahan, DNSC, RN, president of International Healthcare Management and Consulting, a New York-based case management consulting firm, to chair one of the key committees at the National Quality Forum, and he was elected, Newman says.

CMSA continues to promote the value of case management and to raise awareness of the contribution that case managers make, not just to healthcare professionals, but to purchasers and recipients of case management services, she says. "Purchasers, such as employer groups, who contract for case management services, are primarily interested in cost reduction and savings," she says. "We know case managers affect the cost of care by ensuring that patients get evidence-based care in a timely manner and by helping individuals keep their conditions under control, and stay healthy and out of the hospital."

The organization is working with the Bureau of Labor Statistics (BLS) to create a new occupational classification for case managers. "As we have worked with Congress on the Affordable Care and Patient Protection Act and other initiatives, lawmakers have asked how many case managers are in their states. That's a question we can't answer because there is no case manager classification in the BLS. RNs and social workers are clearly classified, but case mangers as we know them are not," she says.

To help individuals understand what they need to do to move to the next level of case management or to enter the case management field, the organization is creating a Career Knowledge Pathway. Teri Treiger, RN-C, MA, CCM, CCP, a case management consultant based in Holbrook, MA, and immediate past president of the CMSA, is leading the development of the online program. Phase I is expected to be available in June 2012.

"Case managers are at different stages in their career in terms of experience and training. They want to know what they need to do to move to the next level. The Career Knowledge Pathway will guide them," Treiger says.

For example, consider a nurse with 20 years experience who wants to go into case management or a new nursing school graduate who wants to be a case manager. "Their needs are different," she says. "One has extensive clinical experience and the other has none, and there are people at all levels in between who want to be case managers and need to know what they need to do to get started."

The Career Knowledge Pathway will be an online program that contains tools that allow people to input their experience and career goals and create a customized curriculum based on their unique goals, needs, and backgrounds. CMSA will provide online training to help them meet their goals.

[The Case Management Society of America's Resource Toolbox, available to members, is a collection of more than 100 white papers, websites, and other resources for case managers. Visit www.cmsa.org and click on "Resource Toolbox."]