Problems, challenges on the horizon

Layoffs, opportunities are the norm

Depending on where you live, the changing healthcare environment could mean opportunities or challenges, case managers across the country say.

Some case managers who have been laid off in a downsizing move by their employer are having trouble finding a job. On the other hand, in areas where accountable care organizations (ACOs) and patient-centered medical homes proliferate, case managers might have their choice of jobs.

It's an exciting time for case managers and an opportunity to build the professions, says Cheri A. Lattimer, RN, BSN, executive director of the Case Management Society of America (CMSA), with headquarters in Little Rock, AR. Lattimer predicts a bidding war for case managers as the demand increases.

"There's already a workforce shortage, and the demand for good case managers is only increasing," she says. "Case managers may be recruited away from their current job by a higher salary or bonus structure. We believe there will be salary increases that are justified because of the extent of the services expected from case managers."

All of the initiatives being promoted by healthcare reform call for care coordination, points out Margaret Leonard, MS, RN-BC, FNP, senior vice president for clinical services at Hudson Health Plan in Tarrytown, NY. "Care coordination is mentioned frequently in the Patient Protection and Affordable Care Act," Leonard says. "We are in demand, and people know who we are. It's no longer a question of who is a case manager."

In New York State, some case management jobs are being eliminated by hospitals, but the case managers are finding jobs in health homes, ACOs, or at health centers. "Case managers are at a premium, and a lot of organizations are looking for case managers. I don't see the job market shrinking or salaries going down," Leonard says.

Rather than major raises, more companies are increasing benefits, including paying for case management certification courses and memberships in professional organizations, Leonard says.

In the Midwest, particularly in the health plan industry, some case management jobs are being eliminated because of streamlining efficiencies, says Mary Beth Newman, MSN, RN-BC, CMAC, CCP, MEP, CCM, president of the CMSA. "As health plans are focusing on transitions of care and readmissions, they're finding new ways to cut staff in the name of efficiency and cost savings," Newman says.

She tells of a case manager who was named Case Manager of the Year by her peers in the local CMSA chapter. The next week, she was laid off by the health plan where she worked because of budget cuts.

Some health plans have switched to automated reminder calls rather than having case managers call the members. Some tasks that case managers typically perform, such as screening members for acuity, are being outsourced to off-shore companies as well, Newman says. "They're not actually outsourcing case management, but there are pieces of what case managers used to do that are being outsourced," she says.

Members of the outsourcing companies' call center staff are calling patients to make sure they have appropriate follow-up care and have filled their prescriptions. If there is a red flag, they are transferring the call to a case manager at the health plan, Newman says.

Because of cutbacks in case management staff, most case managers in Newman's area are more concerned about keeping their jobs than they are about salaries going up, Newman says. "Salaries are inching up, not increasing significantly," she says.

There are a lot of job opportunities for case managers, but it may not be called "case management," Newman says. "They may be called health coaches or patient navigators, and the job may not be in the traditional sense of a case management job," she says. "Case managers have got to take the time to learn what is going on and the opportunities that are available for them."

In the Southwest, there are not a lot of job openings, and many case managers are sticking to their positions, says B.K. Kizziar, RN-BC, CCM, principal of BK & Associates Case Management Specialists, a Southlake, TX, consulting firm. Providers in the area are just beginning to talk about forming ACOs and patient-centered medical homes, she says. "The evolution of case management into transition care management and collaboration among levels of care are just beginning to cause some ripples in this area," Kizziar says.

At the same time, many employees have to pay more for their health insurance, she reports. For example, one Texas healthcare system has developed a tiered benefit plan in which the employee's contribution to insurance benefits is determined by healthcare risk. "I see more and more employers opting out of the healthcare benefit altogether," Kizziar says. "We as employees expect healthcare benefits, but in this economy, employers can't afford it, at least not at the same level."

Organizations also are cutting back on paying for continuing education, certification, and conference attendance, she says. "Case managers are going to have to assume responsibility for their own professional development," she says.