Executive Summary

Case managers have skills and experience that make them natural public policy advocates. This is a role that’s greatly needed in this era of an evolving healthcare landscape, experts say.

• Case managers can influence public policy on the federal level as rules and guidelines continue to be written as part of the Affordable Care Act.

• States also need to hear from case managers about issues that affect the field and practice of healthcare.

• A goal should be to build long-term relationships with policymakers at all levels.

Professional case managers (CMs) make natural public policy advocates because of their broad knowledge of healthcare and their leadership experience. Such skills especially are needed to ensure case managers can have an impact on healthcare legislation and rules during this time of a changing healthcare landscape, according to several case management leaders and speakers about public policy involvement.

“Case managers’ involvement in public policy is critical,” says Patricia Noonan, RN, MBA, CCM, director of transitional and ambulatory care management at Northeast PHO in Beverly, MA. Noonan has spoken at conferences and written about public policy and case managers.

“With the healthcare landscape rapidly changing, it’s important the professional case manager’s voice is at the legislative table,” she adds.

“Case managers can be champions of public policy,” says Chriss Wheeler, RN, MSN, CCM, partner at Innovative Care Consultants in Independence, MO.

CMs are leaders with social influence and often have the elements of transformational leaders, including the ability to influence, inspire, motivate, stimulate intellectually, and consider individuals and what skills and talent they bring to the table, Wheeler explains. (See story on evolving into a CM leader in this issue.)

Organizations representing case managers have spent years advocating for the profession in public policy, says Connie Sunderhaus, RN-BC, CCM, vice president of CXJ Corporation in Glen Ellyn, IL. Sunderhaus and Wheeler have also spoken at conferences about public policy.

“Legislators need to be aware of how case managers coordinate care,” Sunderhaus says.

This has been especially true in recent years with the Affordable Care Act, she adds.

“With the passing of the Affordable Care Act [ACA] in 2010, we have all seen the healthcare landscape really be transformed and provide so many opportunities for new healthcare models that include professional case managers,” Noonan explains. “The fact remains that case managers have been blazing trails to advance quality healthcare in America for a long time.”

Federal grants and incentives have propelled the new care models of accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and community care transitions, she adds.

Centers for Medicare & Medicaid Services (CMS) transition grants are being used to improve the quality of care across the country, particularly for people living with chronic conditions, Noonan says.

“We know clearly from the latest published reports that one of the challenges our country faces is the growing aging population,” Noonan notes. “And we know that as the population ages, they are faced with chronic conditions.”

These realities provide an opportunity for professional case managers to work with patients and providers and take lead as part of a care team that is driving and advancing quality care, she adds.

When CMs decide to become more involved in public policy, the next step is to decide how they would like to be involved. There are multiple opportunities and needs right now, Noonan and Sunderhaus say.

For instance, the following are several examples:

Federal policy advocacy. The Affordable Care Act has resulted in many policy and regulatory changes that often are introduced without any input from case managers, Noonan says.

“Some of these policies may contain funding or specific language as to who can be a provider or be funded for the provision of services to various populations,” she explains. “So it’s critical that case managers be an active participant in reaching out to their legislators.”

Each person has a right as a constituent to talk with federal or state lawmakers and to show them how case managers are helping to advance quality care across the nation, Noonan says.

“We can do that by simply writing a letter or contacting our federal legislator and asking for an opportunity to meet and share information about how professional case managers are involved in healthcare and advancing quality care as part of the care team,” she adds.

One of the ACA’s missions is to improve care quality through a focus on prevention and management of chronic conditions while also reducing unnecessary costs and hospital readmissions. This mission fits in very well with what case management is all about, and it’s important that CMs meet with legislators and their staffs to help them understand how important case management is to improving healthcare, Noonan explains.

Professional organizations representing case managers have been meeting with federal lawmakers about ACA and other issues. So one easy way for individual CMs to get involved is to join a case management organization and support that group’s public policy efforts, Noonan says.

“It’s important we take the mystique out of getting involved in public policy,” she notes. “We have so many professional organizations that have mentors and public policy champions and individuals who would be happy to share and help or mentor and lead the way with case managers who want to be more actively involved in public policy.”

Case managers who are RNs could join the American Nurses Association (ANA) and the Case Management Society of America (CMSA) — both of which have public policy tabs on their websites, Wheeler says.

“Their websites have information about different bills that the professional organization is following,” Wheeler notes. “I receive e-blasts from ANA saying, ‘ANA is supporting this bill,’ and then they give me information about the bill, and if I want to make sure my legislators know about that bill and that I support it, I can put my name on a letter that they wrote.”

The organizations even provide a quick ZIP code search for CMs to find their local legislators, she adds. “It takes 10 to 15 minutes.”

CMs also could help influence federal policy by learning more about Congressional action telehealth, Wheeler suggests.

“Telehealth is something that can impact case managers,” Wheeler notes. “Some case managers are following patients [by telephone] from the hospital all the way into the primary care physician’s office.”

Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 in April, and this bill addresses telehealth policy, providing merit-based incentive payments for the use of telehealth to communicate test results and to use remote monitoring as part of care coordination. Also, the 21st Century Cures Act was passed by the U.S. House of Representatives and is now being considered in the U.S. Senate, where some senators have expressed interest in adding language that would address telehealth.

Wheeler has met with CMS officials when they’ve visited her city to discuss concerns over how Medicare defines case management services and to express concern that it isn’t defined so generally that it is meaningless when a healthcare organization says that it uses case management and meets Medicare rules: “I shared my concern that if we don’t have the right person doing the right job, then patients won’t have the right outcomes.”

State policy advocacy. A current example of how case managers can influence state policies involves the Nurse Licensure Compact (NLC).

The NLC allows nurses to have one multistate license for states involved in the compact. It was revised on May 4, 2015, after initially being launched in 2000 by the National Council of State Boards of Nursing (NCSBN) in Chicago.

The NLC was revised to address some states’ concerns that the original compact did not require criminal background checks, Sunderhaus says.

The original compact was approved by 25 states, but the new one must be approved again. (See story about the NLC in this issue.)

“This is a state-based issue and our state legislators need to make decisions about it,” Noonan says. “They could learn from case managers in states that have not joined the compact why it’s important that this particular state join the compact.”

When legislators are in their local districts, there is a good opportunity to meet with them and explain why the compact would benefit healthcare, as well as case managers and nurses, she adds. “Set up an appointment and be an active participant.”

Build relationships with policymakers. Even at the local level, it is important for CMs to meet with council representatives and other policymakers to share information about case management, Noonan says.

“Seek out opportunities to meet with your local legislators at a town hall meeting,” she suggests.

“My personal best opportunity has been to contact my local legislators’ office and find out when they’ll have their next town meeting,” Noonan says. “Then I set up an appointment and can be an active participant.”

Town meetings with constituents provide some of the best times to meet with policymakers to discuss issues that concern case managers and quality healthcare, she adds.

“Our legislators are interested in hearing from their constituents and hearing what are the issues impacting the population in their local district,” Noonan explains. “They’re interested in hearing from professional case managers.”

Meeting with your policymakers — both state and federal — when in their local district, also helps to build long-term relationships, Noonan and Wheeler note.

“It’s about individuals getting their voices out there, even if it’s to say, ‘Hey, I’m a case manager, and there’s a lot going on in healthcare. If you ever have any questions about case management, I’d love to help,’” Wheeler says.

“Our stories and our passion really resonate each time we meet with either local policymakers or legislators on Capitol Hill,” Noonan says. “It’s a great activity — to advocate for our professional practice.”