EXECUTIVE SUMMARY

Case management positions and hiring are on the rise as healthcare organizations respond to changes brought by the Affordable Care Act.

  • Supply of experienced care coordination and case managers is limited.
  • Organizations increasingly are sending a group of employees to take case management training.
  • Young nurses are drawn to the contemporary case management role because of its emphasis on working with patients.

Healthcare organizations nationwide recently have increased hiring of case managers and care coordinators as they respond to the Affordable Care Act’s push toward a population health model.

One of the chief obstacles to scaling up on care coordination and case management programs is the limited supply of experienced and trained case managers. However, this is beginning to change as new education programs are helping registered nurses and others transition to this role.

“Training new case managers is critical when you think about population health, Medicare, Medicaid, commercial insurers, who are all driving toward a more value-based climate,” says Kathy Parrinello, RN, PhD, chief operating officer at Strong Memorial Hospital, University of Rochester Medicine in Rochester, NY. The university’s school of nursing has a certificate program with up to six modules geared toward registered nurses. It includes a supervised mentor experience for care management.

“And now with physician reimbursement conditioned on meeting certain metrics, physicians are very anxious to get involved in new models because it provides them with an easier pathway,” Parrinello says.

In the last decade, the passage of the Affordable Care Act (ACA) and the Institute of Medicine’s report on the future of nursing suggested the need for increasing training programs for case managers, says Kelly Kruse Nelles, RN, APRN-BC, MS, faculty and co-director of the National Registered Nurse Case Management Training Center in Blue Mounds, WI.

“They were a strong impetus for us to really look at what was available for experienced registered nurses in practice who were going to move into these case management roles and would need a strong framework to impact successful care coordination,” Nelles says.

Awareness of the changes led Nelles and her co-director, Mary Jo Borden, RN, APRN-BC, CCM, MSN, to focus on training the next generation of case managers.

“We were both faculty in Madison, Wisconsin, and identified the need for this to happen quickly,” Borden says.

Nelles and Borden’s training program provides online, on-demand courses with interactive learning tools, as well as matching content in a classroom setting for students who prefer this educational venue. Students receive a contemporary case manager’s certificate of completion when they finish the course.

“One of the key components of active interest in enrolling in the course has occurred as a result of the shift to quality in payments,” Borden says.

Health systems are struggling with improving patient satisfaction and need to raise the bar to improve their quality of care, she adds.

“We’re moving from a sustainable growth rate to a value-based macro program, and it’s resulted in a lot of health systems finally understanding they can’t wait and need to implement changes to become patient-centered,” Borden explains.

“We have a couple hundred students take the program each year,” Nelles says. “We’re starting to see a definite increase in those numbers.”

Other educational organizations also are seeing increased interest in case management and care coordination classes among healthcare organizations.

“What I see increasing is organizations wanting to train lots of people all at one time,” says Elizabeth C. Shaid, MSN, CRNP, advanced practice nurse and clinical education core leader at the University of Pennsylvania School of Nursing in Philadelphia. The university has a continuing education seminar on the transitional care model.

“That’s been a real change in the last year,” Shaid says. “I’m getting calls from either organizations or insurers, or I had a state health agency that was putting together a program for a whole region of the state, and we trained 15 people all from that region.”

From a hospital or community nurse’s perspective, case management training is a way to bridge the gap between their clinical knowledge and experience, and the skills they’ll need to be care coordinators and case managers.

“What I hear from a lot of people trying to move from the nursing field to case management is a lot of places aren’t hiring because of the lack of experience in case management,” says Robin Sullivan, RN, BSN, CCM, team leader for case management at Deaconess Hospital in Evansville, IN. Sullivan is an instructor for an online certificate course in case management and care coordination, offered at the University of Southern Indiana in Evansville.

“The suggestion I give people is that the more education, the better,” Sullivan says. “I tell them to go and take certification courses that prepare them to take the certification exam because that’s a huge step.”

Many healthcare organizations are requiring employees to be certified. Also, the need for case managers has increased as a result of the Medicaid expansion and the ACA, which are increasing the numbers of people eligible for health insurance, Sullivan says.

“Nurses on the floor truly want to broaden their horizons and start something new, so they’ll take courses in case management as a first step to preparing themselves,” she adds.

The university’s case management program is one of 17 online healthcare certificate programs the university offers. The program’s enrollment was fairly small until the last few years, when it’s grown to more than 100 students in the last session, says M. Jane Swartz, DNP, RN, ACNS-BC, interim director of continuing education at the University of Southern Indiana.

Young nurses are attracted to the case management roles emerging and being reinforced in the post-ACA era, case management educators say.

“Younger nurses are attracted by the contemporary RN case manager role,” Nelles says. “They desire to be in a direct relationship with patients, caregivers, and families.”

Younger RNs also want to work with healthcare teams and are committed to moving into leadership positions within organizations that prioritize case management, she adds. “They see so many things happening in their organizations that they know they can contribute to.”

All RNs are involved in some type of care coordination, so the case management role is not alien to their experience, Borden notes.

Still, nurses will need some additional training when taking on the case manager role. Education plays a huge role, and students hopefully gain through training a better understanding of what case management is and the importance of the care continuum, Borden says.

Some case management educational programs, such as the online transition of care training offered at the University of Pennsylvania School of Nursing, can be easily scaled up to handle greater numbers of students, Shaid says.

“There’s no reason why it couldn’t educate more people,” she says.

“The foundation of transitional care seminar offers 20 units of continuing education with only one hour live per week,” she explains. “There are four hours of somebody doing the work on their own, so there is no reason it couldn’t be scaled up.”

Also, the training can be brought to any organization’s workplace for onsite education, she adds. “Last year we had several additional seminars set up specifically for an organization.”

Currently, the seminars are held five or six times over eight months with about 15 to 20 people attending each seminar, Shaid says.

For other educational programs, it would be more challenging to increase class sizes. For instance, the University of Southern Indiana’s web-based training is designed to be interactive with discussion boards, posted comments, questions, and feedback, Sullivan and Swartz say.

“I encourage my instructors to have interactions with the students, and you can’t do that when you have too many students,” Swartz explains.

The case manager instructors report that students gain more confidence, as well as knowledge about the continuum of care, when they complete these courses. They also gain training they can use to improve their workplaces and careers.

Nurses taking case management and care transition training just want to do a good job, Nelles notes.

“Over half our students pay their own tuition because they know they need the information,” Borden says.

The organizations that enroll staff in the sessions also find that care coordination training can make a difference.

“It’s not unusual for organizations to contact us to send a cadre of nurses to take the program together,” Nelles says. “When they take the program together, they are actively engaged in identifying strengths of existing practice, barriers, things they can improve on the practice level by themselves, as well as things that require system improvements and changes to improve patient care.”