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Opportunities for CMs in changing health care arena
Make the public aware of your value
As the Patient Protection and Affordable Care Act makes sweeping changes in the health care environment, case managers have the opportunity to be the critical link between the patients and providers. At the same time, the profession also faces the challenge of educating the public about the role of case managers and the value they bring to the health care arena, says Teri Treiger, RN-C, MA, CCM, CCP, new president of the Case Management Society of America (CMSA).
"Making the public aware of case management and how we can help facilitate care is a subject near and dear to my heart. In today's world, where consumer-driven health care is coming to the forefront, case managers should take the opportunity to make the public aware of what case managers do and what case managers can do for them," says Treiger, a case management consultant based in Holbrook, MA.
Despite the efforts of the profession, many people, even those in the health care field, don't understand the case management process and the value that case managers bring to the table, she says.
Treiger tells of recently trying to schedule surgery around the CMSA annual conference.
"The surgeon turned to me and in the most sincere way asked, 'What is a case manager?' This was coming from a surgeon in a hospital with a very strong case management department. He truly had no clue," she says.
As the concept of patient-centered medical homes gains ground, there's a lot of discussion about how the primary care practices will coordinate care and ensure that people who need them receive resources in the community.
"People talk about these functions as if it's a new concept, but it's what case managers have been doing for decades," she says.
Even people who have benefited from case management services may not understand what case managers do, Treiger says.
"Many people don't realize that it's the case managers who are responsible for making sure their tests and procedures in the hospital occur in a timely manner, and that they have the services they need after discharge," she says.
Before people can have an understanding of case management, they have to know exactly what the job entails, Treiger says.
"The term case manager has been so misused and abused that it really is taking a focused effort to redefine it. If you look at the job descriptions of some people who are called case managers, they're clearly utilization managers or risk managers but they're called case managers," she says.
The public's lack of understanding about case management was brought home to Treiger last year when she worked with an organization that was setting up a case management pilot project.
"The level of mistrust was one of the biggest barriers to getting people involved in the program. Some thought we were bill collectors from the hospital. That demonstrates how misunderstood clinical case management is," she says.
CMSA has been working to educate the public on the definition of case management and is making progress, she says.
"As an organization, CMSA has been asked to present at various conferences to increase consumer awareness of case management. Case management is being invited to work with more and more important organizations. We have representatives on the URAC board of directors and advisory panels and on the National Quality Forum work groups. Last year, CMSA was invited to give input into the health care reform bills under consideration by Congress," she says.
"CMSA is working with educational institution and employers in the development of mentorships, partnering with hospitals and medical associations to define best practices, meeting with legislators and regulators to discuss pressing health care issues, and presenting at international conferences regarding case management and transitions of care," she adds.
As an individual, Treiger has worked on the local level to educate people about case managers and the services they provide and suggests that her fellow case managers do the same.
"I have reached out to elder councils and senior centers in my area and offered to come and speak to seniors. I tell them what case management is, what case managers do, and how they may have been affected by a case management intervention," she says.
Treiger's presentation includes information the seniors can use, such as tools that are available to help them keep track of medication and what they need to know if they are admitted to the hospital.
"This is not a situation where you put up a PowerPoint presentation. You just sit around the table and talk. If one person learns the value of case management or has a better understanding of what goes on when a loved one is admitted to the hospital, I consider the visit a success," she says. There's a grassroots effort to speak to more community groups about case management, she adds.
One of the biggest career opportunities for case managers is the patient-centered primary care home, Treiger points out.
"The direction the guidelines and standards are going make it clear to me that case managers are going to play a critical role if a medical practice wants to take a big leap forward and not just be a primary care provider but really become an advanced medical home," she says.
Case managers are going to be the fulcrum of the health care team in the patient-centered primary care practice, she says.
"The health care system is truly taking a leap forward by putting the patient in the center, rather than having the provider dictate the care. Some of the disciplines on the health care team may vary, but the constants are going to be the patient, the physician, and the case manager," she says.
The wave of new technology in health care offers big opportunities for case managers who want to step away for direct patient contact and are technologically inclined, Treiger says.
"We need people who are knowledgeable about case management to work with vendors and developers to come up with fantastic tools for case managers. We already have case management software, but what we really need is an electronic medical record with a case management component," she says.
Technology also presents a challenge for case managers to learn about and use the new technology in their daily jobs, she says.
"Now that the Centers for Medicare & Medicaid Services has issued the final rule to promote the adoption of electronic health records, there is a flurry of activity in the health care arena around use of technology and electronic communication. If case managers don't keep current with technology, it won't necessarily impact their jobs but it will impact the health care environment in which they work," she says.
One of Treiger's goals as president of CMSA is to keep case managers apprised about what is going on with health care technology and to help them understand how to use it to increase their efficiency and effectiveness.
She urges case managers to make their voice known as their organizations develop or purchase new technology, Treiger says.
"Case managers' input may make a huge difference in the development of technology guidelines and work flow. Case managers' expertise and value will be lost if they sit back and don't say anything," she says.
Treiger challenges all case managers and case management leaders in every practice setting to join together and derive strength from unity within the profession rather than working in silos.
"We will be our own worst enemy if we continue to go down the road with one group doing this and another group doing that. It causes confusion and will water down the message and the strength of case management. We need to respect each other's area of expertise and strength and figure out ways to work in unison, rather than with separate voices,' she says.