What’s in the future? More opportunities, fewer case managers

CMSA issues its top 10’ list of case management trends

There’s an increased demand for the services of case managers but, at the same time, a shortage of nurses, who typically move into the case management role.

These are among the trends identified by the board of directors of the Case Management Society of America (CMSA), based in Little Rock, AR.

CMSA polls its board of directors annually about trends in case management as part of the organization’s focus on meeting the needs of practicing case managers in a changing health care environment.

The nursing shortage will have a big effect on case management, since the large majority of case managers are nurses. At the same time, there is an increasing demand for case managers.

"If you look back just five years ago, case managers worked primarily in workers compensation and in independent case management businesses," says Karen Chambers, RN, CCM, CDMS, president of CMSA. Now many health plans, physician offices, and other providers have case managers.

At the same time, the aging baby boomer population creates a growing demand for coordination of health care services, including a trend toward individuals hiring case managers to help patients navigate the health care system.

"Case managers have a lot of opportunities, but along with opportunity, there is an increase in demand," Chamber says.

Because the role of case managers is expanding at the same time the nation is facing a nursing shortage, some case management roles are being consolidated for efficiency’s sake, creating frustrations and a heavy case load for case managers.

Chambers cautions that some businesses may be tempted to put people into the case management role without sufficient training, which could have a negative impact.

"The increased opportunities for case management and the shortage of nurses raises the question as to whether we should look past nurses and social workers to find case managers. I think that is one trend we are going to have to watch and see," Chambers adds. Here is the list of trends in case management for the future:

1. Demonstrating and improving outcomes of case management

"All case managers have anecdotal stories about how wonderful we are, but there is no standard method for measuring outcome and impact. We need to be able to demonstrate our value and our worth in terms that a CEO can understand," Chambers says.

The Council for Case Management Accountability, led by Sherry Aliotta, RN, BSN, CCM, has undertaken a lengthy project to develop indicators that measure the effectiveness of case management.

An initial draft of measurements that case managers can use to show their effectiveness is scheduled to be available for public comment in time for the CMSA conference in June, Chambers says.

The Council has been working on three state-of-the-science papers: "Patient Adherence Outcome Indicators and Measurement in Case Management," released last year; "Involvement/Participation Empowerment and Knowledge Outcome Indicators of Case Management," released in late 2002; and "Coordinator of Care," scheduled for completion later this year.

2. Consumer-directed trends

The public’s growing awareness of the case manager as a source of help with health care coordination and direct-to-consumer case management will create more demand, the board report says.

3. Chronic care management

These trends include disease management and population health management, elder care medical management, and the increasing need to spend more time with patients who require medicines but cannot afford them.

4. Education

There is an increasing demand for web-based case management education as well as in-house case management training to deal with the lack of experienced case managers.

The board of directors sees an increasing need for continuing education to maintain certification along with increasing difficulty in finding time and resources for case management education.

5. Case manager/physician relationship

Case managers can expect to work as a team with the physician and the patient in the future, the board predicts.

CMSA is convening a physician summit this month to improve effective collaboration between physicians and case managers in both payer and provider settings. Participants will represent multiple practice settings, payer/provider venues, and specialty disease states.

"I do believe that physicians are aware of case managers and based upon their personal experience have either a positive or negative impression. It is our hope that physicians can understand how to utilize our services and how to work with us for better patient care," Chambers says.

6. Increasing attention to cultural and linguistic competency

As our country becomes more multicultural, there will be an increased demand for culturally diverse case managers and for educational resources to support cultural competency, in addition to more demand for bilingual case managers, Chambers says.

"It is imperative that case managers understand the needs of patients and develop a plan of care with the provider, the patients, and their families. When case managers are working across cultural boundaries, it becomes even more important," she adds.

7. Legal and ethical issues grow in concern for case managers

There is a growing interest in legal and ethical issues relating to case management practice and how to understand the issues and avoid legal and ethical pitfalls.

8. Increasing CM legislation, rules, and regulations

Case managers need to be familiar with HIPAA, other federal regulations, and a growing body of state legislation, rules, and regulations governing case management.

9. Shifting case management roles and job functions

Among the items listed by the board under this category are use of case management software and other health care technology; increased need for certification and accreditation; an increase in case managers in emergency departments, home health, and skilled nursing facilities; decrease in use of critical pathways in favor of "evidence-based practice tools" and consolidation of utilization review, discharge planning, and case management into one department.

10. Growing need for more case managers

The growing recognition of the services that case managers provide, the aging of baby boomers, and their need for medically complex care and chronic disease management are among the factors contributing to this trend.