Future offers CMs opportunities, challenges

Services will be needed more than ever

As the Commission for Case Management Certification (CCMC) celebrates its 10th anniversary this month, leaders in the case management field believe that the demand for case management will continue to grow as the health care system becomes more chaotic and complicated than ever.

"There is an increased need, not just because of the convolutions in the health care system but because there will be more people who are not well served. They will require someone who is not a hands-on provider to guide them through the process and act as their advocate," says Catherine Mullahy, RN, BS, CRRN, CCM, of Options Unlimited, in Huntingdon, NY, and a member of the original task force that developed the credential.

Case managers are going to be dealing with an aging and more seriously ill population as the baby boomers grow older and people with catastrophic illnesses or injuries and people with complex care needs survive longer.

In addition, as our country becomes more diverse, the number of people with cultural and language barriers can be expected to increase. These people will need an advocate to help them through the system.

With increasing health care costs and more people who need complex care, case managers will be under pressure to move patients through the continuum quickly and ensure that they get the care they need.

At no time has there been a bigger need for case managers to act as advocates for patients as there is now, says Patricia McCollom, MS, RN, CRRN, CMDM, CCM, CLCP, president of Management Consulting and Rehabilitation Service Inc. in Ankeny, IA. She chaired the original steering committee of the National Task Force on Case Management, which concluded that the certification of case managers was necessary. She is past chair of CCMC.

"We have an opportunity to help resolve the problems that exist in health care delivery by putting a well educated, experienced care manager in the center with the patient. We’ve talked for many years about moving patients into the community quicker and sicker," McCollom says

The nursing shortage will affect case managers in all settings, says Carrie Ann Engen, RN, BSN, CCM, president of EnvisionCare Alliance Inc, in Naperville, IL.

Hospitals are facing shortages of care providers and simply do not have time for the patient education and patient monitoring that are necessary for good outcomes, making it more important than ever for case managers to act as patient advocates.

The staffing shortage also may mean that independent case management companies may have problems recruiting personnel because they simply can’t compete with the incentives that hospitals can offer, Engen says.

"In the other direction, you can provide better working conditions, better hours, and more flexibility, but we can’t keep up with the salaries," she adds.

Along with the shortage of nurses, the health care industry faces a shortage of experienced case managers as well.

"Many of my colleagues who began when case management was in its infancy are now retiring. Case management is not something that a new graduate can do. It requires experience and critical thinking," McCollom adds. Case managers must be experienced health care professionals who have the capability of integrating health care resources and options, she adds.

Case managers in the future will face constant economic pressure to show the value of what they do, from economic value to quality of life, Engen says. They will have to provide more information and documentation as to the value of case management services.

"The problem is that we are not good at measuring outcomes or identifying outcomes from a measurement standpoint. Because case management is a practice and not a profession, there is a big gap between those who do the research and those who practice," she says.

Educating the public about what case managers do is another challenge, since a very small percentage of people have ever been involved with case management and most have no idea what "case management" means.

The variety of settings in which case management is practicing presents another challenge — designing a credential that embraces all types of case management.

When leaders in the case management field were working on establishing the CCM credential, most case managers were either independent or in the insurance world, recalls Mindy Owen, RN, CRN, CCM chair of the ethics committee and a member of the executive board of CCMC.

Now, facility-based case managers are the fastest growing segment of the profession, she says.

Just 10 years ago, disease management and population-based management were practically unheard of, but now they’re a part of case management, Owen adds.