CMSA president: CMs must demonstrate their value

Educate consumers, physicians about what you do

As she takes office as the 14th president of the Case Management Society of America, Sherry Aliotta, RN, BSN, CCM, is determined to make sure case managers no longer are "the best kept secret in health care."

"The evidence that is needed to truly demonstrate the value of case management is mounting, and the ability to measure creates the opportunity for growth and improvement," says Aliotta, president and CEO of S.A. Squared Inc., an independent consulting firm for the development and implementation of case management programs.

"We must take our message to consumers to educate them about case management and how we can work with them. We need to influence legislators and get a seat at the table where decisions are made and to collaborate with our physician partners to better serve our clients," she adds.

Case managers are in a position to wield considerable influence as the country tackles the burgeoning cost of health care and the problems with the system, Aliotta says.

"We have the opportunity to get our message out there in a way that is meaningful and understandable to the public and the other stakeholders. If people aren’t clear about what we’re doing, they’re not going to know how to use case managers as a resource," she adds.

One of Aliotta’s major goals for CMSA is for case managers to be able to demonstrate their value with quantifiable outcomes.

"An increasing challenge is to be able to demonstrate our value in very measurable ways," she says.

CMSA already has projects under way to help define and track three major outcomes directly related to case management: improved patient adherence, improved coordination of care, and improved patient education and involvement.

"The goal of the project is to have consistent outcomes measures used regardless of the setting so we can compare our outcomes in those areas. We have a project team that is working on producing an outcomes measurement tool," Aliotta says.

The organization has published Case Management Adherence Guidelines and is rolling out software support for the guidelines in conjunction with National Case Management Week, Oct. 10-16.

"We’ve known about the problem of nonadherence for years and nobody has done anything about it, even though there is a lot of information out there," Aliotta says. Nonadherence to medication costs the health care system more than $100 billion a year; increasing adherence by just 1% will save $1 billion, she adds.

"If we could show that we are able to improve patient adherence and we know what nonadherence costs, we can demonstrate the ability we have to make an impact on patient quality of life and on the cost of health care," Aliotta says.

CMSA guidelines

The CMSA guidelines give case managers a tool to assess patient adherence and attention, looking at their readiness to change, health care literacy, medication knowledge, and their social support system.

The guidelines help the case managers determine the patient’s particular level of readiness and give strategies to increase adherence based on the patient’s knowledge and motivation.

"The database will allow the case managers to record their assessments, interventions, and changes in adherence. We will be able to use the data they collect to report outcomes," Aliotta says.

The organization has published state-of-the-science papers on patient adherence and patient education and involvement and will publish a state-of-the-science paper on coordination of care in the near future.

Today’s case managers also must face the challenge of handling increasing numbers of cases at a time when the nursing shortage is impacting the supply of case managers, Aliotta adds.

On an individual level, case managers should educate the clients they are working with about what they do and what value case managers can provide.

Aliotta suggests that case managers create information for senior management in their company that describes case management’s value.

"In our everyday lives and in our professional lives, we need to be talking to people about case management, what case managers do, and the value they provide to the health care system," she says.

For instance, at one health plan Aliotta works with, the case management staff presents a case management success story at the monthly company meeting.

"They show how the case manager intervened to improve outcomes. This gives the other employees a better understanding of what they do, and when they see a friend or relative who could benefit from the services, they can suggest a case manager," she says.