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If you’re not talking to patients, you aren’t doing case management, asserts Catherine M. Mullahy, RN, BS, CRRN, CCM, the new president of the Case Management Society of American (CMSA, with headquarters in Little Rock, AR). Mullahy is on a mission to make sure that everyone — payers, providers, patients, and the public — understands exactly what case management is and what it is not.
Case management is not a new concept. It is firmly entrenched in the health care delivery system, says Mullahy, who also is president of Options Unlimited in Huntington, NY. "Our goal is to clarify our role as advocate, educator, and facilitator," she says. "We address the needs of critical and chronic care patients in ways that benefit patients and all partners in care."
That’s why CMSA sponsors Case Management Week, an annual event to recognize case managers, educate the public about case management, and increase recognition of the contributions case management makes to quality health care for the patients, providers, and payers. "Case Management the heart of health care" is the theme of Case Management Week, Oct. 7-13.
"Case management is not brand-new anymore. It is in its adolescence, with the typical challenges of any evolving group of individuals," Mullahy says. "The problem is that, although there are standards of practices and codes of conducts and definition, case management still is not well understood — even by those who profess to practice it."
Mullahy’s goal is to make the distinction between what is and what is not case management and to let people know that the patient is at the heart of case management. Case managers tackle the kind of cases that can’t be solved by algorithms, care maps, or critical pathways, Mullahy points out. "There are all kinds of computerized systems, software systems, and databases to analyze data to death, but the people who need case management have complicated and diverse problems that do not lend themselves to the technological advances that are out there," says Mullahy. "They need a human solution."
"Case management is a collaborative process, and I am amazed at how people can think they can do it well without having a conversation with a patient or a family member who is the patient representative," she adds. "How can you develop a care plan, assess the needs of patients, and know if the interventions are working unless you have input from the patient or family members?"
Mullahy calls on other case managers to join CMSA in helping define the role of the profession. "As CMSA collaborates regularly with people involved in managed care and case management, we have a responsibility to our members to communicate what case management is. Not everyone who calls himself a case manager is indeed a case manager. If we aren’t making those distinctions, then who else could?" she says.
Mullahy suggests that case managers use Case Management Week as an opportunity to begin letting the public know about the role of case managers. (For tips on what to do, see "How to spread the word about case management," in this issue.) "We continue to talk only to each other and wonder why people don’t understand."
"The 3% to 5% of the population with major illnesses and convoluted problems can be served very well by case management. If more people understood how we help bridge the gaps in care, and how we can improve compliance and care outcomes, more people would be asking for a case manager," she says.
"The fact that the majority of case managers are women, with either a nursing or social work background, may make it more difficult for the profession to assert itself, Mullahy says. "Nurses or social workers often chose our profession to be team players and to make a difference in a supporting role. Now we find ourselves taking on the challenges and many opportunities to make a difference in leadership positions."