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By Sherry L. Aliotta, RN, BSN, CCM
S.A. Squared, Inc.
Farmington Hills, MI
No matter what you "used to be," you are now a case manager. I have been a case manager since before my son was born. As preparation for this article, I asked him to describe my job.
"Well, you used to be a nurse. Now, you find people who are really sick, and find cost efficient, yet effective ways to help fight the people’s illness. You’re a case manager."
After 16 years of living in the same household with a woman who nearly lives and breathes case management, he still struggles with a clear definition.
His and other comments have caused me to reach the following conclusions.
First, consumers must have a clear understanding of who a case manager is, what a case manager does, what they should expect from their case manager, when they should contact a case manager, and how to contact a case manager. We must make sure people know who we are and what we do.
Second, case management outcome measures are extremely important. We must demonstrate that we make an impact. However, we can’t just measure results. Results without a clear definition of the variables that yield the success can’t be reproduced.
Many individuals and organizations have taken great time and care in mapping out definitions of case managers and case management. Yet, many case managers find that they have to explain what they do to anyone outside and many within the health care industry.
There are many reasons. We come from a variety of educational and professional disciplines. We work in a variety of settings, and even our certifications are diverse
The perspective of each discipline only serves to enhance our effectiveness in handling the range of issues we encounter on a daily basis. The real issue is what we do.
Every day, managers are heard asking potential applicants, "What does case management mean where you currently work?"
If managers must ask, and the answers are only meaningful only to those of us "in the know," how can consumers be expected to understand?
We must identify when we are in the case management process and when we are not.
Our challenge is to communication our functions in a way that consumers understand. We must make it broad enough to encompass the diversity of situations faced by case managers and yet make it precise enough to be understood.
At the onset of case management, it seemed that "management" was the word that said it all. Now, case management has become a ubiquitous term. One physician recently told me, "Everyone I talk to now seems to be a case manager. I fully expect to go to Wal-Mart, have a person hand me a basket, and say Welcome to Wal-Mart, I am your case manager’."
What are the hallmarks of case management?
First and foremost we talk to the person who is at the center of our efforts—the client. One colleague recently said, "If you aren’t talking to the client, you are not doing case management."
Second, we are problem-solving experts. We handle anything relating to problems. A look at the steps of the case management process will help drive home this point.
With a health care system that even proponents admit has many problems, people who can involve individuals to solve health care problems would seem to be a valuable asset.
Third, we are guides. We point people in the right direction. We tell them of the perils ahead and how to avoid them. We help them navigate the strange and unfamiliar world of health care delivery and reimbursement. In a world where we commonly hear consumers say, "When it comes to health care, I am lost," a capable guide could represent a substantial benefit.
We are also connectors. In addition to guiding people to the best resources to solve their problem, we make sure the connection occurs, that the individual feels the right connection, and that the connection addresses the problem for which it was intended.
Case management is a very personal and individualized experience for those who are involved. Most of us derive a great deal of satisfaction from the relationships and the results. Somehow, this is often enough. None of us became case managers for the fame and glory.
Getting our message across just hasn’t seemed that important if we are making a difference one person at a time. Some of us are just plain uncomfortable in showcasing our accomplishments and values. I have often heard case management referred to as "the best-kept secret of health care," and in many ways this is true.
We must clarify our identity in a way that allows people inside and outside of health care to understand the role we play.
People don’t puzzle when you say you are a nurse. No one seems confused if you reveal you are a social worker. The role of the case manager needs to be as clear as these and others.
Because the role of the case manager requires many skills and encompasses a wide variety of tasks, this will not be an easy job. There are many documents that speak to this point.
And, while we still need to work making those in health care understand what we do, we should also try writing documents directed at our numerous consumer groups such as patients, health plan members, employees, and others.
We need to define and report what we do and the impact of those actions through outcomes that consumers of case management value. These outcome measurements must clearly reflect our mission as a professional discipline.
Our accountability needs to be clearly recognized and honored.
Satisfaction with our services should be researched and reported. This approval of our services should also be based upon clearly established expectations. Merely stating what should be expected of the case manager helps educate the consumer. Our accountabilities will help all of us decide who is and is not fulfilling the consumer’s expectations.
Most of us have transcended what we used to be, but we have yet to clearly identify what we have become.
The solution lies in sharing our story in ways that matter and have meaning to consumers. Everyone who has ever had an effective case manager wants one the next time they find themselves in need.
Our role is clear to people who have had case management. It has meaning. It has value. They can express their results. To them what we used to be is irrelevant. They value what we are. The solution lies in communicating that essence to those who need us.
[Sherry Aliotta may be reached at: S. A. Squared, Inc., 30137 White Hall Drive, Farmington Hills, MI 48331 Telephone: (248) 788-2986 e-mail: firstname.lastname@example.org.]