New year heralds increased need for case managers in health care

Look for emphasis on communication, disease management, technology

The new year is likely to bring more changes in the health care environment, and some of the changes could affect the way case managers do their job. The good news is that case managers will be needed more than ever as the health care system evolves. The challenge is that case managers are going to have to adapt to new ways of doing things in order to succeed.

The next phase of case management will involve much greater collaboration with payers and providers, and an increased flow of information among all parts of the health care system, predicts David Kibbe, MD, MBA, chief executive officer of Canopy Systems Inc., a health care technology firm based in Chapel Hill, NC.

"The next generation of case managers is going to have to be part of a team that is making care more efficient and more effective. They’re going to have to think more about information management and using technology. It’s going to be a real challenge that all case managers are going to have to face," he says. (For more information on the need for technology in case management, see "Get on the tech bandwagon or be left behind," in this issue.)

Case managers are the glue that holds a fragmented health care system together, and if the current system is to survive, case managers will have to be increasingly involved in coordinating among the various levels, asserts Brian D. Klepper, PhD, president of Healthcare Performance Inc., a Jacksonville, FL-based health care business development practice, and executive director of the Center for Practical Health Reform.

"Case management is the professional embodiment of managed care. It is a professional role that has the job of taking a multifaceted, compartmentalized system and being the intermediary link within it, being the advocate for all the players in the system," Klepper says.

The combination of increasing health care costs and the current financial downturn could wreak havoc with the current system, Klepper says. (For details, see "Reform needed to save flagging health system," in this issue.)

"If we are going to save the existing health care system, we’re going to have to develop standards requiring that things are done in a relatively consistent way within a complex and fragmented system. Case managers are the only ones who are in a role to provide oversight in that process," Klepper says.

As the system becomes healthier, the case management role will become more and more important, Klepper asserts.

But increased autonomy for case managers is not a done deal, Kibbe says. He tells of a CEO of a 15-hospital system who commented that if things ran smoothly with the patients and payers connected, there wouldn’t be any need for case managers.

"Case managers need to be very smart about showing their value and adopting the appropriate information technology to make them part of an efficient system," Kibbe says.

He recommends that case managers be able to show that they are tracking avoidable days and how their interventions are decreasing costs. "Case managers will come into their own, provided they are smart about proving their value, and ask for and receive the right tools and resources. They are going to have to get better at the business side of health care," he says.

As the consumer movement in health care grows, case managers are likely be on the front lines, helping patients make appropriate choices about treatment options and health care providers, says David B. Nash, MD, MBA, the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and Medicine and Director of Health Policy and Clinical Outcomes at Thomas Jefferson University in Philadelphia. Nash will make a keynote presentation at the Case Management Society of America conference in June. "The consumer movement in health care is a powerful force. Case managers are going to be leading the charge and even, perhaps, reluctantly dragged along," he says.

Instead of just going where their primary care physician recommends for care, health care consumers of the future are likely to shop around and look for providers with the best published outcomes that they can track online, Nash says.

"With the growth of the Internet, consumers are becoming savvier shoppers for health care services, and they are going to turn to case managers to guide them to the appropriate web sites for patient education materials and provider settings, and for their personal advice," he adds.

That’s why case managers need to educate themselves to help consumers make the most appropriate choices, he adds.

New technology is going to make tremendous changes in the way health care is delivered, and case managers need to keep up in order to help their patients, Nash adds.

For instance, already patients are able to send information on blood sugar, cholesterol levels, lung status, and other conditions to their physicians over the Internet.

"Case managers need to educate themselves and be up to speed on the new technology so they will be in a position to explain it to the patients. Physicians aren’t going to be able to take the time to educate the patients," he says. Case managers will be on the front lines of consumerism in health care, Nash asserts.