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Case Management Advisor asked a panel of experts for their predictions of how the health care system will change in the next few years and what case managers need to do to stay in step.
Here are some of their predictions:
• Job opportunities are likely to increase.
There’s not a shortage of case managers yet, but a lot of companies are looking for people with case management skill sets, says Liza Greenberg, RN, MPH, vice president, research and quality of Washington, DC-based American Accreditation Healthcare Commission (URAC).
The larger insurers are looking for new ways to work with their data and to identify which patients can benefit from more intensive services early on, she says. Case managers can be part of the early warning system to show which cases are going to be high-cost as well as coordinating care and making sure patients move swiftly through the continuum, she says.
"Case managers are going to be more involved in getting people through the system more efficiently and making sure they’re not being held up because of a test and to make sure patients are at the right level of care," she says.
The recent URAC survey of 115 companies registered to do utilization management showed an increased interest in an expanded role for case managers, she says."The companies are using their data to predict patterns of high use in the future and to get the case manager involved earlier," she says.
• The increasing threat of bioterrorism will change the role of traditional case management and result in a new job — public health case managers.
Public health departments, particularly in large cities, are likely to employ case managers to manage vulnerable populations of patients in case of an infectious disease outbreak or other public health threat such as the anthrax scare, predicts David Kibbe, MD, MBA, chief executive officer of Canopy Systems Inc., a health care technology firm based in Chapel Hill, NC.
"There is going to be a need for a nurse case manager to be available when there are alerts and potential attacks," he says.
Case managers in all settings may encounter the need to transfer information about patients or groups of patients securely among facilities in the event of a catastrophe or emergency, he adds.
• There will be a new emphasis on disease management.
Recognizing that complications from chronic illnesses consume large chunks of the nation’s health care dollars, payers, providers, and employers are looking at ways to avoid hospitalizations and improve the lives of people with diabetes, hypertension, congestive heart failure, and other chronic illnesses. "If we can’t get a handle on patient care, the cost of health care is going to continue to increase. Case managers are going to be part of the solution to manage these populations," Kibbe says.
A small group of case managers on the payer side have been working with population-based health care guidelines, identifying target populations and high-risk patients and working with physicians to try to change patient behavior, Kibbe says.
"The disease management case management model involves guidelines that adhere to best practices. It’s moving into the provider organization," he adds. Large health plans, PPOs, and self-insured companies are turning to disease management to [achieve] better outcomes for people who are sicker or have more potential to get sick in the future," Greenberg adds.
• A new generation of patients will demand more computer-related health care information.
The Depression-age population is dying off and being replaced by baby boomers who are more involved with their own care and who demand more information about their conditions, Kibbe points out.
"Patients want a computer-literate information exchange. They want to know what their options are when they are sick, and payer organizations are going to have to provide that," he says.
If it hasn’t happened already, it’s likely that a patient will call you with information about a new treatment he or she learned about on the Internet and ask your advice, 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.