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Monday, October 12, 2015

Celebrating the Practice of Case Management





Plans for the first National Case Management Week first started in 1998 as an effort to help move the Case Management industry forward.  The Case Management Society of America’s Board of Directors agreed to a Case Management Week celebration during the week of October 10, 1999, a date chosen in honor of the Association’s establishment on October 10, 1990. Later, it was decided to mark the second full week in October each year as National Case Management. Today, Case Management Week is celebrated by all of the major professional organizations, certification bodies, payers and provider organizations across the broad healthcare landscape. The week is a time for all involved in the advanced practice of case management to highlight and share what they do and the outcomes they have achieved in improving the health and healthcare of all who transition through the complex and diverse healthcare system.

As a leader in the practice of case management, I wanted to use my Blog to highlight the important role case mangers play throughout the system in assisting patients, their families and all healthcare providers deliver safe, quality cost effective care across the broad healthcare system. 

Today, case managers can be found at every entry point of the healthcare system. Each are charged with ensuring patients receive safe, quality cost effective care that is evidence based and delivered at the right time and in the least restrictive setting. When this is standard practice, barriers are decreased, fragmentation and duplication are reduced and the cost of care is lowered.  

Today, consumers are starting to ask for a case manager from the payer or the provider organization caring for them. They are leaning that by working with a case manager, they better understand their diagnosis and have a way to remove the barriers that impact their ability to address their health and healthcare as well as their quality of life. It has been proven that wellness even in spite of illness is achievable when patients and their caregivers are active participants in their care.  Today, it is exciting to see the good work going on throughout the system when everyone works together; lives are saved, costs are contained and patient and provider satisfaction is improved. 

Yet we still have gaps to close as many people who could benefit from a case manager don’t know one is available, or are not offered case management services in a timely manner causing them to fall through the cracks of the system.  Many issues cause this; restrictions put on case management services, confusion as to what case managers do. In addition, providers and consumers confuse case management services with utilization management. One way to remember the difference is that utilization management is a reactive process where case management is a proactive process. There is a need for both, but they are not the same. Today, professional case manager use their clinical expertise to anticipate and address problems before they occur.  As a result, patients are more prepared and adverse events can be avoided. These proactive activities reduce readmission's and save healthcare dollars.Experienced case managers take the time to break down barriers and when given the opportunity are able to find resources to meet the patient's needs in a creative manner.

Case managers who work with the patient and their families take the time to establish relationships enabling them to have better success. They take the time to understand their patient’s goals and communicate them to the rest of the team so the plan of care is in concert with what the patient feels is important to them. 

They also take time to educate and empower their patients which gives the patient the ability to understand their condition and the plan of care that can help them deal with the stress it takes to improve their health and healthcare. Case managers work with patients throughout the lifespan from pre-birth to death. They are there to support patients and families when life changes occur and they are forced to enter the complex world of healthcare. 

When patients are part of the process and have a say in their care they are more prone to adhere to the plan of care. Case managers also take the time to work with the team to ensure they are informed and educated on barriers that exist that can derail the plan. 

To have a successful case management program, the program must be led by someone who understands the role and function of what case management is and can communicate this to the leadership. The Director, managers and supervisors must stand up for what case management is and work to have the concept infiltrated throughout the organization if it is going to work.  All members of the team have a role to play to ensure successful outcomes. Today, with outcomes tied to reimbursement this is more important than ever.

Case management when utilized appropriately, can make a difference in your organizations overall operations, finance, risk management, quality management, public relations as well as improving the morale of your staff and the consumers who utilize your organizations services whether you are a payer or provider. 

Case management should be taken seriously by the leadership of your organization and given the resources needed to run a successful program. As mentioned, the concepts of case management need to explained to all members of the healthcare team as well as the consumers who utilize the services your organization provides. 
 
In closing, I wish everyone a Happy Case Management Week! Thank you for all you do! Please know that you work is appreciated. 

I hope you and your team takes the time to celebrate your success and share the important work you do each day to improve the patient experience. Feel free to share the link to this week’s issue of Nurse Advocate with your team as well as consumers. If you have questions on case management, please feel free to email me at allewellyn5@bellsouth.net 

Also please take a minute to share how your organization is celebrating Case Management Week! 

To assist professionals seeking to enter or better understand the practice of case management or for the veteran case management professionals wanting to improve their personal and/or professional practice take time to review my 2016 Reading List for Professionals engaged in case management and care coordination. You can access the list by clicking here.  

Thanks for reading Nurse Advocate and have a good week!