Posted on 09/06/2023 - 10:00 AM by MaryBeth Kurland, MPA, CAE, ICE-CCP | CEO, Commission for Case Manager Certification
In June, the Centers for Medicare & Medicaid Services (CMS) launched its newest innovative health care delivery model, Making Care Primary (MCP). The team-based care approach seeks to address complex health needs in the context of whole-person health. That includes evaluating and addressing identified health-related social needs—housing, food security, and behavioral health among them—and ensuring that covered individuals benefit from care coordination—what CMS calls “full care transformation.”
CMS’ new model is only open to primary care practices in eight states at this early stage, but its 10.5-year roadmap anticipates a future with much broader adoption. That’s because CMS is launching MCP with confidence that it will produce great outcomes. A recent report from the Department of Health and Human Services cites the evidence for positive impacts from holistic care models that address social determinants of health (including behavioral health), especially for those with chronic conditions. Whether it’s coordinating health care alongside help with housing, food, or transportation, studies show that keeping the person at the heart of collaborative care improves health outcomes and lowers cost.
For case managers, this notion of “full care transformation” is quite familiar; it’s simply keeping the person-centered approach to their client’s care—a perspective they bring to their role every day.
Collaboration can truly be transformative. This year, the Commission for Case Manager Certification (CCMC), the Case Management Society of America (CMSA) and the American Case Management Association (ACMA), have joined together as one voice to champion case managers as advocates, navigators, and change agents. During National Case Management Week in October, our organizations are united in spotlighting the important role case managers play on the health care team with the theme, “Keeping the Person at the Heart of Collaborative Care.” Together, we are raising awareness about case managers and the value of teamwork and partnership in ensuring optimal health outcomes through coordinated, whole-person care.
Our united voices are a powerful demonstration of collaboration for collective impact. All three organizations share a commitment to advocate for case management excellence and empower case managers through professional development. Our collaboration amplifies our ability to advocate for the case management profession as the whole becomes greater than the sum of its parts.
As advocates for collaborative care, case managers ensure that individuals are actively involved in their care decisions and planning. And as natural communicators, case managers know that you can’t help an individual achieve better health unless you’ve assessed the whole person—including clinical, behavioral and social health factors. Case management planning and implementation must include connection to the health and community resources they need. As navigators, case managers leverage knowledge and expertise to facilitate seamless transitions between providers and health care settings.
Care coordination and continuity reduce delays in care, which can be critical for complex cases involving multiple health care providers. Improving health outcomes and long-term well-being requires navigating essential social services as well. Making connections to the social services individuals need flows from expert communication, coordination, planning, and follow-up—all essential elements of the value-driven case management process.
Whether an individual is covered by a public program or employer insurance, the cost is too high to ignore the value of case management in whole-person care. Case management is rapidly gaining prominence among payers because it lowers the overall cost of care and boosts satisfaction rates. A recent JD Power health plan study found that Individuals with complex health needs benefit the most from case management, yet a recent study found that even among the commercially insured, only 17% of those with the worst health status were assigned a case manager. As our population ages and health needs become more complex, more skilled professional case managers are needed that are ready to listen, assess, and guide individuals to better health.
Advancing and supporting quality case management practice are among the Commission’s highest priorities. As we unite with other case management organizations to elevate the critical importance of case managers in team-based, whole-person care, we look to a future that leverages the strengths of our social, behavioral, and health care landscape—keeping the person at the heart of collaborative care.
 Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., & Sommers, B. (2022, April 1). Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. Washington; U.S. Department of Health and Human Services.
 Commercial Health Plan Member Satisfaction Declines in Key Areas, J.D. Power Finds. www.businesswire.com. Published May 31, 2023. https://www.businesswire.com/news/home/20230531005072/en/Commercial-Hea…
This blog was originally posted to https://allnurses.com/