The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care delivered is efficient, effective, high quality and low cost. Never in our history has the role and the function of the professional case manager been more important. The expectations of today’s case manager are evolving and the experts in policy, research and industry are talking with the Commission about changes affecting case management practice.
The Commission’s Issue Briefs are offered as part of the CMLearning Network®. Each publication covers topics that are timely and relevant to today’s professional case manager. If you would like a hard copy of an Issue Brief for your staff, or for use at a meeting, we can send you a limited amount at no charge. Simply make your request by filling out the form in the sidebar, and we'll be happy to send them to you.
The Issue Briefs displayed below are the most recent.
A strong health care team that collaborates well can drive safer care delivery and improve client outcomes. The World Health Organization (WHO) recognizes interprofessional collaboration as an evidence-based strategy to enable stronger collaborative practice. Interprofessional collaborative practice can improve quality of care, prevent medical errors, reduce length of stay, and lower costs. As key care coordinators and excellent communicators, case managers can be integral to effective interprofessional collaboration.
“The WHO has defined interprofessional collaboration as occurring when ‘multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care,’” says Vivian Campagna, DNP, RN-BC, CCM, ICE-CCP, Chief Industry Relations Officer at the Commission for Case Manager Certification. “It is a partnership that starts with the patient and includes all healthcare providers working together to deliver patient- and family-centric care.”
Case managers, especially geriatric case managers, heroically help advocate for senior clients as they age and face end-of-life challenges. A century ago, the average American’s life expectancy was 57 years. At that time, there was no Social Security and no Medicare or Medicaid (or, for the most part, any health insurance). Those benefit programs weren’t universally needed, as only a small percentage of Americans lived into their 80s. Over the last couple of decades, life expectancy has greatly increased (although it has decreased in recent years—partially due to deaths from COVID-19). Now that it is common for Americans to make it to their 80s, and now that most deaths are due to chronic illnesses rather than from infectious diseases (save for the aforementioned COVID-19), seniors living with frailty may need assistance as they face their last days. While Medicare, Medicaid, and private insurances help with some aspects of care near the end-of-life, they do not perfectly help families care for their seniors in the care setting they prefer.
As a certified case manager or disability management specialist, you’ve likely either encountered or will encounter a client who needs to change their behavior for the sake of their health. When people’s habits are entrenched, encouraging beneficial behavior change can feel like an uphill battle. Fortunately, motivational interviewing (MI) can serve as a useful tool to motivate clients to improve their wellbeing.
“Case managers should know that many therapists use MI techniques, and so they should consider referring clients who have a need to address problematic health behaviors for expert help,” says Patricia Nunez, MA, CRC, CDMS, CCM, director at the office of claim supply management at CNA Insurance. “Case managers and disability management specialists may wish to get MI training to enhance their communication and coaching of their clients.”
Effectively transitioning a client from one care setting or provider to the next is fundamental to client wellbeing. Given that ineffective transitions can put clients at clinical, emotional, and financial risk, board-certified case managers must be experts at adeptly facilitating transitions to optimize health outcomes.
The variety of providers that clients see after leaving acute care can increase the likelihood of medical errors and patient safety mishaps. If a client is at high risk of falling after hospitalization for an injury and that risk is not conveyed to their next provider at a rehabilitation center, the client may be more likely to fall without close supervision. Suboptimal handoffs and inadequate transfers of information can increase the danger of detrimental outcomes.
“Primary care is inextricably linked to behavioral health.” With that, Teri Treiger, RN, MA, CCM, CHCQM, FABQAURP, chair-elect, Commission for Case Manager Certification articulates both the problem and the solution. Most outpatient mental health care takes place in the primary care setting. If you think about it, it makes sense: Primary care providers are often the first to observe and diagnose mental health issues, and they frequently write prescriptions for psychotropic medication.