The Evolving Role of the Professional Case Manager

Case Management MattersStorytelling is a powerful way of connecting your passion to professional case management practice. Significant research demonstrates that this form of communication is very effective as a learning strategy in engaging others to build unique perspectives and understand the value and impact of a case manager on the individual patient, their family, and the organization of which they are a part (Davis et al., 2021). From a personal perspective, this article is a way for me to talk about my grief and build a compelling argument that there is a significant need to build professional case management practice in rural health care. Rolbiecki et al. (2021) would describe this article as my therapeutic intervention. So, let us begin.

Section: Reflective Discussionmentioning

confidence: 99%

The Tipping Point: A Personal Journey and Lessons Learned

White

2023

“…Although the report specifically addresses nurses, there are clear implications for case managers, the majority of whom have a professional background in nursing (Tahan et al, 2020). Specifically, the report's mention of care management speaks directly to case management practice, across professional disciplines, backgrounds, and care settings.…”

Section: Extending the Reach Of Care Coordinationmentioning

confidence: 99%

Addressing Social Determinants of Health

Campagna

Mitchell

Krsnak

2022

Purpose: Social determinants of health (SDOH) continue to gain attention as the factors that weigh heavily on physical and mental health. In response, professional case managers need to develop a deeper understanding of the entrenched nature of SDOH, particularly the spiraling and compounding effects of economic, environmental, and social factors on the health and well-being of individuals and populations. Professional case managers are essential to helping identify both the barriers experienced by individuals in accessing and receiving the care they need and the resources to eliminate or mitigate those barriers. These responsibilities should be most keenly felt by case managers who are board-certified and therefore held accountable by codes of ethics to ensure justice and fairness. By embedding greater awareness of SDOH into the case management process—from intake and assessment through implementation, evaluation, and across care transitions—case managers can establish rapport with clients (known as “patients” in some care settings) and support improved outcomes through best practices in care coordination, thus contributing to the Triple Aim of improving the health of people and populations and reducing the per capita cost of care. Primary Practice Settings: SDOH impact individuals across the health and human services, including acute care, subacute care, primary care, community-based care, and workers' compensation. Implications for Case Management Practice: Case management plays a vital role in providing people with episodic care and ensuring adequate follow-up. The latter includes if and how people are able to access the ongoing care they need, including medications (access and affordability), doctors' visits, therapies and other services, healthy nutrition, and more. However, a lack of affordability undermines an individual's ability to receive preventive care and treatment of chronic illnesses and potentially more serious and life-threatening conditions such as cancer. Compounding the impact of affordability can be a lack of transportation that inhibits access to health care professionals, which can affect individuals in both rural and inner-city environments. Although poverty and homelessness play a direct role in SDOH, case managers cannot assume which clients are impacted by these factors and which are not. Higher costs of living, loss of job or reduced income, unexpected expenses, and death of, or divorce from, a partner/spouse can negatively impact a client's ability to access and afford care. With this understanding, case managers can meet individuals where they are to explore how SDOH affects their lives, without judgment, bias, or assumption.

“…Documentation on the early history of CMSA reveals that a key rationale for creating a national case management organization in 1989 was to elevate case management from a practice to a recognized profession (Moreo, 1999). More than 30 years later, case management is a professional practice with oversight by national certifying boards, standards of practice well engrained in everyday practice, and advanced academic training in case management (Tahan et al, 2020). As the complex care of patients has evolved over time, the growth of advanced case management competency education has increased (Stark, 2020).…”

mentioning

confidence: 99%

Can History Change Our Future Course? Lessons From Case Managers Across Time

Moreo,

Llewellyn,

Sands

et al. 2023

Purpose/Objectives: History can tell us a lot. Through the lens of case management history, we can appreciate how our practice has evolved and what have been the sticking points along the way. We can better understand how our practice became knitted into the fabric of the health care system, and why we apply certain functions and processes of case management across different practice settings. Historical lessons captured by national case management organizations or found in the literature can help us think about how to improve the future, as well as the care we deliver today. Higher education is another good resource for honing our skills. As the complex care of patients has evolved over time, there has been growth in advanced case management education (P. Stark, 2020). Yet, not everyone has access to formal education. Primary Practice Settings(s): Practical knowledge gained from the experiences of other case managers is not only free but also valuable. When we are exposed to the practical experiences and advice of seasoned case managers, we create an opportunity for knowledge sharing and reverse mentoring, which can result in leadership development (S. Powell, 2013). This article provides a historical glance into the evolution of today's case management practice, as well as provides salient lessons and advice from senior case managers who share practical tips and stories for tomorrow's case management leaders. Mentors share their career-long experiences in hospital case management, rehabilitation case management, pediatric case management, military case management, and hospice case management. Findings/Conclusions: Valuable lessons can be learned from reviewing case management's history that can be applied to improve current and future case management practice. Sources of information can be obtained from national organizations as well as from a review of the literature. Senior case managers who have dedicated their careers to case management can also be a vital resource, lending insights into pitfalls to avoid and best practices to implement in everyday practice. Implications for Case Management Practice: The case management mentors in this article have imparted the following key points to assist tomorrow's case management experts in maximizing their value: Case managers across practice settings need to work together to streamline services for patients, enabling patients to navigate the health care system and find appropriate resources. Patients' biopsychosocial needs are as important as their clinical prognosis, whether in rehabilitation or at the end of life, and will require creativity to develop an individualized care plan. To remain motivated in an often stressful job, case managers should celebrate one accomplishment each day and be continuously mindful of one's own well-being. Identify and quickly adapt any specific nuances, information, and tools required to be successful in your particular case management setting. No matter what rank your job places you in, be a leader within your health ecosyst...