Case Managers: The ♥ of Health Care

Pat Stricker, RN, MEd, Senior Vice President, TCS Healthcare Technologies
 

Congratulations, Case Managers!                   It’s your week.                     October 12-18 is:

A week to recognize the contributions and commitments you make every day of the year.
 

According to the History of National Case Management Week, case managers have been honored with their own week since CMSA initiated it in 1999. As other organizations began to establish Case Management Weeks, CMSA approached them to collaborate and have all organizations celebrate during the second week of October in order to strengthen the movement and avoid confusion. In 2000, Tennessee was the first state to issue an official proclamation of National Case Management Week, and since then 43 of the 50 states have also done so. In 2011, the federal government recognized the value of case management when the Administrator of Health Resources and Services Administration at the U.S. Department of Health and Human Services sent a letter to CMSA citing the "vital contribution of case managers in coordinating quality, cost-effective patient services in collaboration with providers and insurers."

The evolution of case management began in the early 19th century with the development of professionalized social work and publicly-funded human services that provided services to the poor and needed. The first case managers were social workers and public health nurses who provided care and contained health care costs by coordinating services. This was prior to any organized government role in the delivery of these services. The first hospital-based social work program began in 1906 at the Massachusetts General Hospital.

In the 1920s, the need to manage chronic illnesses in psychiatry and social work increased, and house calls became commonplace. The, in 1932, the Social Security Act established a major role for the federal government in meeting human needs, bringing together several different programs (e.g., public assistance, social insurance maternal, and child health). Following World War II, insurance companies began to employ social workers and nurses to coordinate care for soldiers with complex injuries requiring multidisciplinary interventions. In the 1960s, federal legislation moved toward coordinating services by focusing resources in a systematized approach to target problems.

Formalized case management began with Medicaid and Medicare demonstration projects in the early 1970s. Legislative actions created separate social service agencies organized around the concept of a single service or set of services, resulting in a delivery system of separate bureaucracies. Attempts were then made to establish programs that would integrate services; these programs usually employed a social worker to arrange for and coordinate health and social services. In the mid-1970s, independent case management programs employing nurses were developed; these programs became the forerunners of today’s case management.

In the 1980s, as programs continued to evolve and become more widespread, case management teams began to include therapists, interdisciplinary teams, comprehensive service centers, and HMO-based physicians. In the mid-1980s, health insurers developed case management programs targeted at catastrophic injuries and chronic conditions, with the main focus on cost containment. Due to spiraling health care costs and reduced revenues and reimbursement, many organizations focused more on utilization management than case management. Hospitals were particularly challenged to focus on patient length of stay, early discharge, and management of costs. As a result, utilization management programs began to expand more rapidly than case management programs.

However, during the 1990s, case management programs began to increase in both the public and private sectors. The Case Management Society of America was established in 1990, and in 1996 it merged with the Individual Case Management Association (ICMA) to create the CMSA organization we know today—dedicated to the support and development of the profession of case management.

In the beginning of the 1990s, case managers worked without formalized standards of practice until 1995, when CMSA became the first professional organization to develop Standards of Practice. These Standards demonstrated to physicians, payers, legislators, and other members of the health care team exactly what the practice of case management was. The Standards of Practice made it possible for organizations to create policies and procedures to ensure compliance with requirements established by licensing bodies and accreditation organizations. With the successful implementation of these standards and consistent practice, organizations began to increasingly use nurses as case managers for the ever-increasing number of case management programs being developed. And today, case management is an integral part of health care delivery and becoming more important and widespread as healthcare continues to evolve.  

So... what is a case manager?  The following attributes explain the role of a case manager:

C     oordinator, Care Planner, Collaborator, Communicator, Cheerleader, Critical Thinker, Confidential Partner, Counselor
A     dvocate,  
S     upporter, Shared Decision-maker, Service Facilitator
E     ducator

M     ediator, Mentor, Motivator, Monitor
A     dvisor
N     avigator, Negotiator
A     ssessor
G     oal-setter, Guardian
E     mpowerer, Encourager, Evaluator,
R     esource, Record keeper (Documenter), Researcher, Relationship Manager

In addition, a case manager is a problem-solver, implementer, innovator, and an invaluable member of the health care team – the ♥ of health care!

A secondary goal of National Case Management Week is to educate consumers, other health care professionals, and policy makers about the value of case management and explain the case manager’s role. The following quotes found on Good Reads, Today in Science History, and NurseBuff exemplify these values and the role of case managers.

The final quote I will leave you with is one from Mary Gambosh, RN, CCM:

         "1975: an era where selling case management services was like selling ice cubes to an Eskimo."  

Even though it was difficult in 1975, Gambosh persevered and became a pioneer in the case management field, founding one of the first and largest case management companies in the U.S. In 1989, she was an integral part of the initial group that founded CMSA and served as the organization's first secretary-treasurer. Gambosh also served as CMSA National president in 1996 and was instrumental in merging the Individual Case Management Association (ICMA) and CMSA into today’s CMSA organization. As president, she tirelessly visited chapters sharing her limitless knowledge as well as encouraging and mentoring young leaders. The advice she offered in a 1999 article is equally applicable to today's case manager:

      "What can you do? Join the association of your choice and volunteer to assist wherever your talents lie. Ask what is being done to spearhead collective efforts to educate lawmakers, employers, health care consumers, and the media. Don't leave it to someone else. Your future may be at stake."

Gambosh worked tirelessly to educate others and mentor young leaders. Thankfully her vision, commitment, and dedication was passed on to our current CMSA leaders who have made the case management profession a valued, integral part of the health care delivery system. We all need to remember to do our part to advance the practice of case management for those who come after us.

Congratulations! Have a wonderful week!

Pat Stricker, RN, MEd, is senior vice president of Clinical Services at TCS Healthcare Technologies. She can be reached at pstricker@tcshealthcare.com.