CMSA Today - Issue 4, 2013 - (Page 8)

2012-2014 President’s Letter A View of Case Management Today “Too many people overvalue what they are not and undervalue what they are.” Malcolm S. Forbes C ase managers have moved from a period of anonymity – having previously served roles such as resource managers, discharge planners, and utilization managers – toward a future of recognition as care coordinators, patient navigators, and transitional care managers. In previous roles, we stood in the background – validating medical necessity, negotiating the cost of services and reviewing the appropriateness of continuing care plans. In the following years, the role of the case manager evolved to embrace responsibilities that were focused on fostering the identification and implementation of a care pathway for each patient the care manager served, which was designed to lead the patient toward patient-centered goal realization. This shift from cost manager to care coordinator gained the attention of payers, providers and – most importantly – the patients, families, and clients we assisted. Over the years, I have frequently said, “Case management is the best kept secret in health care.” And – until very recently– that was true. Today, however, the secret is out! The terms care coordination, care management, and case management are beginning to receive the recognition they so rightfully deserve. The phrase “care coordination” flows from the mouths of a number of individuals, including: legislators and regulators in Washington, D.C.; the leaders of both payer and provider systems; our professional colleagues; and patients who were previously lost in a maze of options, services, and uninformed decision-making – only to realize care coordination could light the path and lead the way toward the health care goals they were seeking to achieve. The Affordable Care Act has moved case/care management to the forefront, contributing to the establishment of strategies and a health care system that is safe, timely, effective, efficient, equitable, and patient-centered. Included in that legislation, as well as in the regulations born from it, are the following: • Value-based Purchasing including penalties to reduce readmissions and outcomes associated with a set of quality measures • Bundled Payments for Care Improvement • Comprehensive Primary Care Initiatives • Medicare Shared Savings Program for Accountable Care Organizations It is important to note that, in 2014, patient satisfaction surveys – commonly identified as the Hospital Consumer Assessment of Hospital Providers and Systems – are anticipated to include the following Care Transition Measures: 1. The hospital staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left the hospital. 2. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. 3. When I left the hospital, I clearly understood the purpose for taking each of my medications. BY NANCY SKINNER, RN-BC, CCM In the future, I believe case/ care managers will become the primary facilitators of positive patient satisfaction in regard to both the transitional care process and the achievement of a smooth “hand over” to the next level of care and the next provider of services. Based on an enhanced emphasis on coordination of care and the importance of patient education, empowerment, and engagement, I believe case managers have come a long way in gaining the recognition their endeavors have justifiably earned. However, as we celebrate, we cannot lose sight of the achievements yet to come and the barriers we must still conquer. In my own practice of nursing, I have noted some loss of unity and cohesion among nursing professionals; sometimes, I have heard less than collegial discussions regarding roles and responsibilities based on practice setting, educational background, and organizational alliance. If nurses would join together to recognize our commonalities rather than our differences, we might be even more successful in achieving the place in health care we have earned. This is also the case with case management, care coordination, and patient navigation. Abraham Lincoln stated, “A house divided against itself cannot stand.” The profession of case/care management will not stand the test of time if we, as case managers, do not join together with several goals, including: advancing the delivery of quality health care services and positive patient outcomes through each transition of care; learning from each other to facilitate a smoother transitional path for our patients; and, continued on page 35 8 CMSA TODAY Issue 4 • 2013 • DIGITAL http://www.naylornetwork.com/cms-nxt

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2013

2012-2014 President's Letter
Message From CMSA's President-Elect
2011-2012 President's Letter
Association Department
Ready to Launch: An Update on Career and Knowledge Pathways
Collaborative Care Team and the Benefits of Communicating Across Disciplines
View From Capitol Hill
Case Management and the Law
Ethics Casebook
Mentoring Matters
CMSA Corporate Partners
Index of Advertisers

CMSA Today - Issue 4, 2013

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