CMSA Today - Issue 4, 2016 - (Page 6)

President's Letter Navigating 360 Degrees of Health Care: Medical, Behavioral & Social BY KATHLEEN FRASER, RN-BC, MSN, MHA, CCM, CRRN T his issue is designed to focus on the professional aspect of case management, bringing to you- our case management community-a comprehensive navigation of the full circle that healthcare can revolve and incorporating all points of view. You should always try to get 360-degree feedback on case management innovations so that you know you are breaking things down from every angle. We discuss and examine unique and proactive approaches to case management that promote resiliency, member self-management, and skill-building to achieve optimal outcomes. Also, we cover how health plans are working with strategic provider partnerships to engage individuals in integrated case management programs that use patient-centered care planning techniques to achieve high performance goals. Timely data management and analysis supports and motivates interdisciplinary care teams to deliver outstanding quality scores and member satisfaction ratings, and these elements will be examined. Our self-titled "honorary case manager," Garry Carneal, will provide us with a look at the health insurance appeals process for case managers. Also, we will address the issue of professional case management versus nonprofessional case management, and the implications and varying perspectives. We will look at these perspectives in a 360-degree vantage, but are reminded there is a fine line between having a panoramic view of our healthcare topography and ending up down in the weeds and going around in circles, making no progress nor providing any positive outcomes. Healthcare trends and challenges are both energizing and exhausting for case management professionals, and we have started to be recognized, moving us from having to battle for our respected place to having it officially written into various models of care. CMSA, like case management itself, transcends every level of care in the full continuum. 6 CMSA TODAY Issue 4 * 2016 "Alone we can do so little, together we can do so much." -Helen Keller Our discipline is very large yet in many ways continues to be very small. The body of knowledge required to practice case management is rapidly growing as the specialty continues to evolve. Modern patient care must be based upon the holistic intertwining of information from a variety of disciplines, from the physical and behavioral sciences as well as the arts. As our activities become more sophisticated, so must our resources. Case management is neither linear nor a one-way exercise. Facilitation, coordination and collaboration will occur throughout the client's healthcare encounter. Collaboration among physicians, pharmacists, nurses, case managers, social workers, allied health and supporting staff is critical to achieving the goals of the team, the organization and changing the way we deliver healthcare today. Never before has the role of the case manager been incorporated into so many national mandates and local initiatives. We are called upon to educate and empower patients and their caregivers in order to activate them to truly take responsibility. Healthcare, however, is complex and difficult to understand and patients are searching for assistance in navigating it. Case managers engage patients to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve the best possible outcomes. To effect change and continue to assist in streamlining our delivery arena, we must all work together. As Helen Keller stated long ago, "Alone we can do so little, together we can do so much." I truly believe we were born caring, we went to school for the knowledge and we have worked hard to gain the experience. With the tools and the comradery that CMSA delivers, we can change the world! Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN President, CMSA National Board of Directors Kathleen Fraser is the president of CMSA National, and a past president of Houston/ Gulf Coast CMSA Chapter. She has more than 35 years of nursing experience, and more than 21 years of case management experience with 20 years in workers' compensation. Fraser has worked in acute hospital, long-term care, and insurance managed care. She can be reached at

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2016

President’s Letter
Association News
CMSA Corporate Partners
Triple Aim Requires Case Management “Target” Practice
Finding the “Right” Care Management System: “Must Have” Requirements + Structured Demonstration Process
Understanding the Health Insurance Appeals Process for Case Managers
Keeping the “Professional” in Professional Case Management
Patients Get Better Care When Doctors, Hospitals and Insurers Share a Common Interest
Index of Advertisers

CMSA Today - Issue 4, 2016