CMSA Today - Issue 2, 2016 - (Page 6)

President's Letter Collaboration in Case Management BY KATHLEEN FRASER, RN-BC, MSN, MHA, CCM, CRRN W elcome to our second edition of CMSA Today for 2016, with the theme of Collaboration in Case Management! In my opinion, the theme could actually be titled Collaboration Is the Case Manager's Middle Name. It is what we do every single day of the year without even thinking about it. Collaboration is a deep, collective determination to reach an identical objective by working with others to achieve shared goals. As case managers we always advocate, not only for the patient, but also for the providers, the payer and in some instances the employers, to facilitate positive outcomes for the patient, the health care team, and the payer. However, as our CMSA Standards of Practice state, if a conflict arises, the needs of the patient must be the priority. A case manager's primary obligation is to his or her patients, and with ideal collaborative practice, the positive patient outcomes of quality care will be achieved. Case managers are found in hospitals, managed care within insurance companies, home health, long-term care, skilled nursing facilities, and the list goes on. We may be internal or external case managers, providing telephonic or field case management, or an amalgamation. We are most often the only party that is communicating with all stakeholders regarding diagnosis, treatment plan, and/or any activity need or report that is necessary to achieve the goals of optimum recovery of health and function. In my world of workers compensation dealing with the maximum number of stakeholders, the collaboration begins with the claims adjuster, the injured worker(s) (and/or their attorney), family members or significant others, the providers (there is always more than one with physicians, therapists and specialists), the employer, possibly a union representative, and last but not least, other case managers involved in each level of care from the emergency room, hospital, clinics, home health, step-down facilities, and on and on. Collaboration is the key, no matter what aspect of case management is your 6 CMSA TODAY Issue 2 * 2016 area of expertise - not an intersection of common goals, but sharing knowledge and building consensus. In this issue, we will discuss family-centered case management: improving outcomes with effective communication. Also, we'll discuss maximizing technology to improve clinical outcomes, illustrating ways that technology is improving care coordination and population health management. We will also look at ways of reducing avoidable admissions by building collaborative management teams addressing the needs of high-risk patients. Our own CMSA definition states, "Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, costeffective outcomes." It is a coordinative and goal-oriented process, to handle cases from opening to closure, interactively between all stakeholders. The most successful collaboration requires a leader, and since we are usually the only one in the team communicating with every stakeholder, the case manager is the natural choice. Although care may be provided by a range of providers and professionals, the case manager should retain oversight over the entirety of an individual's situation over time. "Fundamental to the collaboration is the presence of the case manager, taking the responsibility for overseeing and coordinating that care, and helping patients and caregivers to navigate the system." This gives a valuable sense of continuity for the patient, which is an important characteristic of any case management program. Indeed, patients and caregivers commonly report that it is easier to receive a response from a case manager than a provider or other health care professional. Categorization might suggest that case management is a linear process with sequential elements. In practice, of course, it is much more complex. Case management is neither linear nor a one-way exercise. The assessment responsibilities will occur at all points in the process; therefore, collaboration must occur throughout the client's health care encounter and in every step of our case management process. Through collaboration we can reduce duplications of health care, avoid gaps, and reduce health care costs: the essence of case management. It involves continual communication with patients, their caregivers, and the various professionals and services in which they come into contact. Fundamental to the collaboration is the presence of the case manager, taking the responsibility for overseeing and coordinating that care, and helping patients and caregivers to navigate the system. This navigational role is important, because most individuals selected for case management need services or input from one or more providers. The cumulative impact of multiple strategies (rather than single interventions) is more likely to be successful in improving patient experiences and outcomes case management and, therefore, should be seen as one of the key tools that is part of a wider strategy for integrated care. The key skill that case managers must have to integrate fully successful collaboration is having great interpersonal skills. It is essential that case managers are able to develop good relationships and communicate with a range of people. They need to be approachable and be able to demonstrate empathy, even when addressing minor concerns. A successful case manager needs to build effective relationships with patients and a

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2016

President's Letter
Association News
CMSA Corporate Partners
Index of Advertisers
The Ever-Changing Concept of Patient-Centered Care
Integrating and Coordinating Specialty Behavioral Health Care with the Medical System

CMSA Today - Issue 2, 2016