CMSA Today - Issue 3, 2013 - (Page 5)

President’s Letter Case Management at the Crossroads There are moments in our lives when we find ourselves at a crossroads. The choices we make in those moments can define the rest of our days. And, of course when faced with the unknown, most of us prefer to turn around and go back. —Lucas Scott L ong before I accepted my first case management position in 1984, there were many social workers and nurses who developed care coordination strategies and established case management as a vital component of health care delivery in America. They were the true innovators of the professional practice of case management who sought to balance the delivery of quality health care services with the necessity of conserving health care dollars. Through the years, case managers have continued to employ strategies that advanced these important goals. In doing so, we occasionally focused more on the cost of care and reimbursement for required services than on advancing the quality and the effectiveness of care provided to our patients. In some environments, case managers became the primary guardians of cost who validated the appropriateness of care without consistently advocating for either care coordination or the quality of care advanced through each stage of the health care continuum. As we move forward, familiar pathways for the provision of care and for the appropriate reimbursement will erode and, ultimately, be replaced with unique avenues for both care delivery and funding of necessary health care services. Even though care coordination and case management are mentioned in almost every strategy and regulation flowing from Washington, D.C., the legacy of the case manager as a gatekeeper of benefit dollars and the conservator of services remains. I believe that legacy has fostered a misconception of the primary roles and functions of case management. BY NANCY SKINNER, RN-BC, CCM In some environments, case managers wear multiple hats and the role of advocacy is often buried under mandates to achieve rapid, rather than efficient or effective, patient movement through the health care continuum. In other environments, the term “case manager” is relegated to those professionals and, in some cases, unlicensed or non-professional staff whose role is dedicated to establishing the medical necessity and appropriateness of care while facilitating a structure of health care delivery that conforms solely to the benefit plan. These steps may not consistently Case Management Issue 3 • 2013 • DIGITAL CMSA TODAY 5

Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2013

President's Letter
Public Policy Committee
Are You Just a Care Coordinator?
Moving Toward Meaningful Outcome Reporting
Lost in Translation
Association News
Index of Advertisers
CMSA Corporate Partners

CMSA Today - Issue 3, 2013