CMSA Today - Issue 1, 2018 - 17

TALKING POINTS FOR DISCUSSION
GOALS:
CASE MANAGEMENT IS ESSENTIAL TO POPULATION HEALTH
1. Title Protection for Case
Management - Case managers are
licensed professionals with the experience to support consumers and their
families. Several professional groups,
including the Case Management Society
of America (CMSA), develop and maintain professional standards of practice,
along with several nationally recognized
certification bodies. Using non-licensed/
certified individuals for case management can jeopardize patient care and
creates opportunities for fraud.
2. Promoting Clinical Outcomes
- The Case Management Model Act
addresses many of the key building
blocks to improve clinical outcomes.
Case management is a collaborative
process of assessing, planning, facilitating, coordinating and evaluating,
to meet consumers' and their family's
comprehensive health needs.
3. Optimizing Value-Based
Purchasing - The Model Act can be
configured to be national in scope or
more targeted to support a range of
value-based purchasing initiatives. Case
managers can serve as the lynchpin on
many initiatives, including collaborative
care, to improve quality while optimizing the healthcare dollar spend.
4. Advancing Integration - By
leveraging a wide range of resources
and utilizing dynamic population
health solutions, the Model Act creates a pathway to healthcare integration. Case management offers a
unique and effective way to mobilize
resources to promote transitions of care
and reduce unnecessary readmissions
in a variety of healthcare settings. One
primary example is encouraging case
managers to help integrate care for
consumers who need both traditional
medical/surgical services in conjunction

with mental health and substance use
disorders (MH/SUD) services.
5. Improving Quality - The Case
Management Model Act promotes a
systems approach to quality improvement and clearly delineates between
the role of the case manager and other
support personnel, such as a navigator
or case manager extender. Case management provides services that are crucial
to improving quality and saving costs in
a healthcare system where the majority of healthcare dollars are spent on
chronic illness.
a. Facilitate Consumer Self
Determination - Shared and informed
decision-making, counseling and health
education. It is important to include
the patient or consumer as the main
decision maker.
METHODS:
HOW DOES CASE
MANAGEMENT WORK?
1. Coordinating Care - To address
current fragmentation and other inefficiencies, case management provides
critical services to help consumers and
their caregivers navigate, coordinate
and transition through a dynamic, interactive and evidence-based approach to
achieve their healthcare goals. These
efforts promote better clinical and
financial outcomes.
2. Engaging Stakeholders - A
primary goal of the case manager is to
bring together all the key stakeholders who are involved with supporting
a consumer. By working with attending
providers, family members, community
officials, payers and others, the case
manager creates a community supporting a customized case management
plan of care. This treatment plan creates
a blueprint shared by healthcare team

participants to guide the consumer's
care. As such, it provides the structure
required to coordinate care across multiple sites, providers and episodes of care.
3. Achieving Real Change -
Another primary goal is to engage the
consumer receiving case management
services to make real change in their life
to improve their health status and to
sustain a healthier and more active life.
Case management typically provides a
comprehensive needs assessment and
follow-up treatment plan that factors in
the individual's complex healthcare and
social needs, including co-morbidities.
SOLUTIONS:
THE NEXT GENERATION OF
HEALTH CARE REFORM
1. Identify Sponsors - Case management programs must be sponsored
and paid for as part of ongoing healthcare reforms and population management strategies. Case management
services are an under-utilized resource
for many programs. Without both public and private sector support, a key
opportunity to make a real difference
will be lost.
2. Getting the Word Out - Case
management remains one of the bestkept secrets in healthcare. Case managers assume a unique role advocating
for the best care for consumers, often
in settings where resources are limited
and needs are complex. As a result, case
management is one of the most effective
solutions in healthcare and must become
an integral part of the medical management system. ■
The Case Management Model Act,
revised version, was adopted by the Case
Management Society of America (CMSA)
Board of Directors in August 2017.

DIGITAL * Issue 1 * 2018

CMSA TODAY

17



Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2018

President’s Letter
Association News
CMSA Corporate Partners
CMSA: Reflection on Achievement and Moving Forward in 2018
Revised Case Management Model Act Promotes National Standards
The National Nurse Act
Changes to the Nurse Licensure Compact (NLC): Critical Information for the Nurse Case Manager
The Reflection of a Professional Case Manager: What Do You See in Your Looking Glass?
Past Presidents Corner
Index of Advertisers
CMSA Today - Issue 1, 2018 - Intro
CMSA Today - Issue 1, 2018 - cover1
CMSA Today - Issue 1, 2018 - cover2
CMSA Today - Issue 1, 2018 - 3
CMSA Today - Issue 1, 2018 - 4
CMSA Today - Issue 1, 2018 - 5
CMSA Today - Issue 1, 2018 - President’s Letter
CMSA Today - Issue 1, 2018 - Association News
CMSA Today - Issue 1, 2018 - CMSA Corporate Partners
CMSA Today - Issue 1, 2018 - CMSA: Reflection on Achievement and Moving Forward in 2018
CMSA Today - Issue 1, 2018 - 10
CMSA Today - Issue 1, 2018 - 11
CMSA Today - Issue 1, 2018 - Revised Case Management Model Act Promotes National Standards
CMSA Today - Issue 1, 2018 - 13
CMSA Today - Issue 1, 2018 - 14
CMSA Today - Issue 1, 2018 - 15
CMSA Today - Issue 1, 2018 - 16
CMSA Today - Issue 1, 2018 - 17
CMSA Today - Issue 1, 2018 - The National Nurse Act
CMSA Today - Issue 1, 2018 - 19
CMSA Today - Issue 1, 2018 - 20
CMSA Today - Issue 1, 2018 - Changes to the Nurse Licensure Compact (NLC): Critical Information for the Nurse Case Manager
CMSA Today - Issue 1, 2018 - 22
CMSA Today - Issue 1, 2018 - 23
CMSA Today - Issue 1, 2018 - 24
CMSA Today - Issue 1, 2018 - 25
CMSA Today - Issue 1, 2018 - The Reflection of a Professional Case Manager: What Do You See in Your Looking Glass?
CMSA Today - Issue 1, 2018 - 27
CMSA Today - Issue 1, 2018 - Past Presidents Corner
CMSA Today - Issue 1, 2018 - 29
CMSA Today - Issue 1, 2018 - Index of Advertisers
CMSA Today - Issue 1, 2018 - cover3
CMSA Today - Issue 1, 2018 - cover4
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