CMSA Today - Issue 1, 2018 - 28

PA S T P R E S I D E N T S C O R N E R

OH, THE PLACES CASE
MANAGERS HAVE BEEN...
AND WHERE YOU'LL GO!
BY CATHERINE M. MULLAHY, RN, BS, CRRN, CCM AND JEANNE BOLING, MSN, CRRN, CDMS, CCM

W

hile we (the authors) have
been involved in one aspect or
another of case management,
from the clinical and entrepreneurial sides
to education and training, for over four
decades, we weren't around when case
management started. That was back in the
mid-1800s. Then, the forerunner to what
we call case management today consisted of
providing healthcare services to the nation's
most needy primarily through a state agency,
specifically the Massachusetts Board of Charities. Of course, much has changed for case
managers from those earliest days when
"case managers" were largely coordinators
of public health services, record keepers
and, oh yes, patient advocates. Needless to
say, the opportunities for advancement and
financial reward for these case managers
were minimal, as were the education, training and credentials required. As our nation's
public health programs developed (e.g., The
Medicare and Medicaid Program in 1965),
so too did the profession of case management. Subsequent legislation designed to
facilitate the delivery of better healthcare to
Americans continued to ramp up the need
for case management provided by skilled,
qualified professionals.
Most recently, we've seen the "Patient
Protection and Affordable Care Act
28

CMSA TODAY

of 2010" ("ACA") set in motion higher
exposures for not having effective case
management in place. This has been particularly true for providers whose failures
to manage their patients' transition plans
resulting in preventable readmissions, earn
them lower Medicare reimbursements. Fast
forward to 2017 and what it means today
to be a case manager. Let's start by saying,
the opportunities are as wide open and
long as the journey taken by our predecessors starting back around the turn of the
19th century.
A MARKET VIEW
According to data in the Persistence Market
Research Report, "Global Medical Case
Management Services Market" (Report
ID: 4040035, August 2016), the global
medical case management services market
is expected to grow at a compound annual
growth rate (CAGR) of 3.0 percent over
the forecast period from 2015 to 2021.
Revenues are projected at over $5 billion
by 2021. Our aging population, increased
incidence of chronic diseases, greater multiculturalism, and heightened healthcare
legislation, from the Health Insurance
Portability and Accountability Act (HIPAA)
and ACA to the Health Information
Technology for Economic and Clinical

Issue 1 * 2018 * DIGITAL

Health (HITECH) Act, all have introduced
new incentives and needs for case management. Of course, there also remains the
evergreen reason why providers, carriers
and healthcare insurance plan sponsors
use case management: to manage claims
and contain costs. All of these factors have
changed the role and career paths for case
managers, who likely entered the field with
their nursing or social service licenses and
the desire to care and advocate for their
patients' better outcomes. They now have
before them multi-layered job descriptions
that require them to have new skills, meet
new regulatory demands, and serve older,
perhaps more ethnically diverse patients in
healthcare systems that reflect many new
characteristics.
LOOK HOW HEALTHCARE IN
AMERICA HAS CHANGED
Case managers today serve in a valuebased healthcare system marked by
increased hospital consolidation and new
care models, including patient-centered
medical homes and Accountable Care
Organizations (ACOs). These two new
models are noble in their missions to promote greater focus on patients, quality of
care and cost performance. They also have
placed case managers in the challenging



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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