CMSA Today - Issue 6, 2012 - (Page 7)

President’s Letter LOST IN TRANSITION n 2001, the Committee on the Quality of Health Care in America released a report entitled, Crossing the Quality Chasm: A New Health System for the 21st Century. This report sent forward a call to action to identify specific gaps in quality, to implement quality improvement strategies and to advance the delivery of quality health care BY NANCY SKINNER, services in all practice settings and RN-BC, CCM across all environments of patient care. The document also presented a vision of a redesigned system that consistently provides health care services that are safe, timely, efficient, equitable, effective and patient-centered. In the ensuing years, there has been much discussion from funders, payers, providers, and health care consumers regarding the overarching principles and concepts that are necessary to reach the goal of a quality focused and costefficient American health care system. These stakeholders sought one or more interventions, structures or actions that might be the solution to closing that quality chasm. And, although many solutions were proposed, implemented, and subsequently evaluated, no one program was shown to be consistently quality focused and fiscally accountable across all provider environments through each transition of patient care. As a case manager, I often rushed forward to suggest to those funders, payers, providers, and even those groups of health care consumers that care coordination across each transition of care is an essential element of advancing quality and promoting the appropriate use of health care dollars. While many of those stakeholders appeared to realize the value of case management, they often expressed concern regarding the primary goals of case management. On more than one occasion, case management has been solely viewed as a cost management tool; dedicated to managing the medical necessity or appropriateness of care or limited to authorizing required care or services. This is not the sole role or primary function of case management. Case management may incorporate some cost management functions but the true role of the case manager is the coordination of care through each patient transition of care. That role includes patient engagement, empowerment, and education in order to advance patient-centered care, to promote patient safety, to support timely access to care, and to support the advancement of care that is efficient, equitable and effective – all components of that call to action that was I recommended by the Committee on the Quality of Health Care in America over a decade ago. It is my opinion that even as our patients may be lost in a transition from one site of care to another, the practice of case management is experiencing some transitional issues itself. Although the Standards of Practice for Case Management clearly define the role of case management, some employers, some professional colleagues, and some health care consumers continue to view case managers as cost managers with no focus on patient advocacy. If our primary focus was once solely cost containment, have we, as a profession, truly transitioned to a comprehensive role of care coordination through each transition of care? And, what is the true value of those services and interventions? To gain consensus, we must participate in research that seeks to validate the efficacy of health care case management through each transition of care. Several articles in this issue of CMSA Today demonstrate how research contributes to confirming the value of care coordination. Review them and consider how you might participate in future research that seeks to confirm the important role that case managers play in balancing quality and value, in advocating for individuals and populations, and how we make a difference for all we serve. And, while we await the results of future research that validates the value of the care coordination role of the case manager, we must continue to celebrate the unique role each of us embraces as case managers. We are the mesh that holds the divergent pieces of health care together. Case management is the sole profession that balances the needs of the patient with the availability of services while fostering the delivery of quality health care interventions through each transition of care. Today, I ask each case manager to take a moment to realize the great gift the profession of case management represents. Each case should be viewed as an incredible opportunity to make a difference for our patients. When patients are lost in a sea of options and confusing requirements for care, we are available to listen, to assess, to plan, to facilitate, and to advocate. Each moment spent in the role of care coordinator is unique and one that may never come again. So, celebrate the opportunity and continue to contribute to the body of knowledge and research that is case management. And, again, thank you for working in partnership with the leadership and staff of CMSA to advance the practice of case management. Nancy Skinner, RN-BC, CCM CMSA President, 2012-2014 Issue 6 • 2012 • DIGITAL CMSA TODAY 7

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2012

VA Connecticut Healthcare System Improves Cancer Care
Operation: We Care
The Path to Payment for the Medicare and Medicaid EHR Incentive Programs

CMSA Today - Issue 6, 2012