CMSA Today - Issue 7, 2012 - (Page 5)

President’s Letter EMBRACING THE ROLE OF CARE COORDINATION Through the Health Care Continuum T BY NANCY SKINNER, RN-BC, CCM One case manager told me she often felt like a hamster in a wheel; running faster and faster but never making any progress… Case management should never be “running” from one task to another task; it is not a check-off list; it is not successful in environments that foster a “did that, need to do this next” mentality. he title of this article evokes a memory of an enthusiastic orator at an educational program that I once attended. The speaker was steadfast in his conviction that case management is the ultimate solution for removing almost every barrier that compromises the ability to consistently deliver quality health care in America. During that presentation, he listed all the members of the multidisciplinary team and stated the role of care coordination must fall to case managers since other health care professionals embrace a variety of direct patient care responsibilities and are generally unable to advance the processes necessary to achieve a successful transition of care. He went on to describe the case manager as primarily a patient advocate who is the guardian of health care dollars while supporting the patient in navigating each health care encounter through the health care continuum. He also referred to case managers as the glue that holds health care together and the conduit for the provision of safe, timely, efficient, equitable, and effective health care interventions. While his fervor was greatly appreciated, his expectation that the case manager was in possession of the magic wand that could repair all gaps in care, and be all things to all people, was absolutely unrealistic. Nevertheless, when I left that program, I was riding a new high. The role I had been performing for over two decades no longer appeared to be the “best kept secret in health care.” It seemed to me that case management was finally being recognized as a vital component of the care that every American health care consumer deserved. I was elated. I was absolutely, positively stoked. I was feeling like a mixture of Florence Nightingale, Jane Adams, Anne Sullivan, Mother Teresa, and Wonder Woman. And, then it hit me: I am none of those people. I am a case manager who is primarily trying to find my place in a system that does not consistently understand my role, my function, or my capabilities. As I work with case managers from a variety of practice settings, I often hear a concern that case management responsibilities include a revolving door of change. Some of these changes are formalized and more sweeping. Some are verbalized with the Nike philosophy of “Just Do It.” Some are based on meeting the needs of patient populations. In other cases, change is made in response to payer mandates or governmental regulations. And, sometimes, change occurs because the current system is flawed and focused on populations rather than the unique individuals who comprise those populations. Some variances in case management responsibilities occur because the title alone may elicit different concepts regarding the primary functions of the case manager. Is the case manager’s sole responsibility utilization management? Is that role pre-certification of medically necessary services or confirmation of benefit determinations? Is discharge planning viewed as a consulting event for the case manager but not a primary function? Do case managers hand-off or hand-over patients to the next level of care, the next provider of care, Continued on page 6 Issue 7 • 2012 • DIGITAL CMSA TODAY 5

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2012

President's Letter
Case Management Adherence Guide 2012
Case Management Foundation: Focusing on the Profession of Case Management for Today and Tomorrow
Association News
CMSA Corporate Partners
Index of Advertisers

CMSA Today - Issue 7, 2012