CMSA Today - Issue 1, 2013 - (Page 8)

Case Manager’s Role The Case Manager’s Role in the Patient-Centered Medical Home Promoting Accountability, Collaboration, and Engagement W ithout a doubt, we are living in a time of unprecedented change, growth, and transformation in health care. New models of health care delivery and reimbursement are quickly evolving in response to numerous critical needs: the need to minimize fragmentation and improve transitions of care; the need to focus on patient safety and improve quality of care; and the need to improve patients’ experience with care, to name just a few. BY MARY BETH NEWMAN, MSN, RN-BC, CCP, CCM Some of the innovations being implemented to address these needs include care delivery models such as patient-centered medical homes and accountable care organizations, as well as new payment models such as outcomes-based reimbursement with shared risk and value-based purchasing. The great news for case managers is that case management is essential to the success of these new models! This article will focus on the role of the case manager within the model of primary care known as the Patient-Centered Medical Home (PCMH), with an emphasis on how the case manager can promote accountability, collaboration, and engagement in the PCMH setting. Essential Elements of the Patient-Centered Medical Home • Comprehensive Team-Based Care • Patient-Centered Care • Coordinated Care • Accessible Services • Quality and Safety Figure 1. Essential Elements of the Patient-Centered Medical Home health care needs, including prevention and wellness as well as acute and chronic care. Care is delivered through the collaborative efforts of a highly functional team of care providers such as physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, and case managers. 2. Patient-Centered Care Patient-centered care, defined as “care that is respectful of and responsive to individual patient preferences, needs and values” (Institute of Medicine, 2001), is absolutely fundamental to the medical home concept. Patient-centered care is relationshipbased (as is case management!) and requires an effective partnership between care providers, the patient, and the patient’s family and/or support system to help assure a clear understanding of each patient’s unique needs, culture, values, and preferences. The medical home care team builds on that partnership to ensure that patients are truly engaged, fully informed, and active participants in goal setting and shared decision making. ESSENTIAL ELEMENTS OF THE PCMH Case managers need to have a good understanding of the philosophical components of the patient-centered medical home in order to maximize their role. The five core elements of the PCMH are (Agency for Healthcare Quality and Research, 2011): 1. Comprehensive Team-Based Care The primary care medical home is accountable for meeting the majority of each patient’s physical and mental 8 CMSA TODAY Issue 1 • 2013 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2013

Offering a Perfect Symphony of Caring
Promoting Accountability, Collaboration, and Engagement
Little Things, Big Coordination
Spotlight on CMSA’s Award of Service Excellence (AOSE)
Association News
Index of Advertisers
CMSA Corporate Partners

CMSA Today - Issue 1, 2013