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
While 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 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 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 which 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 value-based 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 position of having to meet their employers’ goals related to these criteria, while also adhering to their professional code of ethics. For example, case managers may question whether these value-based models, with their emphasis on financial incentive strategies, compromise quality of care for lower income patients who may not be in the financial position to follow better health behaviors such as purchasing foods with higher nutritional values that may cost more than those with lower nutritional values. Another ethical dilemma case managers face relates to their interaction with non-adherent patients in home settings when these patients assert their rights not to be fully-engaged with their treatment plans which the case managers recognizes may cause a preventable readmission. The rights of the patient are clearly a component of the Certified Case Manager (CCM)’s “Rules of Conduct” wherein they agree to respect and uphold the rights of their patients. The Case Management Society of America’s “Standards of Practice for Case Management” also includes a mandate for case managers, “To respect individuals’ rights to make their own decisions.”
With the proliferation of technology in healthcare, most notably for population health management and quality improvement benchmarking, case managers are also challenged with new concerns relating to medical errors traced to the use of technology. Under ACA’s reporting provisions, case managers are required to report errors, including those made by members of their own clinical teams.
The Road Ahead for Case Managers
The picture painted may seem a bit cloudy for case managers. Yes, today’s case managers are expected to:
- Serve in new settings with new challenges and goals;
- Be able to provide services for an older, more diverse patient population; and
- Perform additional functions such as quality reporting and benchmarking using advanced Information Technologies.
There is, however, a silver lining when you consider the growing demand for, recognition of, and increased opportunities and salaries especially for professionally certified case managers. The U.S. Bureau of Labor Statistics projected job growth for case managers with a Bachelor’s degree in Nursing and licensure at 16 percent over the period from 2014 -2024, and for social workers with bachelor’s or master’s degree in social work and licensure (depending on the state) at 12 percent. The Commission for Case Manager Certification (CCMC) reported the median annual salary of case managers as of December 2016 was $74,005. Case managers who hold the CCM designation are in especially high demand as reflected in the CCMC’s finding that the percentage of employers requiring board-certification has almost doubled since 2004 and is now over 40 percent.
In addition to the traditional practice settings for case managers (i.e., hospitals, medical groups, insurance companies and managed care organizations, employers, unions, and government agencies), and new healthcare models, there also has been increased interest in hiring case managers by professionals such as elder lawyers and financial planners. The market also has never been better for starting a case management firm. This route does, however, require that in addition to a strong nursing foundation and/or social work foundation, the case manager has an entrepreneurial mindset and can develop the necessary skills to successfully manage and operate a business. For all case managers, regardless of the practice setting, continuing education and training, and maintaining your credentials is critical given our rapidly changing healthcare system and all of its new characteristics
So there you have it. Where will you let your case management experience, skills, care and compassion for your patients take you? The road ahead is wide and paved with opportunity. ■
By Catherine M. Mullahy, RN, BS, CRRN, CCM, President and Jeanne Boling, MSN, CRRN, CDMS, CCM, Vice President of Mullahy & Associates, LLC (www.mullahyassociates.com, Huntington, NY), a leading provider of case management training, certification workshops, online case management training and educational tools. Mullahy and Boling are widely-recognized case management pioneers, who have held leadership roles in the development of professional standards and certification for case managers, while driving greater awareness of the important role case management plays in improving patient outcomes, processes and cost efficiencies. Mullahy is the author of The Case Manager’s Handbook, Sixth Edition, the authoritative case management reference book relied upon as the foundational text for nursing schools across the world, healthcare providers, managed care organizations, insurers, plan sponsors and government agencies.
Photo credit: Rasica/Shutterstock.com