Case Management Society of America

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Integrated Case Management

BY JOSE ALEJANDRO, PhD, RN-BC, MBA, CCM, FACHE, FAAN

In 1996, the Case Management Society of America (CMSA) began work to develop a foundation that highlights the importance of integrated case management. At a foundational level, integrated case management considers the individual as a whole person. Integrated case management specifically considers an individual’s physical and mental health in relationship to social determinants of health. In this regard, integrated health attempts to identify and address barriers within multiple domains in order to develop a comprehensive care plan across the continuum of care. The work continues today with CMSA’s Integrated Case Management Manual written by Fraser, Perez & Latour (2018). In short, this manual reignites the conversation that helped case managers and others change mental models regarding the importance of seamless transitions of care across the healthcare delivery system.

As case management professionals, it is important that we consider how to continue deployment of the integrated case management model within our practice setting. In some settings, there continues to be a division between physical health, mental health and the social determinants of health. Integrated case planning, in many instances, continues to be fragmented due to our antiquated healthcare delivery and referral models. As noted extensively in scholarly research, it continues to take many years to incorporate evidence-based practice within traditional healthcare.

From a personal perspective, I have admittedly made incorrect assumptions about the needs of the patients being served within my diverse community. For example, in an acute care setting, the medical diagnosis is the primary driver of the care plan when in fact there were multiple physical, mental and social factors contributing to the patient’s care progression. Reimbursement methodologies play a significant role in why healthcare addresses treatment and care management plans. Limited resources often get in the way of developing case management systems that appropriately assess the needs of complex and high-risk patients. Integrated case management (ICM) requires us to expand the scope of patient assessment, care planning and transition across the continuum. ICM recognizes that comorbidities and social determinants of health are critical considerations when developing an action plan to improve the health of both the individual and a population within a community.

Integrated case management requires case managers to expand their mental models and consider how co-morbidities and social determinants impact an individual’s primary diagnosis. ICM recognizes that a care and transition plan cannot be created within a vacuum. ICM further solidifies the importance of multi-disciplinary practice and development of strategic partnerships across the continuum of care. Effective case management requires partnerships with psychologists, licensed clinical social workers, mental health workers and others to meet the needs of the individual. I am proud of the work of the Case Management Society of America to build awareness to the importance of integrated case management through multidisciplinary education and networking opportunities.

Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN

President, CMSA

2018-2020

Dr. Alejandro is the director of case management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.

Image credit: CIFOTART/SHUTTERSTOCK.COM

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