Case management is an advanced practice within health and human services, bringing together professionals with diverse backgrounds such as nursing, social work, rehabilitation counseling, occupational therapy and others. Case management is characterized by advocacy, communication, and resource management in pursuit of quality and cost-effective interventions and outcomes. As the Commission for Case Manager Certification states, “The case manager links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient and equitable. This approach achieves optimum value and desirable outcomes for all—the clients, their support systems, the providers and the payers.”
Among case managers, certain individuals stand out as having demonstrated their competency to practice independently, promote quality and safety, and protect the public: certified case managers. Only a qualified, certified individual can direct the provision of services in a way that meets the needs of individuals, protects the public and produces quality, cost-effective outcomes. Further, the direct human link between patient and certified case manager contributes to success in delivering quality, cost-effective outcomes.
With a greater emphasis on care coordination, healthcare organizations should look to case managers—and, in particular, professionals who are certified—to fulfill this function. The CCMC's Role & Function Study, completed in 2009, identified care coordination as typically being performed by case managers. This field research, based on a survey of nearly 7,000 case managers practicing in a variety of settings, found that as complexity of care increases and the demand for accountability grows within new models of care, the case manager is increasingly important.
Certified case managers have demonstrated that they possess the knowledge and skills to coordinate care for patients as they transition from one facility to another or one level of care to another. Transitions of care continue to be a major focus in healthcare, given the risks of poor coordination, especially for frail elderly patients and others who are typically treated by multiple practitioners across many care settings.
Through their knowledge and expertise, case managers can provide oversight and coordination across settings and providers, which is essential to managing transitions of care. For example, case managers facilitate communication among care settings and providers, ensure medication reconciliation from one setting to the next, and educate patients and/or their support systems on improving self-care and adherence to physicians' orders.
Care coordination is one solution to the complex problem of improving the quality, efficiency and efficacy of care delivery in the United States today. As healthcare reform continues to unfold, care coordination will undoubtedly gain further attention. Healthcare systems, therefore, must ask themselves: Who is performing this function? In order to have the best possible outcomes, healthcare systems and facilities need highly qualified, certified individuals performing the vital function of care coordination.
Chair-electCommission for Case Manager CertificationSt. Paul, Minn.Managing Director of Global Emerging BusinessCARF InternationalTucson, Ariz.
CommissionerCommission for Case Manager CertificationSt. Paul, Minn.President and FounderCQI – Healthcare Management ServicesSan Diego