By Jeni Miller
Although case management has been around for decades, the profession itself remains widely misunderstood and undervalued.
“A lot of times, because we have our hands in so much, no one knows where we belong,” says Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, president of the Case Management Society of America (CMSA). Morley adds that case managers tend to fly under the radar a bit more and are the “best kept secret” in the hospital. The unfortunate result is simply confusion about case management.
In the hospital, providers might assume that the case manager only handles discharge planning, when in reality the profession has evolved to so much more than that. Morley notes that highlighting gaps in care and finding the resources to fill those gaps is one of those behind-the-scenes tasks that providers and others in the hospital may not notice. That work, of course, is in addition to all the other roles the case manager fills.
“It astounds me,” Morley says. “If every case manager took the day off, the hospital would come to a standstill.”
Outside of hospital staff, families and patients often do not understand the role of a case manager, either, leading to hesitancy to work with them.
“If the case manager first appears with the insurance bill, then the patient doesn’t want to meet because they think it’s about the bill,” Morley says. “Or when they hear ‘social worker,’ they think you’re there to take their kids.”
The patients might have no idea that the case manager is there to advocate for them. Usually, they do not know what benefits the case manager offers.
“Patients don’t get the benefits if they don’t know what we do,” Morley says. “We walk through the continuum hand-in-hand with them. We can help and access resources, set patients up with Meals on Wheels or low-cost meal delivery, we can transfer patients, and teach them how to get transportation. There’s so much.”
Connecting Care and People
Morley recalls a situation in which a patient was in a difficult position, had a bad reputation, and was in pain. Through a home visit, Morley listened carefully to the patient and even observed how her knee looked and sounded. The patient had many healthcare providers, but they were not working together. Next, Morley set up a conference call with all the physicians — while still in the patient’s house — and they created a plan together.
“We created a pain management program, got doctors to start talking to each other, and just wrapped that whole thing together,” Morley says. “I asked, ‘What else does she need to be successful in her community?’ We took the extra step and connected her with community-based resources to help her.”
This kind of care is typical for case managers, but it is not typical for people to understand that in many case management models, this is how the case manager works to keep communication flowing across all disciplines. Taking care of the patient by making connections both inside and outside of the hospital is a key role for most case managers, but it is not well-known.
The role is critical. “Case managers should be everywhere,” Morley explains. “They should be everywhere that patients are seen. Unfortunately, they are not consistently there right now, and that can have terrible consequences. I’ve seen firsthand the cognitive decline and other problems that can arise when a case manager is not there. But when they are there, it means better outcomes.”
Valuable to All
Although Morley has seen her fair share of patients over many years in practice, the firsthand example that she shared was that of her mother.
“She was seeing her primary care physician every month and had lots of different conditions, including Graves’ [disease], Crohn’s, lots of autoimmune issues, she was forgetful at 70, and she had lost over 50 pounds,” Morley recalls. “But there was no one to pick up on all of those signs because each provider was only spending 15 minutes with her.”
What was needed was “someone to stop all of that and ask, ‘Where is the patient in all of this?’ She needed a case manager,” Morley notes.
When all providers are on the same page, emergency visits are significantly reduced. Furthermore, when a patient is an older adult or has a rare diagnosis, it is even more critical to be on the radar of a case manager who can help them navigate the system.
“These case managers are equally as important as any other member of the care team,” Morley says. “They facilitate conversation and make safe transition plans for patients, and often it up to us to be the ethical compass of the healthcare team. It’s the case manager who typically stops and says, ‘You know what? This is not a safe discharge or transition plan. I know we need the beds, but if the patient is not safe, then they will have a bad outcome.’”
The value of a case manager begins and lies in promoting quality, cost-effective, and efficient outcomes for patients. “We work for the patient above anyone else,” Morley says. “We may be employed by the healthcare system, but sometimes we are the only voice the patients have.”
Understanding the true value of the case manager helps to solidify the role and prevent a lack of confidence in the importance of the work.
“We can’t function without case managers, even when people don’t know what we do,” Morley explains. “It’s more than just discharge planning. We are the masters of social Determinants of health and of finding out what people need to be supported. But the case managers themselves need to know and believe this, and be ready to say, ‘You need a case manager because …’”
Although case management has been around for decades, the profession itself remains widely misunderstood and undervalued. In the hospital, providers might assume that the case manager only handles discharge planning, when in reality the profession has evolved to so much more than that.
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