How were you trained to become a professional case manager? For the vast majority of us-nearly 90%, according to the most recent role and function study conducted by the Commission for Case Manager Certification (CCMC)-the answer is "on the job" (Tahan, Watson, & Sminkey, 2016).
Coming from professional disciplines such as nursing, social work, or rehabilitation (among others), we possessed knowledge and skill sets that enabled us to enter case management, which is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs (CCMS Code of Conduct for Professional Case Managers, 2015). As we supplemented that knowledge with specific training, for example, around reimbursement or care transitions, we honed our expertise. Many of us further demonstrated our expertise and professionalism by pursuing board certification. This has served us well individually and as a field of practice, as the value that case managers contribute across the spectrum of health and human services increasingly is recognized.
More employers today require certification; in the most recent role and function survey, 40.36% of survey respondents said that their employers require certification, up from 35.9% 5 years ago. In addition, nearly 30% of employers provide financial reward or compensation for achievement of certification, compared with 26.7% 5 years ago (Tahan et al., 2016).
Other changes are affecting case management. Among them is the maturing of practitioners in the field. Nearly half the respondents in the role and function survey were between the ages of 51 and 60 years; among them, nearly 25% were between 56 and 60 years (Tahan et al., 2016). These practice demographics remind us that many experienced case managers will retire in the years ahead. At the same time, there is increased demand for professional case managers, especially those who are board-certified. The aging of the overall population and more previously uninsured people entering the system (Henry J. Kaiser Family Foundation, 2015) are increasing the number of individuals with complex health conditions who typically benefit from case management services. In addition, more payers (e.g., the Centers for Medicare & Medicaid Services) recognize the benefit of care coordination, which is central to case management.
These changing demographics and health care dynamics raise important questions: who will replace case managers as they retire from the field, and will these new professionals be prepared for their roles? Will on-the-job-training be enough? What can be done to increase formalized programs and training in case management?
As an assistant professor of nursing, I recognize the value of introducing undergraduate students to the practice of case management. New professionals entering their respective health and human services fields need to understand that they will retain their professional identity if and when they choose to pursue case management. Moreover, they must recognize that what they are doing even now as nurses, social workers, rehabilitation specialists, occupational therapists, physical therapists, pharmacists, mental health counselors, and in other roles is aligned with the case management process. The CCMC's Case Management Body of Knowledge (CMBOK) defines the case management process as iterative, cyclical, and recursive (as opposed to linear) phases that are applied until the individual's needs and interests are met. These phases are screening, assessing, stratifying risk, planning, implementing (care coordination), follow-up, transitioning (transitional care), communicating posttransition, and evaluating (CMBOK, 2015).
As case management is practiced across the spectrum of health and human services, we are united by foundational principles such as advocacy and taking a whole-person approach. As advocates, we put the individual and his or her health goals at the center. We advocate for the right care and resources (from inpatient treatment to community support) at the right time and in the most cost-effective ways. With a whole-person approach, we look beyond a particular episode to view the individual's physical and mental health holistically. The goals of reducing unnecessary hospital readmissions and emergency department visits highlight the importance of care transitions and the impact on the individual's overall health, well-being, and ability to engage in self-care.
In the future, there must be more formalized programs to introduce and reinforce the case management process. To encourage more formalized academic programs in case management, the CCMC is in dialogue with colleges and universities to help raise awareness around case management and prepare the professionals of the future. Bridges of learning can be built from existing curricula. For example, the Essentials of Baccalaureate Education for Professional Nursing Practice, published by the American Association of Colleges of Nursing, emphasize such areas as quality improvement and patient safety; evidence-based practice; information management and patient care technology; health care policies, including financial and regulatory; and communication and collaboration among health care professionals (American Association of Colleges of Nursing, 2008)-all of which are highly congruent with case management.
In addition, academic programs, both undergraduate and graduate, often need guest speakers from the field. As an assistant professor, I know how much nursing students benefit from professionals in the field who bring to life the practices and principles discussed in lectures and textbooks. Experienced case managers who are passionate about the practice and educating others likely will be welcome visitors to the classroom.
At the same time, we cannot lose sight of the fact that on-the-job training will probably remain the most prevalent method of educating professionals about case management practice in the foreseeable future. Here all of us play a role, as supervisors and mentors for those who are interested in or actively pursuing case management. We provide insights related to a specific setting such as acute, subacute, primary practice/accountable care organization, insurance, or workers' compensation. Individuals have more options than ever to learn about the breadth of case management practices through conferences and webinars. Online options are a flexible choice for busy professionals, such as continuing education credits through CMBOK. National board certification is another avenue to sharpen skills. Board-certified case managers, who must continue their education as a requisite for maintaining certification, are role models for continuous learning. Everyone benefits through networking in professional organizations, both new and experienced case managers, by learning from each other in a reciprocal process.
Experienced case managers must "replace themselves" in the years ahead. This is not simply a matter of filling a position; rather, it is passing on our knowledge and giving others the benefit of our expertise. As case management continues to be learned on the job, we are the teachers and mentors to whom our new colleagues will turn.
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