Readers: Please take a look at PCM Journal's masthead and the picture below. This is the Editorial Review Board and a list of many of the "best" in case management. I often refer to them as my "think tank." I am honored to be a part of such an exemplary team of case management leaders and experts. I recently asked them for their predictions for case management in the coming year and received an abundance of responses. I share these with you, as the wisdom in these predictions cannot be overstated.
The Aging Case Management Workforce
Beyond our own scope of practice, the aging healthcare workforce has tremendous implications for case management and who will be the future case managers? Looking into the mirror of reflective practice, case managers see not only their ever-larger numbers of aging clients but also their own family members and, with a slight tilt of the glass, themselves. Case managers need to get the word out about the wonderful profession of case management. It is necessary to develop more case management courses and workshops in schools of nursing and medicine and in graduate programs; cooperative ventures between schools and businesses; tours of duty for case management practicum; and mentorships for the new/younger recruits will boost the numbers in the waning months of the 1st decade of the 21st century.
International Case Management
The rapid rise of international medical care heralds the need for international case management; the potential for growth and opportunities is enormous, and the need for ongoing consumer-relevant quality in this expanded setting will be challenging.
Medical Home
As the medical home concept continues to spread, all case managers may alter their practice to be a support and promote this concept. In addition, case management in ambulatory care settings will grow due to the spread of the medical home. Thus, case management will expand into clinics, outpatient surgical centers, multispecialty centers, and other ambulatory service centers. Case managers that practice outside ambulatory settings will need to engage and communicate with these new ambulatory case managers.
Safe Transitions of Care
The term transitions of care (TOC) has become a hot topic and, as such, is having a significant impact on how healthcare stakeholders are looking at case management. TOC is a thrust of regulatory agencies, and several demonstration projects are currently being funded. Collaboration between case managers at various levels of care will become more important for patient safety and for reimbursement. Much has been written about TOC in this journal, and it is a formidable, but necessary, issue.
What has not been adequately addressed is a dangerous trend that is occurring simultaneously: a potential misrepresentation of case management with "new" titles such as health navigators, health coaches, transition coaches-many with little-to-no training or professional degrees. The variations of how organizations perceive, translate, and define the role of the case manager continue to not only fragment and devalue the profession but also put all consumers of case management at risk. This prompted many on the editorial board to write about the following trends: definitions for case/care management and title protection.
Definitions for Case/Care Management and the Need for Title Protection
The ramifications of "anyone" calling him- or herself a "case manager" (or even the nebulous and confusing "coach" definitions) can certainly dilute the professionalism and public perception; further, with the numbers of case managers increasing in all environments of care, the consistency of roles and functions has never been more essential. The launch of the latest revision of the Case Management Society of America-Standards of Practice in 2009 is an important opportunity for consensus regarding consistent roles, functions, and qualifications of a case manager.
Some suggest that we need to go one step farther. Title protection and subsequent consumer protection are legislative efforts that will solidify case management's presence by mandating a standardized comprehension of the role and the competencies that define it. This way, only one who has achieved the education and credentialing eligibility requirements defined by regulatory entities to be a case manager may call himself a case manager. There are some states that have been successful in title protection for social work. The Association of Social Work Boards has also written a supporting model law.
HACs, RACs, MACs, and Other Regulatory Mega Trends Affecting Case Management Work
Case management is no longer (nor has been for quite some time) merely utilization management and discharge planning. Acronyms such as HAC, RAC, HCAHPS, MAC, POA, HAI, P4P, and VBP (to name a mere few) will impact our organizations, and our case management lives more than many realize. We must become more knowledgeable about our organizations' financial reimbursement and understand the impact of political trends on funding for programs and resources[horizontal ellipsis]because as this evolves, case managers will be expected to help reduce clinical costs associated with practice variations through the use of evidence-based medical protocols, specific documentation, and accountability. (Note: If you do not know the meaning of the above acronyms or the ramifications on your world, please re-read the past and future issues of PCM Journal!!)
At the End of the Day, It's ALL About YOU!! The case manager's world will continue to intensify. With the economic downturn, there will likely be an increase in the Medicaid population as well as the state-sponsored health plans for the near poor. We deal with increasingly complex physiological and psychosocial situations, a nation of growing uninsured/underinsured populations, family violence, war, political actions, substance abuse, poverty, terrorism, disparities, and access to care issues[horizontal ellipsis]the list goes on. This requires case managers to be skilled in working with populations that pose health and human services challenges and the blending, integrating, and addressing of physical health with behavioral health issues.
However, all the predictions and work involved would mean nothing if you, the case managers, were sick or too stressed to function on all cylinders. One prediction is that case managers will (or at least should) care for themselves. Two important methods were cited: (1) the use of self and workplace resilience (see part I in PCM Journal 13(3), p. 175, and part II in this issue) and (2) the use of humor (see PCM Journal in January 2009, 14[1]).
Use of humor and awareness of the importance of continuous resilience will ensure a future competent workforce for those we serve. We must take care of ourselves in order to have anything left for our patients/clients. Assessing and developing resilience for oneself and in one's workplace is critical for long-term survival in a stressful case management environment. Use of humor as a healing force in healthcare is well documented. The seriousness, sensitivity, and sincerity of case managers are a staple of our profession. Case managers must actualize-in everyday practice-the value proposition of a health-promoting belly laugh, a tension-reducing chortle, or even a smile-producing pun. The Case Management Society of America conferences always incorporate good food, good company, and good education with at least one good laugh-extracting general session. Whether humor-challenged or humor-endowed, the right use of right-timed, right-targeted, and right-measured quips, gaffs, guffaws, jokes, jabs, and turns of fancy will put the life in proliferate right away, tomorrow if not today.
I believe Nostradamus himself would be proud of these prognostications-now, if only we could manage some nifty quatrains. Wishing you all a safe and wonderful holiday season!!
Section Description
Mission Statement:Professional Case Management is a peer-reviewed, progressive journal that crosses all case management settings. PCM uses evidenced-based articles to foster the exchange of ideas, elevate the standard of practice, and improve the quality of patient care.