Understand How Your Role is ImportantWhether your title is case manager, care manager or care coordinator, know that you are on the frontline in improving quality and patient experience.
Case managers play such a critical role in the healthcare field that they are practically becoming the face of care.
Understand Your Role as a Care Manager
As you are well aware, the essential functions of care managers is to assist with discharge planning or the management of medical care by insurers or managed care organizations. However, the essence of care management and the skill a care manager needs to truly impact care and achieve win-win outcomes for both the health care industry and the client in today’s climate is much more evolved.
Case managers within Medicare and Medicaid health plans, in particular, are charged with a range of responsibilities when working with an individual. From coordinating medical treatment and confirming medication compliance, to building a relationship with clients and advocating for their care, those in care management have a wide array of responsibilities. Thus, care managers are at the center of the complex world of improving health, managing costs and improving patient experiences.
According to literature reviewed for a recent needs assessment by the funders supporting the Care Excellence initiative, “the primary role of person‐centered care is not always met due to the lack of job readiness amongst newly hired and less qualified personnel.”
This means that care management roles are more fragmented than holistic. And that is a problem.
“The way health plans used to think about case management is that it was mostly focused on helping people manage chronic diseases,” said Dr. Kelly Pfeifer, director of High-Value Care at California HealthCare Foundation.
“The new populations that are in managed care are populations that have lived in poverty for generations that have experience childhood traumas, which impact their health, and impact their resources and the resourcefulness,” she added. “The new care management that we are learning really works is that it addresses the whole person. The person who is suffering from mental illness, addiction, and medical problems. In our healthcare system, all three of those problems are addressed in different buildings, by different people who do not talk to each other.”
Know the Different Case Management Roles
Care management roles are currently divided amongst three employee profiles: registered nurse care managers, social worker care managers, and care coordinators, who are also known as care navigators or health educators.
According to the needs assessment, registered nurse care managers are typically tasked with the role of completing medical assessments, medication reconciliation, care plans and care coordination, whereas social worker care manager are often tasked with connecting clients to services, coordinating and supervising care coordinators, completing care plans and coordinating care. Care coordinators help ensure assessments are done, track and follow patients, complete most of the contact with patients, and direct registered nurses and social workers where to go and what to do.
With three different employee profiles and a wide range of responsibilities, how can we be sure that work is not only being completed, but teamwork and interdisciplinary care is being championed?
“The health plan care manager can be the connector and the person who helps a person who may be from suffering with all three — mental illness, addiction and medical problems — get the care they need. Not only in the healthcare system, but also in the social services system,” Pfeifer said. “To find secure housing, to find secure food sources, to potentially connect with other people in the community if they are isolated. All of these things are critical for health, but are news to us thinking about this as a healthcare problem. Housing is a healthcare problem. Where we used to think housing was someone else’s job, and my job is diabetes, we are in a different world now.”
How to Address the ‘Whole Person’ as a Case Manager
We know that today’s cases are more complex, so we should change our way of thinking about healthcare. As Pfeifer said, care management should address the whole person.
But with different backgrounds and fragmented roles in care management, how can you make sure you are taking a holistic approach with your clients?
Care Excellence can help.
Care Excellence provides a flexible online source of continuing education for case managers by providing the most up-to-date training for all levels of care management. By continuing your education, you can discover how to meet the needs of growing and diverse populations with special and complex needs, while decreasing costs and improving the quality of care.
“Care Excellence can do many things for health plans,” Pfeifer said. “It can help them nurture and grow new graduates, to help them develop the skills that they need to make a difference in patients’ lives. It can also train people who have done care management for a long time, but maybe have done it with populations that do not have so many challenges as the Medi-Cal population.”
Care Excellence’s learning management system is far beyond webinars and video playbacks. Experts in the field with significant care management real-world experience created the courses. They are delivered online with highly interactive activities and testing to assure deeper integration.
Foundational courses are available for those new to case management, care management and those who would benefit from a review of fundamental knowledge and skills. Advanced courses are available for experienced care managers and other professionals in the field. Finally, the Care Excellence Leadership series teaches supervisors, managers and others in leadership roles how to effectively supervise and mentor their case management team.