Case managers play critical role in working with complex-care populations
By Melanie Marshall
The U.S. healthcare system has been the subject of intense debate over the past few years, but there’s one thing most can agree on: much of the challenge involves patients with complex needs that have a devastating impact on their own health and on healthcare costs nationwide.
Those needs – including poverty, hunger, and housing insecurity – are social determinants of health, defined by the Centers for Disease Control as “conditions in the places where people live, learn, work, and play (that) affect a wide range of health risks and outcomes.”
The idea isn’t new or surprising, said Erin Westphal, Program Officer with The SCAN Foundation, a public charity focused on transforming care for older adults: “You can’t expect someone who is a diabetic to eat well, test their blood sugar, and keep their insulin refrigerated, when they’re homeless.”
Two new studies on care management show encouraging results regarding the effectiveness of case managers in improving patient outcomes and/or reducing costs.
What are managed healthcare leaders talking about? Certainly at the top of the list is caution and concern about legislative changes in the existing Affordable Care Act, and how Medicaid funding to states may change. Runaway drug costs are also prompting calls from legislators, health plans, and the citizenry, for more pricing transparency and accountability. Change is a certainty, the degree of change is still unfolding.
With more than 25 years in case management, Rebecca Montano, Ph.D., MBA, CRC, CCM, CMC has dedicated her life to helping others, and now she is helping train the next generation of care managers.
Headlines are awash with news of uncertainty and forecasts of doom or change for many sectors of business and populations of people. Healthcare organizations, and organizations like health plans that support them in the healthcare marketplace, are taking postures of “wait and see” because of the uncertainty.
Want to help people? From nurses to social workers, most, if not all, in the health care industry chose their career because they want to help others. But sometimes wanting to help a client leads to trying to “fix” a client, and it’s impossible to “fix” others.
It’s time to add to your case management team. Are you feeling overwhelmed? From the countless job boards to the numerous emails you will likely receive, the hiring process often becomes a time-consuming second job. But finding the right care coordinator or care manager for your company is important. After all, you want the right person for the job — but you also do not want to waste your time and energy.
Just as the number of people enrolled in health plans continues to grow, so too, does the average caseload for case managers. Due to a combination of legislative action, an aging population and an increasing number of chronically and seriously ill individuals, health plan enrollment has gone up, resulting in greater caseloads for care managers.
Whether your title is case manager, care manager or care coordinator, know that you are on the frontline in improving quality and patient experience.
Are You a Stressed out Case Manager? Fact is, a lot of our health problems stem from stress — and we are in the health field! Like many industries, the highly competitive and ever-changing field of health care can be stressful.