“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness...it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us…”
So said Charles Dickens in 1775, and so it was in the year 2012, a year of similarly stark contrasts, when we watched a superstorm ravage our pristine coastline and homes and state budgets; when we watched the Supreme Court uphold the constitutionality of the individual mandate and states struggle with the option to expand their Medicaid coverage or risk losing federal funding; when we watched the Democrats struggle to renew their rent on the White House, healthcare professionals struggle with revamped funding and delivery options and even case managers struggle with a possible revamping of their title.
But through it all, care, err, case managers continued to do what they do best: act as liasions between patients, caregivers and medical professionals, and help patients navigate the healthcare system in the best way possible. Given all the changes, we asked them to tell us what trends case managers locked onto this past year and what they were looking to ramp up on in the coming new year.
Here's what they said:
Teri Treiger, RN-BC, MA, CHCQM-CM, CCM, Founder of Ascent Care Management, LLC:
Many health systems are implementing their own brand of case management and unfortunately it simply requires a change in an individual’s job title rather than an evaluation of skill sets and provision of training and development opportunities in order for that person to be successful. These types of programs are going to be running aground and a need for knowledgeable case management consultants will bloom as the C-suite opts to address these less-than-successful programs.
The home care sector needs for case management are going to blossom as transition of care programs begin to engage more services to avoid readmissions.
Sheryl Riley, RN, OCN, CMCN, Managing Partner, Clarion LLC:
The next big challenge for us as care managers is survivorship, and how to best manage their needs. Given the many strides we've seen in the treatment of cancer, we now have over 50 percent of the (former cancer) population surviving, which opens up a new aspect of oncology care management, care of the survivors, not just immediately but 10 to 12 years down the road when the effects of the treatment can be seen on their vital organs. You’re dealing with drugs that have ravaged the body to kill cancer, but have also had deleterious effects including weakened bone, bone marrow and organs, particularly the heart and the lungs.
Helen Schreiber, RN, BS, CCM, Executive Vice President of S&H Medical Management Services, Inc.
The economy continues to impact this industry. I believe creative marketing is key at this time.
Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz
Reimbursement has been the biggest challenge.
Linda Van Dillen, RN, BA, CCM, Executive VP/Partner of S&H Medical Management Services, Inc.
We have done research into the top cost trends in workers’ compensation and as a result have modified our services to assist the claims staff in making informed decisions as to reserving the claims and making recommendations to mitigate these costs.
JoAnne Vanett, BSN, MA, CCM, CEN, Specialty Case Manager in Readmissions Risk Reductions for Aetna:
I am very interested in case managers who are embedded within physician practices. I think that collaborating with them along with facility providers to offer a team approach to support patient care and education are the wave of the future.
Hillary Calderon, RN, Senior Manager of Corporate Case Management for HCA,
Care coordination. A must for healthcare to achieve better outcomes and cost containments.
Bobbi Kolonay, RN, BSN, MS, CCM, Owner of Options for Elder Care, Medical Care Management Services for Seniors
With medical reimbursement declining for readmissions of specific diagnoses, I do wonder why insurance carriers/hospitals do not look into partnering with medical geriatric care managers. My clients rarely are admitted to the hospital and when they are I follow them, directing their care through the continuum.
Stacey Hodgman, MS, RN-BC, CCDS, CPUM, Senior Director of Care Management at Kindred Healthcare, Board of Directors for the Case Management Society of New England
It is critical that we do not lose sight of what is happening with healthcare reform, and continually plan for the effects it will have on balancing patient outcomes through care transitions along with pay for performance and changes to provider reimbursement methods.
Kerry Stutzman, RN, MS, CCM, Care/Case Manager
Do more with less. Be creative. Be flexible.