The Changing Role of Case Managers in Emerging Care Delivery Models

Thursday, March 7th, 2013
This post was written by Cheryl Miller

“I know some case managers who left on Friday with one title, and came in on Monday with a different title!”

So says Teresa Treiger in the recent webinar The Role of Case Managers in Emerging Care Delivery Models sponsored by the Healthcare Intelligence Network.

A lively speaker with more than 30 years of healthcare industry and 20 years of care management experience, Ms. Treiger discussed the evolution of the case manager in the changing healthcare landscape. With the continued expansion of patient-centered medical homes and accountable care organizations, case managers are taking on a more standardized, collaborative approach to care coordination, she said, creating the need for broadened responsibilities.

Included in the change is the case manager’s title, which seems to constantly be in flux. This stems from the wide ranging responsibilities of the case manager, and its ever changing job description.

The first step? “Case manager job titles need to be codified into a law so consumers know what they’re getting,” Ms. Treiger says, and there needs to be “a set of standards that defines them, what they do, and what their titles are.”

Titles aside, the evolution of the case manager has been an extensive one, transforming from primarily a utilization management role to one involving readmissions avoidance initiatives.

“…The core functions of case management have remained and are consistent, but what’s important is some are shifting because of the changing work environments, the newer settings of care and different employers that case managers can work in. And while the past may have included a significant utilization management component, today we’re more focused on quality, including readmission avoidance type of initiatives.”

Much of those initiatives include care transition programs, long a primary responsibility of case managers. Given the recent explosion of such programs, case managers have the opportunity to step up, and they should, because patient discharges are muddled by too many people, Ms. Treiger says.

Integrative care is another area where case managers need to be educated, so they can not only address the patient-centered stance much of the healthcare industry is taking, but so they can be more patient-focused. Case managers need to apply both clinical and psychological care to their patients in order to truly benefit them.

As case managers continue to expand in the healthcare industry, on and off-site, the use of case manager extenders will be a “tremendous resource,” she said, enabling case managers to focus on clinical issues.

But despite stepping up to more responsibility, case managers also need to realize that “There is no “I” in team.” And in some venues, embedded care environments for one, they are still the newer kids on the block. To solidify and maintain their stance in the industry, they need to “show tangible results, show potential organizations how they can benefit them.”

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