Amplify Your Passion for Case Management Through Public Policy

mary mclaughlin

nancy skinner

CMSA and National Black Nurses Association (NBNA) member Stephanie Doibo and colleagues at Cleveland Clinic case manager meeting with Ohio Congressman David Joyce’s legislative aid.

The past presidents of the Case Management Society of America are leaders who during their terms as president and past president see firsthand the important role case managers play in today’s complex healthcare system and in the area of public policy. Each has been actively involved in health policy on the local, state and national level.

In this issue of CMSA Today, past presidents Nancy Skinner and Mary McLaughlin-Davis share their views on why case managers need to get involved in healthcare policy. Both encourage all case managers to stay alert and involved.


How often have you said, or heard a case manager colleague say, “This rule, law or policy doesn’t make sense?” There are times we are all struck by how the statutes intended to help our patients or our co-workers can create unforeseen burdens, and sometimes barriers, to healthcare.

Many of us feel there is not much we can do to change a policy, so we learn to live with it and oftentimes work around it. However, as case managers, our primary duty is to speak up and advocate for our patients and for ourselves, so that we can help patients find their voice.

It is not necessary for all case managers to go to, or move to, Washington, D.C., to write health policy. You can start in your place of work and participate in the writing and reviewing of the case management policies that govern your practice. Most organizations value the input of the front-line caregivers when they write and implement new policies for their organization. An example of this situation could be the recognition that requiring excessive data about our patients and our interventions to measure outcomes is overburdening our caregivers. Sometimes the science of data collection takes a huge toll on direct providers of care.

Case managers have a tremendous capacity for problem solving and can offer to sit on their organization’s policy committee. The results can benefit the organization and the case managers within, but our most important benefactor of policy changes should be our patients.

There are other avenues to work toward policy change. It may be in your community where you would advocate for changes in your city or county’s health departments to ensure safe health practices in your community. After the crisis in Flint, Michigan involving the lead contamination of the public water supply, healthcare workers from across the continuum of care rallied for immediate remedies and participated in activities to mitigate the damage to the community. They also created viable long-term solutions to assist those affected and to prevent another lapse in a basic public service.

Members of CMSA have many opportunities to participate in public policy initiatives within CMSA. One example is the CMSA Standards of Practice, written and updated by CMSA members. It is a seminal contribution to the case management community as well as to all the patients we serve. The CMSA Standards of Practice are the gold standard to which all case managers are held within their practice and a source of truth for employers, litigators and most importantly patients.

CMSA members also wrote the CMSA Model Act, which details how to create a case management model within an organization such as a hospital or an insurance company to creating a model within the state or federal government.

CMSA members most recently wrote The Practice of Hospital Case Management: A White Paper, also a policy paper on the value and necessity of case managers in providing care coordination services within acute care.

CMSA has spent time as well as human and financial resources on the Nurse Licensure Compact, over almost a decade. The spread of the Compact through the individual states has a direct impact on how case managers practice across state lines. As a body of professionals who do provide case management services telephonically, the energies case managers have devoted to its passing in their individual states has had a profound impact on the case management community.

Case managers have tremendous influence in the current value based healthcare environment. Legislators are seeking the advice of case managers from city councils to the U.S. House of Representatives.

When verbalizing or writing your position on a case management policy issue, know the difference between your opinion and the opinion of CMSA or your employer. It is important to not identify either with a position that they do not support.

While it is a tremendous responsibility to speak your voice on issues that impact your case management practice, it is also a source of great satisfaction and an opportunity to make a significant difference in the lives of your patients and case management colleagues.


I have been a member of the Case Management Society of America for almost 30 years, and largely due to that membership, I have had an opportunity to collaborate with a group of remarkable and dedicated professionals. One of those individuals was Margaret “Peggy” Leonard, MS, RN-BC, FNP. Peggy was not only a past president of CMSA and a recipient of CMSA’s Lifetime Achievement Award but also the chair emeritus of CMSA’s Public Policy Committee. After joining CMSA, Peggy advanced the development of a public policy initiative that supported the birth of CMSA’s Public Policy Committee.

Peggy often stated, “If you are not at the table, you’re on the menu,” and no truer words were ever spoken. With her encouragement and direction, members of CMSA went to Washington, D.C. with the sole purpose and strong resolve to educate our representatives regarding the value of case management interventions.

Now is the time to rekindle those strong educational initiatives and advise those policy and decisions makers that healthcare reform without a significant focus on the delivery of case management services is destined to fail. Case management is the glue that brings patients, their caregivers/support systems, physicians and clinical teams together. And yet today, many patients navigate healthcare delivery systems without a case manager to support them in that journey.

As case managers, we realize that many of our patients fail because of a lack of care coordination to advance their transitional needs as they move though the healthcare continuum. Patients may be impacted by social circumstances and other determinants of health that are beyond a case manager’s ability to resolve without appropriate governmental funding, support and advocacy. This might cause us to question the rationale for the regulatory mandates that compromise our patients’ ability to receive the services they need when they need them.

Case managers realize that the regulatory and legislative framework for healthcare delivery in America requires some change in order for our patients and our case management practices to be even more successful. Because we practice at the point of healthcare delivery and transitions of care, we possess an awareness of what is working and what is inhibiting the ability of some patients to be successful in their healthcare journeys. Because of that knowledge and expertise, the case management community is well prepared to share their valuable insight with the legislators who craft healthcare laws and the regulators who develop healthcare policy. Telling our stories and offering our recommendations for change to lawmakers and policymakers is not just something we might wish to consider but, as patient advocates, it is something we must do.

The question then arises, how do we accomplish this when there are so many other responsibilities both professional and personal that touch our lives? The first step in your individual public policy journey is an awareness of who represents you on a federal, state or local basis. In November 2020, the citizens of this nation will elect a president, 453 members of the U.S. House of Representatives, 35 senators and 13 governors. Become an informed voter by asking questions of candidates regarding healthcare reform and what processes will be employed in order to incorporate case management interventions into any proposed legislative actions. If they are not aware of the impact effective case management initiatives can bring, educate them. And, know the most powerful tool you possess is the ballot. Please remember to vote.

If you ever have an opportunity to travel to Washington, D.C., consider visiting one or more congressional offices. One of the rights we have as American citizens is the ability to offer our opinions to our representatives. This can be a formal process of setting up an appointment with the congressperson or their staff or stopping at their office to offer your thoughts and comments. And, if you do not have the opportunity to go to the Hill, call or email them. The name and contact information for your specific representative is available at

During those conversations, tell the stories that are the hallmark of your practice. Relate stories that are simple, unexpected, credible, emotional and demonstrate the value case managers bring to the American public and healthcare delivery in America. In demonstrating what is achieved when we partner with our patients, we can provide those leaders and those regulators with a view of what healthcare could be when care coordination is included in each treatment map for every patient who would benefit from our interventions. If we all took a moment for a call, email or conversation, think of the difference it would make for our collective and individual practices and the many patients we serve.

Mary McLaughlin DavisDNP, ACNS-BC, NEA-BC, CCMis the immediate past president of CMSA. She has been a certified case manager since 1993; she is a clinical nurse specialist for adult health and the senior director of care management for Cleveland Clinic.

Nancy Skinner, RN-BC, CCM, ACM-RN, CMCNis an international case management educator who advances programs that promote excellence in care coordination and other transitional care strategies. She also provides programs to support case managers in their journey towards certification.


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