Professional case management is vital, especially for clients with complex conditions, such as those involving multiple co-morbidities and/or requiring care transitions intra-facility (e.g., to and from intensive care), inter-facility (e.g., from acute care to sub-acute or home), or inter-provider (e.g., from a general medical provider to specialty care practitioner). As advocates for patients (or “clients”), professional case managers support the achievement of the individual’s health and care goals while also helping to reduce financial risk in the provision of care. In other words, case management has been well recognized as integral to the pursuit of the triple aim to reduce the cost of care delivery and to improve both patient outcomes and population health.
Most recently and on a global level, healthcare systems have been in the eye of an unprecedent storm: the coronavirus disease 2019 (COVID-19) pandemic. Hospitals and healthcare systems across the continuum have become overwhelmed with a sudden influx of patients that could exceed their capacity for months (The Lancet, 2020). To respond to such pressures and the need to serve patients in a variety of settings, healthcare systems have rapidly expanded their modes of care delivery, including digital health, telehealth, virtual care and remote work contexts. The result is an accelerated “disruption in how healthcare is delivered, paid for and perceived,” stated Dr. Stephen Klasko, president and CEO of Jefferson Health, as quoted in Becker’s Hospital Review (Dyrda, 2020). If such changes (or even if only some) in healthcare become permanent, the impact will no doubt also affect professional case managers across a variety of care settings and professional disciplines.
As this article will discuss, expanding the diversity of professional backgrounds (e.g., health disciplines) among case managers continues to be necessary, not only to meet the rising demand for these professionals, but also to adapt to emerging trends in healthcare across the continuum. It is also evident that the essential expansion includes acute and subacute care, home health, telephonic case management, community-based, mental health counseling, accountable care organizations, virtual and retail-based care sites and other care settings. Without question, these diverse and expanding care sites demand a diverse case management workforce.
PROFESSIONAL DIVERSITY TO MEET THE CASE MANAGEMENT CHALLENGE
Well before the global pandemic, the evolving role of professional case managers was already documented. Now, innovative approaches to case management and care delivery to meet the demands imposed by the COVID-19 crisis will no doubt be forthcoming (WHO, 2020). As one of the authors of this article wrote previously, “The context of the case management practice has been shifting from a single care setting or an episode of care to one that does not recognize boundaries” (Tahan, 2019, p. 15). Tahan also identified three key shifts that define the transformation of the professional case management role. First and most important is the provision of person-centered care interventions and services. The second is the focus on multiple care settings (traditional and non-traditional) to facilitate the provision of both health and human services; and the third is the recognition of health promotion, wellness and prevention, instead of the more traditional “reactive approach” of diagnosis and treatment (Tahan, 2019, p. 16).
The challenge, however, is that increased demands have been placed on the case management community for years, concurrent with a need for succession planning in the field. To illustrate, the most recent role and function study conducted in 2019 by the Commission for Case Manager Certification (CCMC) found that more than half of survey respondents (54.31%) were between 51 and 65 years of age, with the largest group within that demographic being 56 to 60 years of age (21.04%) (Tahan, Kurland, and Baker, 2020a). Given a projected nursing shortage (AACN, April 2019), it’s clear that future demand for professional case managers cannot be met solely by nurse case managers, who continue to account for the largest professional discipline among Certified Case Managers® (CCMs) (Baker & Kurland, 2020).
The way forward then is with increased professional diversity among case managers in all practice settings. From the standpoints of workforce management, practice environment and employer, the case management community must engage in and support greater workforce diversity. For example, CCMC has several outreach initiatives underway, including a special focus on increasing the involvement of social workers as case managers (NASW, n.d.), in addition to encouraging more participation in professional case management by mental health counselors, pharmacists and other healthcare professionals.
As another author of this article has written, “The future of healthcare is greater collaboration. What we see in patient-centered practice, in which interdisciplinary teams can improve outcomes for patients, is also true among professional organizations. Greater collaboration among certifying bodies and professional organizations will foster mutual respect, understanding and collaboration” (Kurland, 2019, p.24). The fruits of these efforts are already evident.
CCMC has observed a steady increase in the number of non-nursing case management professionals pursuing certification, in particular social workers. That increase was reflected in the results of the 2019 role and function study, in which 11.2% of those who responded identified themselves as social workers, about double the percentage of respondents (5.8%) in the 2014 practice analysis survey (Tahan, Kurland, and Baker, 2020a). Among other 2019 role and function respondents, occupational therapists and vocational rehabilitation counselors accounted for 1.45%, and counselors and psychologists were another 1.26%. Although small, these percentages apply to a growing population of CCMs overall, numbering more than 48,000 currently in practice, an increase from 37,000 five years ago.
In addition, professional case management is practiced in a variety of healthcare settings, the most common being health plan/insurance company and hospital/acute care. Other settings include workers’ compensation, independent case management, ambulatory/outpatient care/primary care/urgent care clinic, and government agency (2.67%) (Tahan, Kurland, and Baker, 2020a). The presence of professional case managers in diverse care settings is essential to meeting the demands of the healthcare industry amid ongoing changes, especially regulatory standards and reimbursement methods.
What’s important to understand is that greater professional diversity, in terms of the background discipline and practice setting, is not meant to elevate or diminish any one discipline. Nursing case management, as the dominant discipline, has brought many skilled clinicians from the bedside into a specialty practice of providing care and treatment for the whole patient. However, it is important to emphasize that professional case management is, by its nature, interdisciplinary/interprofessional; it spans both health and human services, across diverse health and support service care settings. This reflects best practices in care delivery, as research demonstrates the benefits of interdisciplinary care for patients, as well as for members of the care team of interdisciplinary professionals (Lippincott, 2018). Thus, one can argue that as the case management field becomes increasingly interdisciplinary, it further enriches the profession and its advocacy for individuals and their support systems across health and human services.
Additionally, the current state of case management practice calls for continued workforce planning and management, not only to counter the effect of those exiting the workforce due to retirement, but also to increase the diversity of the workforce (by ethnicity, age group, gender, and professional discipline representation). In addition, expanding the case management population and the professional disciplines among them will support and mentor the next generation of professional case managers, as well.
CERTIFICATION AS THE COMMON GROUND
As the complex and varied dynamics of the healthcare environment continue to influence the role of the professional case manager, it is vitally important to engage in regular field surveys (known as practice analyses). To that end, CCMC conducts its role and function studies every five years, the most recent being in 2019 with results published in 2020 (Tahan, Kurland and Baker, 2020a; 2020b). The purpose of the role and function study is usually twofold: first, to identify and confirm the essential activities (what professional case managers must do) and the knowledge domains (what professional case managers must know to effectively perform their role responsibilities); and second, to inform the relevance and currency of the CCM certification examination blueprint. Clear descriptions of the roles and functions of professional case managers are identified, along with the knowledge required for competent performance (Tahan, Kurland, and Baker, 2020b). Such clearly defined roles and functions capture the essence of professional case management and its evolution over time – regardless of the practitioner’s title, practice setting, background discipline or specialization.
The rigor of this field research and its application to board-certification also establish the common ground among all professional case managers. No matter their professional background or where they practice, case managers who meet the eligibility criteria for and pass the certification examination join the growing ranks of CCMs in practice. Certification in the specialty of case management differentiates those with advanced knowledge and competence in the practice. It also differentiates them as qualified experts who can effectively mentor others, especially those new to or contemplating entry into the practice. These are invaluable considerations in workforce planning and management: how to nurture the next generation of professional case managers.
Over the years, changes in professional case management practice have reflected overall trends in healthcare. To give one example, the emergence of ambulatory care has been accompanied by a rise in the number of respondents to role and function surveys who identify themselves as practicing in that care setting (Tahan, Kurland, and Baker, 2020b). Another example is the need for healthcare organizations to manage their financial reimbursement risks, such as avoiding unnecessary hospital readmissions. To that end, professional case managers can identify and measure outcomes not only from case management services, but also from the interdisciplinary care team and even across the organization.
The changing nature of healthcare – now, more than ever, during COVID-19 – puts the professional case manager in the spotlight. While the ranks of CCMs continue to grow, currently numbering over 48,000 actively in practice, more will be needed. Meeting this demand will require greater professional diversity, and for far more than sheer numbers. As professional case managers enter the field from a variety of backgrounds and disciplines, they will contribute to an approach centered on patients and their support systems/families. Certification will ensure their foundation in case management, while their own specialized knowledge and experience in health and human services will make them even more impactful.
American Association of Colleges of Nursing. (April 2019). Nursing Shortage. Retrieved from https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage
Baker, M. and Kurland, M. (May/June 2020). Case Management Demographics Reveal Insights into Who Is Practicing Case Management Today. Professional Case Management. 25(3):176-178. doi: 10.1097/NCM.0000000000000435.
Dyrda, L. (April 1, 2020). ‘This is healthcare’s Amazon moment’: Dr. Stephen Klasko’s 5 Predictions on Healthcare Delivery Post-COVID-19. Retrieved from: https://www.beckershospitalreview.com/hospital-management-administration/this-is-healthcare-s-amazon-moment-dr-stephen-klasko-s-5-predictions-on-healthcare-delivery-post-covid-19.html
Kurland, M. (2019). CCMC Outreach: Promoting Greater Collaboration Among Health and Human Services Organizations. CMSA Today. Issue 3:24.
Lippincott Solutions. (Sept. 6, 2018). Interdisciplinary Care Plans: Teamwork Makes the Dream Work. Retrieved from: http://lippincottsolutions.lww.com/blog.entry.html/2018/09/06/interdisciplinaryca-z601.html
National Association of Social Workers (NASW). (n.d.). NASW/CCMC Collaborative. Retrieved from: https://www.socialworkers.org/careers/credentials-certifications/apply-for-nasw-social-work-credentials/nasw-and-ccmc-collaborative
Tahan, H. (2019). Forecasting the Near Future of Professional Case Management Practice. CMSA Today. Issue 4:14-21, 27-31.
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Tahan, H., Kurland, M., and Baker, M. (July/Aug. 2020b). The Evolving Role of the Professional Case Manager: A National Study from the Commission for Case Manager Certification: Part 2. Professional Case Management. 25(4).
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World Health Organization (WHO). (2020). Coronavirus disease (COVID-19) technical guidance: Patient management. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/patient-management