BY , MSN, PHCNS-BC, CCM
The CARES Act contains a variety of aspects, all addressing the needs of people across the country dealing with the COVID pandemic. In terms of healthcare, it was written to support America’s healthcare system in the fight against the coronavirus and, though meant to be temporary, can potentially give us new beginnings for changes in the way we deliver healthcare in this country.
From a case management perspective, the Public Policy Committee (PPC) of CMSA has identified three important issues that will be the priorities for the next two years. The priorities are telehealth, workforce development and mental health. Not only were these issues important during the pandemic, but the work that was done in these areas needs to continue beyond the deadlines set up by the government.
TELEHEALTH
During the pandemic, we saw a shift from face-to-face visits with providers to telehealth visits. This shift in the way healthcare was delivered was needed to reduce staff exposure to ill persons, preserve personal protection equipment (PPE) and minimize the impact of patient surges on facilities. Healthcare systems had to adjust the way they triaged, evaluated and cared for patients using methods that did not rely on in-person services. Telehealth service helped provide necessary care to patients while minimizing the transmission risk of COVID-19 between healthcare personnel and patients. While this technology and its use is not new, widespread adoption among healthcare personnel and patients beyond simple phone correspondence has been relatively slow. However, recent policy changes because of the CARES Act have reduced some of the barriers to telehealth access and have promoted its use to deliver acute, chronic, primary and specialty care, including mental health and behavioral health providers.
Not only did telehealth allow people to safely have contact with their providers, but it also gave individuals who did not have access to a provider, because of their geographic location, access to care that they had not had before. Remote access to healthcare services helped increase participation for those who are medically and socially vulnerable in addition to those who did not have ready access to providers. This was especially beneficial to our veterans across this country. Telehealth also allowed people access to case managers who perhaps had not had that advantage in the past. Through telehealth, patients could continue to get health coaching and support to manage their chronic health conditions, including nutrition counseling and medication management. Case managers could also continue to provide follow-up to patients after hospitalization and engage with patients who have difficulty accessing care, e.g., those who live in very rural settings, older adults and those with limited mobility. Case managers were also able to communicate with insurer/payers to understand availability of covered telehealth, telemedicine or nurse advice line services. We also saw the expansion of the Nurse Licensure Compact, which allowed nurses and case managers to expand care across state boundaries based on technology.
WORKFORCE DEVELOPMENT
During the pandemic, case managers were quickly recognized as integral parts of the care management team and were considered critical employees and integral parts of numerous employer and community projects, especially during those crucial public health emergencies. Case managers were called upon to pivot from their daily routines to assist with a variety of tasks such as setting up COVID testing and vaccination sites, assisting with communication between hospitalized patients and their anxious family members waiting to hear about the outcome of their loved ones and to maintain the continuity of care to the extent possible to avoid additional negative consequences from delayed preventive, chronic or routine care. Case managers everywhere saw an alteration of their generally accepted practices and willingly adjusted in this time of need. The pandemic brought to light the importance of the work that case managers do and how critical we are to the well-being of our patients and families.
MENTAL HEALTH
The pandemic took a toll on the mental health of many people across this country. Nursing staff dealing with sick patients over and over again, working long hours, managing the communication between family, providers and patients and dealing with dying patients who had no one to be with them as they passed all played hard on the mental well-being of the healthcare providers, including case managers. Adding to this was the fear of contracting the virus along with significant changes to our daily lives as our movements were restricted in support of efforts to contain and slow down the spread of the virus. Faced with new realities of working from home, temporary unemployment, home-schooling of children and lack of physical contact with other family members, friends and colleagues, it became obvious that we must look after our mental as well as our physical health. There is also clear evidence that the pandemic has not affected all Americans equally. As is often the case, unfortunately, the most vulnerable among us also felt the mental health effects most intensely. Job loss, housing instability, food insecurity and other risk factors for poor outcomes have disproportionately hit some communities more than others. The pandemic has raised awareness of mental health symptoms and service needs, and many agencies are working hard to raise public awareness of the resources that are available to support people’s immediate mental health needs. Healthcare providers have made a rapid transition to phone- and computer-based telehealth, with widespread adoption across both private and public mental health systems.
The mental health impacts of COVID-19 continue. From all that we know, it is clear these impacts will outlive the pandemic itself. Therefore, it is crucial that we work together to apply evidence-based strategies to support the mental health needs of all Americans and to make these strategies broadly available, especially in vulnerable communities. As a result, mental health is now being recognized as a vital component of healthcare delivery by patients, providers, healthcare advocates, as well as payers, employers and a wide array of other interested parties. Case managers have always promoted mental health as a fundamental value of our profession and continue to promote mental health as a part of any integrated case management model of care.
As we come out of the pandemic, case managers across this country are beginning to reflect on where we were, where we have been and where we go from here. We are recognized experts and vital participants in the care coordination team. We empower people to understand and access quality and efficient healthcare. We are advocates for patient well-being and improving both physical and mental health outcomes. We also impact health policy by providing evidence-based tools and resources.
As we approach the deadlines for some of these important issues, the Public Policy Committee of CMSA will continue to support both state and federal legislation around these three priorities and commit to work collaboratively with other disciplines to understand individual federal and state regulations, restrictions on temporary mandates and directives and to monitor for updated regulation actions for healthcare systems and providers. The PPC is passionate about the work that we do and is committed to turning that passion into policy for the greater good of case managers everywhere.
, MSN, PHCNS-BC, CCM, has a diverse background in both nursing and case management. She has served as executive director of medical management with physician hospital organizations as well as director of hospital case management for both large multi-hospital healthcare systems and smaller case management departments in the Midwest. She is a Board-Certified Clinical Nurse Specialist in Community Health as well as a Certified Case Manager. Currently she is on the faculty for Indiana University School of Nursing and does private geriatric case management for Senior 1 Care. Susan is chairman of the National Public Policy Committee for CMSA and is a board member and past president of the Central Indiana Chapter of CMSA. She has published nationally and has presented both locally and nationally on case management topics.