CMSA Standard of Professional Case Management Practice

With an ever-changing healthcare system, policy changes, potential local and federal budget cuts and program reductions and helping clients navigate the complex healthcare system, advocacy is one of the most challenging and powerful skills a case manager can possess. CMSA states that case managers will seek creative ways to advocate for clients’ interests (Case Management Society of America, 2022). Case managers do this every day through high-quality care and evidence-based practices in the right delivery systems. It is essential to recognize that overlapping standards of practice—such as ethics, cultural competence and advocacy—should be thoughtfully integrated into professional considerations.

STORY

An elderly man was being discharged from a primary care practice because he had failed to attend his scheduled appointments more than three times. The office would call the patient, and there was no answer. The patient would call when he remembered to make an appointment, but then not schedule his Medicaid transportation. The local health department was also collaborating with this client and called me to discuss the client’s needs.

The health department evaluated the patient and provided in-home help with appointments, transportation, daily activities and other tasks. The client also needed home care orders for physical therapy, as well as supplies such as adult briefs, and a follow-up appointment. Upon comprehensive review of the case, advocacy for the client, discussion regarding the patient’s needs and consultation with leadership, it was concluded that the client presents with multiple social determinants of health (SDOH), has a diagnosis of dementia, and currently receives home-based care to support effective care coordination. There was no reason for the patient to have been discharged from primary care without a proper assessment. The client re-established care in primary care with my help and was able to get the care he needed and deserved. The primary care practice discharge policy now allows population health to review client charts, discuss SDOH with the client and advocate as is necessary to ensure uninterrupted care.

ADVOCATING FOR CLIENTS

Case managers should ensure that clients are informed about their care, kept up to date and educated on their care with the utmost respect. The story above is a testament to the vital importance of advocacy in the role of the case manager. By collaborating across agencies and engaging with community resources, case managers can remove barriers and support the health and well-being of clients who may otherwise fall through the cracks. Advocacy is not simply a matter of fulfilling job duties; it is an active, ongoing commitment to seeking out what is best for each client, particularly those who are most vulnerable.

Creative problem-solving, persistence and a willingness to challenge existing policies are often necessary to ensure that client needs are met holistically. By engaging in direct communication, coordinating resources and conducting policy reviews, case managers can affect both individual client outcomes and the overarching systems governing care delivery. Advocacy extends beyond the client-provider relationship, shaping organizational procedures and policies to be more equitable, responsive and patient-centered.

Clients should be actively involved in shared decision-making, valuing their autonomy, privacy and confidentiality. Clients also have the right to refuse care, access care and advocate for themselves. Case managers often inform healthcare professionals, families and support networks about a client’s goals and needs because invaluable conversations happen with case managers that may not occur with others. Persisting in the advocacy of clients’ interests, even when others may not widely accept such preferences, but do accurately reflect the expressed wishes of the client.

ADVOCATING THROUGH CHALLENGES

Promoting the best outcomes for all patients, regardless of race, ethnicity, culture, marital status, gender identity, physical or mental health, cognitive disabilities or political beliefs, is necessary to ensure health equity, so that all clients have equal access to timely and well-coordinated care. Social determinants of health should be assessed, and proper resources provided to the clients. Transportation, the ability to pay copays and health literacy can all play a part in receiving high-quality care. Case managers should listen to clients and assess their needs to effectively advocate within the healthcare team and with families, ensuring holistic care.

ADVOCATING THROUGH CMSA

Another excellent way to advocate for our clients is through the CMSA Public Policy and Hill Days. This is an opportunity to use your voice to advocate for policy changes through your thoughts and experiences with state representatives from your state. The senators and their staff enjoy hearing our personal and client stories as part of our advocacy for speaking up about topics such as telehealth, behavioral health, and more.

However, do not forget that you can contact your representatives at any time or join call-to-action campaigns to advocate for change, improve the quality of care or even reduce health disparities. Everyone deserves access to the best care. Case managers have a strong voice to find creative ways to advocate for the client’s best interest.

CONCLUSION

Advocating for clients involves standing up for their rights, ensuring they receive the proper care despite disparities, disabilities, SDOH and giving the most vulnerable clients a voice throughout the healthcare process. The main goal is to ensure clients receive respectful, ethical and practical care while also empowering them to self-advocate. Advocating for clients is a vital skill for case managers that applies in all situations, including those involving exceptional circumstances. So, use your voice, case managers. There is so much to support, change and advocate for.

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