Medical Case Management Today

Medical case managers fulfill a vital role in today’s healthcare

Medical case managers fulfill a vital role in today’s healthcare. They serve as the connectors between their patients, other members of the patient’s clinical team, and various other healthcare and community resources. While the need for case managers continues to grow due to such factors as our nation’s aging population, the increase in various complex, critical and chronic illnesses (e.g., arthritis, cancer, chronic obstructive pulmonary disease, heart disease, etc.), labor shortages, growing multicultural population, and the focus on population health management, there remain new trends and developments affecting medical case management today.

Trends and Developments in Case Management

In their role, case managers must balance their commitment to providing high quality patient care and advocacy with cost efficiency. They must be able to coordinate the care of their patients, calling upon different services and healthcare providers in order to meet this goal. They must be able to effectively utilize new technologies (e.g., electronic health records, patient assessment software, patient portals, telehealth platforms, clinician collaboration tools, etc.) to record and analyze health data for their and other clinicians’ needs, as well as population health management purposes. Additionally, case managers must be able to use evidence-based strategies to best meet their patients’ needs.

Effective collaboration with other members of their patients’ team is also critical to their role. In their collaboration with physicians, specialists, occupational and physical therapists, rehab professionals, social workers and other community resource service providers, they must serve as strong advocates for their patients, filling any gaps in their needs to ensure their patients’ continuity of care.

With the introduction of regulations, from the Affordable Care Act and Omnibus Reconciliation Act to the Health Insurance Portability and Accountability Act, as well as the Centers for Medicare and Medicaid Services (CMS) regulations relating to preventable hospital readmissions, case managers also play a role in compliance. How effective they are in keeping a recently discharged patient making progress in their medical condition can make the difference between a hospital receiving the expected CMS reimbursement versus a penalty for what it may deem to be a preventable readmission.

America’s more diverse, multicultural population also demands that case managers be able to engage with their patients with sensitivity to their ethnicity, language and cultural norms. This often requires the use of case managers with the appropriate knowledge and skills or taking the time to learn about how a particular patient and family members view healthcare based on their culture.

Complex cases, including patients with co-morbidities (e.g., heart disease and diabetes) can be especially challenging. These cases are becoming more common as our population grays and the elderly are faced with more than one medical condition. For case managers, providing the best patient care requires them to develop a customized plan tailored to a patient’s needs, collaborating with specialists, continually assessing and monitoring the patient’s health as related to each of his/her medical conditions, and providing the support and advocacy patients with difficult and multiple health conditions most need.

Case management today is filled with new challenges, but with the right strategies and tools, case managers can fill a vital role in advancing the highest quality of patient care.