DorlandHealth

By Christine Leyden, RN, MSN

Congratulations to CMSA on a successful and engaging meeting. While celebrating 20 years of promoting the value of case management in the health care paradigm, CMSA looked forward to the future in the wake of historic health care reform legislation.

The conference touched on many subjects, from social media and technology and engaging providers to clinical integration issues and making transitions seamless.  At the end of the day, collaboration, integration and performance measurement were the emerging themes that will most impact the case management industry.

As you know, case management is a key focus in the recently enacted health care reform legislation.  A greater emphasis is being placed on case management along the health care continuum, whether it be the requirement for improved measureable outcomes, increased quality, or more cost-effective care. 

Collaboration

Collaboration among providers, practitioners, consumers and hospitals will become ever more vital in the new health care landscape.  Case management programs will have to look toward guidelines to coordinate care across the continuum of health care settings, which will result in more efficient and effective service to consumers.

This is evident across the spectrum of treatment, including hospitals to home health care programs.  The Patient Protection and Affordable Care Act (PPACA) will offer opportunities to more evidently show the increasing value of case management.  This will include an emphasis in catastrophic case management—further building the case for case management to play a major role in the overall health care system.

Organizations who can show quality outcomes will demonstrate to consumers, partners and regulators that they can provide services in a results-oriented, cost-effective way.

Integration

Health care organizations use case management to better meet consumers’ needs and improve their treatment outcomes by coordinating the full continuum of care.  This increased emphasis will rely on all areas working together.  For example, the future will see further integration of disease management programs with case management.  Managed care providers are under tremendous pressure to demonstrate quality.  Value-based health care purchasing will depend on showing quality. Independent accreditation will be necessary to measure quality and ensure purchasers and benefits managers that the plan they are getting has been independently benchmarked.

Changes in health care programs, such as the increasing emphasis on wellness programs, as well as the increased breadth of consumer options that will become available through health care reform, will make case management vital to navigating the continuum of care and provide consumers with the appropriate information, tools and resources to allow hospitals and health care providers to provide quality care.

Measurement

Measurement of health care quality will continue to grow in importance as new standards are developed from health reform actions.  Emphasis will be placed on assessment strategies, reviewing case management plans and establishing case management goals.  A focus will be on positive outcomes balanced by cost effectiveness.  For example, a decrease in readmission rates will show case management quality in producing value for payers and hospitals.  In the hospital setting, case management will be instrumental to reducing readmission rates through effective management and care transition.

Standards are already established to measure key deliverables in case management including medical readmissions, complaint resolution timeliness, overall consumer satisfaction and percentage of individuals refusing case management services.

URAC Case Management Accreditation gives case managers the quality benchmarks to ensure the consumers they serve that they will receive coordinated care across the continuum of health care settings.

The next 20 years offer great opportunity for case management and the future begins today.
 

About the Author
Christine Leyden, RN, MSN, is Senior Vice President and GM Client Services and Chief Accreditation Officer for URAC, the nation’s leading health care accreditation and education organization. For more information, or to contact Ms. Leyden, please visit www.urac.org.