The Importance of Case Management

A friend of mine, Dr. Colleen Morley, current president of the Case Management Society of America, is often heard saying that case management is “the best kept secret in healthcare.”  Case managers serve a critical role in the healthcare continuum.  They serve as a support for achieving patient wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation.  Case managers help identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner to obtain optimum value for both the patient and the reimbursement source.

Case managers typically start their careers as healthcare providers either in nursing or social work.  However, other healthcare disciplines are drawn to the field of case management and are welcome additions to the profession.

Effective case management begins with a thorough assessment to determine the patient’s anticipated needs at discharge, community support, family support, insurance considerations and social determinants of health (SDOH).  SDOH essentially refers to social and environmental conditions that affect a wide range of health functioning and quality of life.

At every level of care, from emergency departments to intensive care units to acute care to post-acute settings and even in physician offices and insurance companies, case managers work to ensure that their clients and patients are well cared for and have the necessary resources to be safe and healthy.  To achieve these outcomes, case managers work hand in hand with medical providers, therapy providers, pharmacists, insurance companies, social service agencies, medical equipment and supply companies and many other resources to support the people they serve.  It is truly an interdisciplinary approach to promote positive patient outcomes and help patients reach their individual goals.

One of the primary goals for case managers is to work with their clients and patients on a plan to return to their home and to keep them safe.  This often presents as a great challenge due to the medical and physical needs of the person served, the accessibility of their home and the support of friends and family.  Unfortunately, patients do not always have an accessible home or the support of friends and family and their medical and / or physical needs necessitate a level of care that is not available at home.  

In these circumstances, the case manager will make referrals to other types of facilities, such as skilled nursing facilities orlong term care facilities.  Home health care agencies are a great resource to help the patient once they return home; however, home health care may not be the appropriate level of care for every patient, depending on their level of autonomy.

Innovative technologies to support patient care continue to be at the forefront of healthcare advancements, and there is continued opportunities for the development of future technologies that will assist patients with going home and staying home safely while reducing the risk for hospital readmission.  Smart home technology is advancing rapidly.  This technology offers a person the opportunity to assist with a variety of tasks with voice commands and automation.  Tasks like medication management can now be done with technology and may only require minimal interaction by a caregiver to ensure that proper medications are administered.  Other electronic devices offer opportunities for surveillance at home so that a loved one or caregiver can monitor a patient remotely and receive alerts for a variety of actions like when a person falls or when they use the bathroom.  This technology also offers the ability to interact with the person remotely either through a video interface or through an intercom system.  New technology developments will continue to have a variety of benefits for patients and their caregivers – including to reduce or even prevent falls, assist with completing activities of daily living, assist with transfers, with limited support of caregivers or family members –  all of which are essential to  keeping people at home and reducing hospitalizations.

Technology specifically designed to assist people with being safe and healthy in their homes is relatively new and can be expensive.  It is typically not covered by insurance companies, Medicare, or Medicaid.  Future legislation should be explored to allow for financial support from these payor sources to reduce the need for placement at facilities.  When possible, people should be able to return to their own homes where they feel comfortable and safe.

Navigating through our healthcare system is a complicated and daunting task even for the most experienced healthcare providers.  Certified case managers are well-informed and a great resource to rely on when dealing with significant illnesses or injuries.