CMSA Logo

The Impact of Case Management on the Healthcare System- Additional Information

Guiding Principles of Case Management

Excerpt from CMSA Standards of Practice for Case Management pgs. 14-15

Guiding principles are relevant and meaningful concepts that clarify or guide practice. Guiding principles for case management practice provide those professional case managers:

  • Use a client-centric, collaborative partnership approach that is responsive to the individual client’s culture, preferences, needs, and values.
  • Facilitate client’s self-determination and self-management through the tenets of advocacy, shared and informed decision- making, counseling, and health education, whenever
  • Use a comprehensive, holistic, and compassionate approach to care delivery that integrates a client’s medical, behavioral, social, psychological, functional, and other needs.
  • Practice cultural and linguistic sensitivity and maintain current knowledge of the diverse populations served.
  • Implement evidence-based care guidelines in the care of clients, as available and applicable to the practice setting, or client population served.
  • Promote optimal client safety at the individual, organizational, and community levels.
  • Promote behavioral change science and principles integration throughout the case management process.
  • Facilitate awareness of and connections with community supports and resources.
  • Foster safe and manageable navigation through the health care system to enhance the client’s timely access to services and achieve desired outcomes.
  • Pursue professional knowledge, practice excellence, and maintain competence in case management and health and human service delivery.
  • Support systematic approaches to quality management and health outcomes improvement, implementation of practice innovations, and dissemination of knowledge and practice to the health care community.
  • Maintain compliance with federal, state, and local rules and regulations and organizational, accreditation, and certification
  • Demonstrate knowledge, skills, and competency in applying case management standards of practice and relevant codes of ethics and professional conduct.
  • Support clients and their support systems with access to available and advancing technologies such as applications, patient portals, and telehealth services.

Case management guiding principles, interventions, and strategies target the achievement of optimal wellness, function, and autonomy for the client and client’s family or family caregiver through advocacy, assessment, planning, communication, health education, resource management, care coordination, collaboration, and service facilitation.

The professional case manager applies these principles into practice based on the individualized needs and values of the client to assure, in collaboration with the interprofessional health care team, the provision of safe, appropriate, effective, client-centered, timely, efficient, and equitable care and services.

Services Provided by Case Managers

The following describes a broad overview of some services case managers provide while working with various populations:

  • Medical case managers work closely with the healthcare team to help patients/clients better manage their acute and chronic conditions and address social determinants of health. They assist with care transitions, care coordination, medication management, community resource facilitation, self-management education, care plan development, and goal setting.
  • Behavioral health case managers aid individuals with mental health conditions, emotional challenges, and/or substance use disorder to access treatment, rehabilitation programs, and community resources.
  • Geriatric case managers help elderly clients dealing with aging challenges navigate healthcare options, access community resources, and plan for long-term care needs, working closely with family/caregivers.
  • Pediatric case managers assess and monitor child safety, family situations and facilitate access to medical, social and educational services as they work to support the well-being of children and their families.
  • Vocational rehabilitation case managers work with individuals with injuries or disabilities to assess their skills and limitations, coordinate care and training programs, and provide career counseling. They advocate for workplace accessibility and work accommodation.

Source: https://www.tealhq.com/career-paths/case-manager#:~:text=Case%20Managers%20are%20pivotal%20in

Case Management Practice Settings

Excerpt from CMSA Standards of Practice for Case Management pgs. 16-17

The following is a representation, though not exhaustive, list of practice settings. However, it reflects where professional case managers practice today, whether in-person or virtually:

• Ambulatory care clinics and community-based organizations
• Federally Qualified Health Centers
• Student or university counseling and health care centers
• Medical and health homes
• Primary care practices
• Corporations
• Geriatric services including residential, senior centers, assisted living facilities and continuing care retirement communities
• Government-sponsored programs such as correctional facilities, military health, and Veterans Administration, and public health
• Hospitals and integrated care delivery systems, including acute care, sub-acute care, long-term acute care (LTAC) facilities, skilled nursing facilities (SNFs), and rehabilitation facilities
• Independent and private case management companies
• Life care planning programs
• Long-term care services, including home, skilled, custodial, and community-based programs
• Population health, wellness and prevention programs, and disease and chronic care management companies
• Private health insurance programs including workers’ compensation, occupational health, catastrophic and disability management, liability, casualty, automotive, accident and health, long-term care insurance, group health insurance, and managed care organizations
• Provider agencies and community-based facilities, including mental/ behavioral health facilities, home health services, ambulatory and daycare facilities
• Public health insurance and benefit programs such as Medicare, Medicaid, and state-funded programs
• Primary care and specialty group practices, Patient-Centered Medical Homes (PCMH)
• Accountable Care Organizations (ACOs) and Physician-Hospital Organizations (PHOs)
• Schools
• Serious illness, hospice, palliative, and respite care programs

References

 

  1. The Role of Case Management in Value-Based Health Care | Emerging Health Information Technologies Are a Key Solution to This Problem the Role of Case Management in Value-Based Health Care.; 2015. https://www.ehidc.org/sites/default/files/resources/files/The_Role_of_Case_Management_in_Value-based_Health_Care.pdf
  2. Harris R, Popejoy L. Case management: An evolving role. Western Journal of Nursing Research. 2018;41(1):3-5. doi:10.1177/0193945918797601
  3. Case Management Society of America. Case Management Model Act.; 2017.
  4. Case Management Society of America. CMSA Standards of Practice for Case Management.; 2022.
  5. Case Management Society of America, The Center for Case Management. Communicating Your Value: The Case Manager’s Guide.; 2023. https://cmsa.org/cmsa-cfcm-position-paper-2023/
  6. What is a Case Manager? Explore the Case Manager Career Path in 2024. Teal. Accessed March 2024.https://www.tealhq.com/career-paths/case-manager#:~:text=Case%20Managers%20are%20pivotal%20in
  7. Richter F. The world’s oldest populations. World Economic Forum. Published February 22, 2023. https://www.weforum.org/agenda/2023/02/world-oldest-populations-asia-health/
  8. CDC. Promoting Health for Older Adults. CDC. Published September 8, 2022. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm
  9. CDC. About Chronic Diseases. Chronic Disease. Published 2022. Accessed September 1, 2024. https://www.cdc.gov/chronic-disease/about/
  10. McLaughlin-Davis M. The practice of hospital case management. Professional Case Management. 2019;24(6):280-296. doi:10.1097/ncm.0000000000000391
  11. Mental Health America. The State of Mental Health in America. MHANational.org. Published 2023. https://mhanational.org/issues/state-mental-health-america
  12. CDC. Fast Facts: Health and Economic Costs of Chronic Conditions. Chronic Disease. Published 2024. Accessed March 2024. https://www.cdc.gov/chronic-disease/data-research/facts-stats/
  13. Hudon C, Chouinard MC, Pluye P, et al. Characteristics of case management in primary care associated with positive outcomes for frequent users of health care: A systematic review. The Annals of Family Medicine. 2019;17(5):448-458. doi:10.1370/afm.2419
  14. Itchhaporia D. The evolution of the quintuple aim. Journal of the American College of Cardiology. 2021;78(22):2262-2264. doi:10.1016/j.jacc.2021.10.018
  15. Doménech-Briz V, Gómez Romero R, de Miguel-Montoya I, et al. Results of nurse case management in primary health care: Bibliographic review. International Journal of Environmental Research and Public Health. 2020;17(24):9541. doi:10.3390/ijerph17249541
  16. Lim CT, Caan MP, Kim CH, Chow CM, Leff HS, Tepper MC. Care management for serious mental illness: A systematic review and meta-analysis. Psychiatric Services. Published online July 13, 2021. doi:10.1176/appi.ps.202000473
  17. Joo JY, Huber DL. Case management effectiveness on health care utilization outcomes: A systematic review of reviews. Western Journal of Nursing Research. 2018;41(1):111-133. doi:10.1177/0193945918762135
  18. Hudon C, Chouinard MC, Aubrey-Bassler K, et al. Case management in primary care for frequent users of health care services: A realist synthesis. The Annals of Family Medicine. 2020;18(3):218-226. doi:10.1370/afm.2499
  19. Grover C, et al. Case management reduces length of stay, charges, and testing in emergency department frequent users. The Western Journal of Emergency Medicine. 2018; 19(2), 238-244. https://doi.org/10.5811/westjem.2017.9.34710
  20. Hudon C, Chouinard MC, Lambert M, Dufour I, Krieg C. Effectiveness of case management interventions for frequent users of healthcare services: a scoping review. BMJ Open. 2016;6(9):e012353. doi:10.1136/bmjopen-2016-012353
  21. Buja A, et al. Health and health service usage outcomes of case management for patients with long-term conditions: a review of reviews. Prim Health Care Res Dev. 2020 Aug 3;21:e26. doi: 10.1017/S1463423620000080
  22. Joo JY, Huber DL. Community-based case management effectiveness in populations that abuse substances. International Nursing Review. 2015;62(4):536-546. doi:10.1111/inr.12201
  23. McCarthy D, Ryan J, Klein S. Models of care for high-need, high-cost patients: An evidence synthesis. Issue Brief (Commonwealth Fund). 2015;31:1-19. Accessed March 2024. https://pubmed.ncbi.nlm.nih.gov/26591906/