The arrival of a new year and new administration inevitably brings a measure of uncertainty. Within that uncertainty may lie some of the healthcare industry’s greatest challenges for 2017, but it also can yield some of its greatest opportunities. That’s the mindset of case management experts as they reflect on the coming year.
“We have the opportunity to look at how we can improve healthcare, and case managers are right at the forefront of that,” said Cheri Lattimer, president and CEO of Consulting Management Innovators, who also serves as executive director of the Case Management Society of America and the National Transitions of Care Coalition. “How can we improve care coordination? How can we make sure transitions of care improve the patient’s journey and the quality of care they receive? How can we work closer with patients and caregivers to engage them in this process?”
A new administration and HHS leadership, an uncertain future for the Affordable Care Act, the implementation of MACRA — their impact on the healthcare industry is hard to predict today. But the shift away from fee-for-service and toward value-based reimbursement will make expert case management more critical than ever before, industry leaders say.
”Regardless of what happens in the next administration, case management is still going to be on the forefront because we know it works,” said Chriss Wheeler, a long-time nurse and case manager who is a partner in Innovative Care Consultants. “Historically we’ve seen how positive outcomes and cost savings happen at the same time.”
A successful move toward patient-centered medical homes and accountable care organizations will require case management expertise, advancing the case management profession out of traditional roles — such as making transitions to outpatient care — and into new terrain, said Wheeler. Also influencing increased demand for case management is the consumer mindset that more of today’s patients bring to their interactions with the healthcare system.
“We’ve moved from the passive patient to the active healthcare consumer,” said Wheeler. “Case managers are helping patients figure out how to maneuver the healthcare system, making sure they’re getting quality care in the most cost-effective and efficient way, and also helping them put together a plan to manage their own healthcare.”
Case managers are responding by educating patients and caregivers and demonstrating the value of case management. Aiding in those efforts, said Lattimer, are accreditation and certification programs that authenticate value to savvy healthcare consumers.
“More consumers want to be part of shared decision making — What is a good hospital? What is a good provider? What are good outcomes?” Lattimer said. “As that awareness grows stronger in a consumer market, they’re going to begin to ask, ‘Are they accredited? Do they have certifications?’”
Both Lattimer and Wheeler agree the industry will continue to push in 2017 for title protection for case management, which will lay the groundwork for CMS to provide reimbursement for professional case management. That process must start with a clear definition of case management, they said.
“In the coming year, as we as case managers continue to partner and collaborate with the healthcare team and help to show the value we add, I think we will make great gains,” Wheeler said.