Highlights

seek solutions that more effectively address the needs

By the CMSA Hospital Case Management of our most vulnerable hospitalized patients.
Taskforce It is no secret that the hospital industry is in the
midst of seismic changes. From the scale of mergers
and acquisitions among hospital and nonhospital

T he Case Management Society of America (CMSA)

has been an organizing force setting the practice direc-
entities to the expansion of convenient ambulatory
services centers, health care systems are under over-
whelming pressure to improve patient outcomes and
tion for the discipline of case management, through lower costs. Value-based inducements were intro-
its representation, advocacy, and education functions. duced to incentivize hospital leaders to improve
The CMSA promotes practice that is evidence based delivery of care processes and promote collaborative,
and discourages the use of practices which, though interdisciplinary interactions. The traditional private
popular or widely accepted, are either not beneficial medical practice is waning, because medical practices
or are contrary to the standards of practice (SOP). are consolidating and medical homes are created. All
Although the increasing emphasis on care coordina- these changes are taking place at the speed of light.
tion by providers and payers has opened professional To adapt and survive in this new marketplace,
debate regarding the models being used in hospitals hospital leaders are scrambling to take advantage of
today, the CMSA intends to clarify its position on every bit of institutional talent to make changes that
hospital case management practice through a forth- reflect the new reality. As a result, hospital case man-
coming white paper and urges hospital leaders to agement, in general, and care coordination specifi-
cally have suddenly caught the attention of hospital
To address the queries and requests for information received by the executives.
Case Management Society of America (CMSA) from hospital case According to the Agency for Healthcare Research
managers across the nation, a taskforce of notable experts in the
field was assembled to explore the current models of hospital case
and Quality (AHRQ), the main goal of care coordina-
management practice and weigh them against the goals and expec- tion is to meet patients’ needs and preferences in the
tations of our rapidly evolving hospital environment. In the pro- delivery of high-quality, high-value health care. Care
cess, the taskforce intends to provide insights on the overarching
theme of care coordination as promulgated by governmental and
coordination is not a synonym for transition plan-
quasi-governmental entities, federal, state, and private payers. The ning but a process that “ensures that the patients’
taskforce also will recommend best practices wherever possible to healthcare needs and preferences are known and
help hospital leadership embark on the road to transformation.
communicated at the right time, to the right people,
The taskforce members from the CMSA are: Stefani Daniels, RN,
MSNA, CMAC, ACM; Victoria Florentine, BA, RRT, CCM, AE-C;
and that this information is used to guide the deliv-
Linda Edmond, BSMHR, LBSW, LNHA; Gary L. Morman, DO; ery of safe, appropriate and effective care” (AHRQ,
Meggan Eaves, MOTR/L; Vivian Campagna, MSN, RN-BC, CCM; 2014). Any activity that bridges gaps between pro-
Juliet Ugarte Hopkins, MD, CHCQM; Ellen Fink-Samnick, MSW,
ACSW, LCSW, CCM, CRP; and Mindy Owen, RN, CRRN, CCM
viders, care teams, settings, and provides information
Sponsored by the CMSA, 2019 important to the treatment plan, and patient flow,
Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN, Executive leads to improved care coordination. Furthermore,
Director case management is designed to “assist patients and
Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN, President their support system in managing their medical,
Address correspondence to Mary McLaughlin-Davis, DNP, ACNS-
social, and mental health conditions more efficiently
BC, NEA-BC, CCM, 24007 Lake Road, Bay Village, OH 44140 and effectively” (AHRQ, 2014). In a 1998 study, case
(MCLAUGM3@[Link]). management was defined as a “means of coordinating
The author reports no conflicts of interest. services” by a single case manager who is expected
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved to assess that person’s needs, develop a care plan,
DOI: 10.1097/NCM.0000000000000381 arrange for suitable care to be provided, monitor

Vol. 24/No. 5 Professional Case Management 259

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
the quality of the care provided, and maintain con- Care coordination is an essential component of
tact with the person (Marshall, Gray, Lockwood, & the SOP promulgated by the CMSA (2016), and is
Green, 2000). Recognition of the confirmed connec- also cited by the National Quality Forum (2010),
tion between case management and care coordina- the National Healthcare Quality and Disparities
tion energized the taskforce in its mission. Report chart book (AHRQ, 2016), and the Insti-
The CMSA established the SOP for case manage- tute for Healthcare Improvement (Craig, Eby, &
ment in 1995 and has revisited and updated the con- Whittington, 2011) as an essential service delivery
tent four times to reflect the changing health care sys- plan (Bodenheimer, 2008). Care coordination is
tem and the changing role of the case manager. The at the heart of any new hospital case management
most recent change in the SOP was made in 2016. model and leaps the brick and mortar boundaries
The CMSA emphasized the professional role of the of the acute care facility into other care facilities,
case manager and the need to empower patients and community-based settings, and the patient’s home.
their caregivers in important decisions regarding their This much broader vision can pose significant chal-
care, to promote health care literacy and self-care, lenges when planning for the future. Not only does
and to engage the patients’ participation and their the hospital system require strength and cohesiveness
transitions from the hospital (CMSA, 2016). Key within the walls of the facility, but also within the
provisions in the SOP include: larger web of the surrounding community’s infra-
structure and support systems. Care coordination can
A. Identify and select patients who can most benefit
no longer exist and function within a solitary hospi-
from case management services.
tal department located in the bowels of the facility;
B. Complete health, cognitive, and social assess-
it must become a core competency of every hospital
ment.
organization and evolve into a program where every
C. Identify problems or opportunities that would
hospital caregiver provides value that results in better
benefit from case management interventions.
outcomes at lower costs.
D. Collaborate with the client and stakeholders to
2. Establish clear roles and responsibilities. The
develop an individualized plan.
2010 Affordable Care Act has put a focus on the
E. Facilitate, coordinate, monitor, and advocate to
improvement of health outcomes, specifically calling
“minimize fragmentation in the services provided
out effective case management and care coordination
and prevent the risk for unsafe care and subopti-
as activities to achieve these outcomes. By moving
mal outcomes.”
the case manager’s focus away from tasks and proce-
F. Employ ongoing monitoring to measure the cli-
dures as the focus of their scope of practice sharpens,
ent’s responses.
opportunities will be created to meet the needs of the
G. Demonstrate the benefits of case management
health care consumer and add to the value of case
services (CMSA, 2016).
managers (Lucotorto, Thomas, & Siek, 2016).
Using these standards, the taskforce endeavored Case management practice extends beyond
to identify what, if any, constraints exist in the hos- the basic training of any single discipline within
pital environment that impede the application of the health care field. Organizing for patient-centric
these practice principles. The taskforce then identi- care coordination suggests a program composed of
fied strategies that can be used to ensure that hospital diverse individuals with the skill sets, critical think-
case management practice models are in synch with ing skills, and enthusiasm to coordinate care for a
the transformation taking place throughout the hos- selected group of patients in the hospital and across
pital industry. the continuum. Eligible individuals may come from
The taskforce identified the following transfor- many professional clinical disciplines and have strong
mation priorities for hospital case manager leaders communication and collaborative skills to engage the
and the hospitals’ senior administrative team: patient and members of the patient’s care team.
1. Redesign scope of services. For many years,
Mary McLaughlin-Davis,
hospital case management was a hospital department
DNP, ACNS-BC, NEA-BC, CCM
charged with managing several hospital functions. But
that model no longer meets the challenges of the mod-
ern acute care delivery system, population health initia-
References
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Vol. 24/No. 5 Professional Case Management 261

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