Nurses play many roles in the delivery of patient care. One important nursing role is case management. However, consumers will not be able to optimize the health benefits of services from case managers if they do not understand this role and how to access related services. For this reason, access to information about case managers is paramount especially on the internet which has become a primary source of information for many consumers. However, it is important to appraise such information about case managers to determine the accuracy and ensure that patients have realistic expectations. The purpose of this paper is to compare information about case managers on the web with descriptions from a textbook, a case manager, and personal observations.
Website Information on Case Managers
The Case Management Society of America (CMSA) (2016) has a page on its website directed to consumers with the heading “What is a Case Manager and How Do I Find one?” Below this heading is the standard professional definition of case management followed by links to 6 subtopics including what a case manager is, where they work, the trainings/certifications/licenses they need to have, reasons for patients to consider a case manager, who reimburses the services of a case manager, and how to find a case manager (CMSA, 2016). The last topic in the links pertains to the importance of transitions of care.
The American Institute of Health Care Professionals (AIHCP) (2006) also has a page on its website on the certified case manager role. The page began with a definition of case manager in relation to case management. An overview of the components and activities of the role and the professions that typically seek case manager certification was given (AIHCP, 2006). Succeeding sections focused on where case managers typically practice, further information on the components of services and related activities, and links for additional information on the topic (AIHCP, 2006).
A third online resource is the Houston Chronicle website. The online newspaper has a section on work with links to careers and further links to management jobs. On this page, one can find a link to the page “What Is an RN Case Manager?” authored by Greenwood (n.d.). As such, the information was limited only to registered nurses. Case management and the specific focus of RN case managers were discussed (Greenwood, n.d.). A brief history of the role can also be read on the page. The author then discussed two types of case management – discharge planning and clinical case management (Greenwood, n.d.). The article ended with information on the education and salary of RN case managers.
Consumer Understanding of the Role
The three websites described above help build consumer understanding of the case manager role. Each defines what a case manager is and often in relation to case management albeit the definitions need more simplification. For instance, the CMSA (2016) used the terms collaborative process, facilitation, and cost-effective while the AIHCP (2006) used the terms theory, continuum, and containment. Greenwood (n.d.) employed the terms fragmentation and systematic. Using simpler terms would ensure that majority of consumers will be able to understand the information.
However, it is worthwhile to note that Greenwood (n.d.) wrote the information with professional job seekers as the primary target while the AIHCP (2006) targeted professionals interested in seeking certification. As such information about the direct care, leadership, and management roles of a case manager and the history of the role were given. The CMSA (2016) page is much more tailored to consumers because the links pertain to what patients and families would typically ask. In addition, there is a short video on the site wherein case managers describe their roles in brief, easy to understand sentences such as “our job is to educate patients” and “answer their questions” (CMSA, 2016). The video also lets patients know that they can request for a case manager in situations wherein they need help in managing a chronic illness or they do not understand their illness and what they need to do. The CMSA (2016) further clarified what must have been a common misconception about the role by stating that case managers do not manage patients to the extent that the latter lose their autonomy but rather, case managers assist them in regaining or maintaining optimum control over their illness.
Comparison with the Text Book and Other Sources
The definitions of a case manager from the websites closely match the definition given by the text book and the case manager. Coordination is the term common in all the definitions and pertains to case managers bridging resources to patients (CMSA, 2016) in order to meet their needs (CMSA, 2016; Greenwood, n.d.) in a comprehensive way (Nies & McEwen, 2015) throughout the continuum of care (AIHCP, 2006). However, to prevent consumer confusion, the CMSA (2016) recognized that case managers are also known as care managers and care coordinators. Nies and McEwen (2015) clarified both terms more in-depth by stating that the goal of care management is to enhance the services offered to members of a care management program. Meanwhile, the purpose of care coordination is to improve the quality of care and therefore the health outcomes and care utilization of persons with chronic illnesses (Nies & McEwen, 2015). The primary targets are those with a high risk of complications and other adverse outcomes and therefore are likely to need care. For these patients, care coordinators identify contributory factors to patients’ risks of complications, provide education on self-management, maximize treatment, ensure integrated care, and follow up to monitor the outcomes of care (Nies & McEwen, 2015).
Meanwhile, Greenwood (n.d.) described two other types of case management that occur largely in the hospital setting – discharge planning and clinical case management. The discharge planner as the case manager works to coordinate patient care throughout their hospitalization. A major focus of assessment and planning is the patient’s discharge to home. The discharge planner makes sure the patient has the necessary financial and social resources to support a timely and safe discharge (Greenwood, n.d.). Meanwhile, clinical case management was described as pertaining to working with specific populations of patients to meet needs such as medication management, appointment scheduling, laboratory testing, referrals and/or transfers, and problems with insurance coverage (Greenwood, n.d.).
Furthermore, two of the websites - the AIHCP 2006) and Greenwood (n.d.) - underscore how case management is a systematic application of theory into practice while the former described it as a model of health care delivery. This was mentioned in the book as well which demonstrated how the concept of case management was applied in the definition of nursing case management. In addition, Nies and McEwen (2015) described the patient-centered medical home as a setting that makes effective use of the case management model because this care setting aims for integrated, coordinated, team-based, high quality, and cost-effective care. While the focus on clinical care was not expressly stated in the websites as it was in the book, case management was portrayed in relation to managing, leading, and coordinating patient care, a role that can aptly be called as being captain of the ship (AIHCP, 2006), which reflects a primary focus on clinical care.
This focus on clinical care was highlighted by the AIHCP (2006) in its overview of the range of role activities undertaken by a case manager. These include, among others, evaluating patient care using utilization review, current goals of quality improvement, and cost to ensure appropriateness while also assessing patients, bridging resources, educating patients, and advocating for them (AIHCP, 2006). The need to bridge resources reflects the difficulty that patients encounter when navigating the complex system of health care and social services. For this reason, case managers need to work with patients, families, the health care team, social service providers, insurers, and organizations. Collaboration as one of the role activities of case managers is indispensable.
Still in relation to the focus on clinical care, the CMSA (2016) included information on transitions of care and why patients should be concerned about such events. This is consistent with what the book stated about continuity of care. Transitions create failures in communication that can lead to medication errors, duplicated care, and other events that threaten patient safety (Nies & McEwen, 2015). Case managers can ease patient transitions from different levels of care in order to ensure patients’ safety and optimal outcomes. It is worthwhile, however, to note that only the case manager and the textbook demonstrated the application of case management in the public health setting.
In addition, the AIHCP (2006) did emphasize the role of case managers in aspects of practice beyond direct care such as in research to generate evidence-based practices that improve patient care; providing advice to organizations regarding policies and procedures governing the safety and quality of care; and reviewing care quality (AIHCP, 2006). Nies and McEwen (2015) described these tasks as the system-centered focus of case management. The AIHCP (2006) also stated that case managers are expected to advance further the knowledge and practice of this role for the purpose of enhancing it and ensuring it remains relevant in a continually changing health care system.
Moreover, two of the websites (AIHCP, 2006; CMSA, 2016) adhered to the textbook and the case manager when they described the case management process as involving the process of assessment, planning, intervention, and evaluation. However, only the CMSA (2016) emphasized the concept of patient-centeredness and collaboration or partnership with the patient or family in the delivery of services as described in the book and the case manager. Advocacy as one of the functions of a case manager is another topic common among the AIHCP (2006), CMSA (2016), the book, and the case manager. Advocacy is one feature of patient centered care as it means determining what patients need and prefer and working with organizations to enable the fulfillment of these needs.
Still other terms used in nearly all the websites and also the book and the information shared by the case manager pertain to the use of limited resources. The book and the case manager discussed the concepts of cost-effectiveness. Greenwood (n.d.) referred to reducing the fragmentation and duplication of care which leads to unnecessary costs while the AIHCP (2006) referred to financial appropriateness. The increasing focus on cost containment is in line with current health care reforms aiming for greater efficiency in health care delivery. For this reason, case managers play important roles especially in the care of chronically ill patients who need lifelong care.
Finally, education, training and certification were discussed by the CMSA (2016), Greenwood (n.d.), and the book. Greenwood (n.d.) suggests that given the complexity of the role, case managers should possess excellent clinical, communication, and problem-solving skills. Nurse case managers must also have knowledge about health care, finance, regulatory mechanisms, and resource availability both within the facility setting, the community, and the larger context of care at the state and federal levels (Greenwood, n.d.). Nies and McEwen (2015) mentioned that in order to function effectively, case managers must meet a minimum level of skill. The book and the CMSA (2016) point the reader to organizations who certify case managers on the basis of meeting established criteria.
American Institute of Health Care Professionals (AIHCP) (2006). Role of the certified case manager. Retrieved from http://aihcp.org/certified-case-manager.htm
Greenwood, B. (n.d.). What is an RN case manager? Retrieved from http://work.chron.com/rn-case-manager-9245.html
Nies, M.A., & McEwen, M. (2015). Community public health nursing (6th ed.). Philadelphia, PA: Saunders Elsevier.