Public Policy

TALKING POINTS FOR THE CASE MANAGEMENT MODEL ACT
Case Management is Essential to Health Care Reform

1. MAKING A DIFFERENCE THROUGH A MODEL ACT — The Case Management Model Act addresses many of the key building blocks to ensure a successful health care program. The Model Act can be configured to be national in scope or to support specific programs that are funded through a variety of sources.
2. REAL REFORM SOLUTION — Case Management is a collaborative process of assessing, planning, facilitating, coordinating and evaluating to meet an individual and family’s comprehensive health needs.
3. IMPACTING POPULATIONS — Case Management offers a unique and effective way to mobilize resources to promote quality-based and cost-effective outcomes for a wide range of populations, with different health care needs.

How Does Case Management Work?

1. BEST IN CLASS PROFESSIONALS — Case managers are licensed professionals with the experience to support individuals and their families. Several professional groups, including the Case Management Society of America (CMSA) and the National Association of Social Workers (NASW), develop and maintain professional standards of practice, along with several nationally recognized certification bodies.
2. SAVING COSTS & IMPROVING QUALITY — Case Management provides services that are crucial to saving costs and improving quality in the health care system with the majority of health care dollars being spent on chronic illness.
3. COORDINATING CARE — With such a fragmented health care system, Case Management provides critical services to help patients and their caregivers navigate, coordinate, and transition through a dynamic approach to better achieve their health care goals. For example, the National Transitions of Care Coalition (NTOCC) is a coalition of 32 diverse organizations which has been convened by CMSA and is dedicated to promoting appropriate transitions of care when a health care consumer leaves one care setting (i.e., hospital, nursing facilities, assisted living facility, primary care physician, home health, or specialist) and moves to another.
4. ENGAGING STAKEHOLDERS — A primary goal of the case manager is to bring together all of the key stakeholders who are involved with an individual, including providers and family members, to ensure that a comprehensive, coordinated action plan is put in place to help the individual.
5. PROMOTING REAL CHANGE — Another primary goal is to engage the individual or patient receiving case management services to make real change in their life to improve their health status and to sustain a healthier and more active life. Case Management typically provides a comprehensive needs assessment and follow-up treatment plan that factor in the individual’s complex health care and social needs, including their co-morbidities.

The Need to Include Case Management in Any Health Care Reform Proposal

1. SPONSORSHIP IS CRITICAL — Case Management programs must be sponsored as part of the federal health care reform initiative. Without federal support, we will not be able to harness the full power of case management strategies and interventions.
2. EFFECTIVE SOLUTION — Case Management is one of the most effective solutions in health care and must become a fundamental pillar of health care reform.

Voluntary Practice Guidelines for the Case Management Industry
OVERVIEW — The standards contain information about case management practice including definition, practice settings, roles, functions, activities, case management process, philosophy and guiding principles as well as the actual standards and how they are demonstrated.

DEFINITION OF CASE MANAGEMENT — Provides voluntary practice guidelines for the case management industry, the standards of practice are intended to identify and address important foundational knowledge and skills of the case manager within a spectrum of case management practice settings and specialties.

QUALIFICATIONS — Developed with representation from various practice settings and case management disciplines, the 2010 version of the SOP identifies the professional qualifications for the practice of case management (mirrored in the Case Management Model Act).

COMPONENTS OF THE CASE MANAGEMENT PROCESS — Carried out within the ethical and legal realm of a case managers scope of practice, the primary steps in the case management process include: client identification and selection, assessment and problem/opportunity identification, development of the case management plan, implementation and coordination of care activities, evaluation of the case management plan and termination of the case management process.

COMMITMENT TO PATIENTS — Rooted in the statement of philosophy and guiding principles, the underlying premise of case management is based in the fact that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement sources.

Download the full Standards of Practice
for Case Management (rev. 2010) at:
http://www.cmsa.org/SOP