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Case management as a nursing role has been around much longer than some realize, yet not as long as other distinct nursing specialties in what we know today as acute care settings. Case management is found in many areas of healthcare and community care. The role evolution of case management has been a remarkable cycle of clarity and confusion as healthcare continues to change in the throes of the managed care marketplace.
Add the 10 most important healthcare trends as identified by the American Hospital Association to what is happening to case managers and you have many issues that will impact case management practice now and in the future of care. The survey sponsored by the AHA examined America's healthcare future, and was directed to 400 health care executives, strategists, marketers, and communicators. 1 In other words, AHA surveyed experts on the cutting edge of to day's healthcare world, and found that the experts came up with a remarkably mixed future.
Despite the many challenges these experts found, most thought the long-term outlook for healthcare to be essentially sound. However, they did agree on 10 most important trends in U.S. healthcare, trends that are now and will in the future impact the role, function, processes, and accountability of every case manager.
These major issues include:
Each one of these major trends calls for innovations in case management as well as those in general nursing practices. Nurses are the heart of the healthcare system. In like fashion, in the complex healthcare scene, case managers are the heart of the need to balance consumer needs and those of third-party payers. The vital role of the case manager is even more important in the challenges of the modem managed care environment of the twenty-first century. Perhaps the most pressing foundational challenge understands the case management role today, and how best to prepare for the challenges of the future.
A discussion of case management innovations for the future must include discussion of the case management role-where it has been, where it is today, and where it may be found in the future. In addition, we must understand the case management standards of practice, the underpinnings of the case management profession's accountability and responsibility to their customers and patients.
An added twist to case management practice is that healthcare providers are seeking to define outcomes of care, including the outcomes and benefits of case management practice. In other words, does case management as a service and as a role provide any measurable positive outcomes for clients? Both practicing case managers and case management leaders must continue to articulate the case management role and identify effective methods to monitor the effect case management has on client outcomes.
This course introduces the nature of the case management role, and the evolution of case management in the past decade or more. With these roles defined, it is easier to apply case management practice guidelines as roots and guides to the future. This text begins with an overview of practice guidelines that can assist with challenges of the major healthcare trends. As the text is read, the reader is encouraged to consider the need for new or revised practice guidelines in select areas. One must keep in mind that overall,
Case management practice in nearly every kind of practice can be directly affected by each of the important trends in healthcare.
The course is presented in seven chapters that first examine case management roles, and then test those roles against the top ten trends that are predicted to alter the way we think of health care and the delivery of health care. The text begins with an overview of case management roles and the case management process within the underlying framework of professional case management practice standards. This foundational chapter is important as many who are in case management roles today did not learn about the history of managed care and practice guidelines in undergraduate course work. In addition, many others may not have current knowledge on the many trends facing healthcare, including cyberspace trends, managed care reimbursement dilemmas, and the impact of complementary medicine on the Western medicine world.
The seven chapters are presented as listed below.
Chapter one: Case Management Role Evolution Chapter two: Boomers go forth
Chapter three: Technological, Biotechnological, and Cyberspace Trends Chapter four: Healthcare Costs - Losses & Gains
Chapter five: Healthcare finance and Insurance Changes
Chapter Six: Care Delivery Models and Shortages, and Squeal Chapter Seven: Complementary Medicine Boom
Key Questions
Within each chapter key questions are presented to spur further thought and analysis for case management practice implications. These key questions are suggested as tools for individualleaming and thought, as well as tools for group discussion in work or academic settings.
Patient Case Scenarios
In addition, patient case scenarios pertinent to the major trend presented, are included within select chapters to provide opportunity to apply the concepts and issues presented to case management practice. Within any learning context, it is vital to integrate application of learned concepts to better enhance taking the knowledge and skills with you to your professional case management role.
Links and Resources
To encourage ongoing learning and competency in future healthcare trends and challenges to case management practice, the author has provided links to web sites and other media. These resources are intended to keep the nurse current in healthcare trends, such as our aging society, Medicare trends, and other important issues.
References