If you search, you will find there are many widely accepted definitions of what case management is. The Commission for Case Manager Certification (CCMC) defines case management as a “collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet the client’s health and human service needs.”(Certification, n.d.)
What is the Process of Case Management and Who is Involved in the Process?
The Case Management Process includes screening, assessing, stratifying risk, planning, implementing (care coordination), follow-up, transitioning (transitional care), communication post-transition, and evaluation. (Certification, n.d.).
The person involved in the case management process is the case manager. This is someone who establishes rapport with a patient and reviews key information related to the patient’s health in order to identify whether or not he/she needs case management (screening). The case manager gathers information and identifies the patient’s needs (assessing). Through the use of assessments, the case manager will assign the patient into one of three health risk categories (low, moderate, and high). This helps to determine the appropriate level of intervention needed (stratifying risk). Next, the case manager works with the patient to come up with an individualized care plan that addresses identified needs. The care plans include specific objectives and goals (short and long term plans) that are specific and measurable (planning). Then, the care plan comes to “life.” The case manager works closely with the patient, family members and medical professionals involved in the process (implementing aka care coordination). It is important that the case manager not only offers support but makes sure the care plan is on the right track (follow-up). Next, the case manager will prepare the patient and their support system for transition to the next level of care and ensure the continuity of care by communicating with your patient, their support system and other members of the healthcare team (transitioning aka transitional care). In order to confirm that the patient has had a “smooth” transition to the next level of care, the case manager will reach out to the member to see how things are going and address any issues or concerns (communication post-transition). The case manager will assess the effectiveness of the care plan and its effect on the patient’s condition (evaluation).
It is important to point out the case management process takes on a holistic approach and looks at all the parts that make up an individual (i.e. physical, emotional, psychosocial, and spiritual, etc.) as well as who makes up their support system. The process is not linear or cyclical. Some steps might be completed at the same time and also might be repeated until the desired outcome is achieved.
Why is Case Management Important?
I became a nurse because I wanted to help people and my work in the medical ICU allowed me many opportunities to make a difference in someone’s life. But I always felt like something was missing. Once my patient was stable, they would transfer out of the ICU to the regular floor and 99% of the time, I would never know what happened to that patient. And I didn’t like that I only got to see a part of the story. So in 2018, I made the decision to transition to case management. At times, I do miss the bedside but becoming a case manager has been one of my best decisions because I see the vital and important role I play in the healthcare field.
Through my time as a nurse and case manager, I can see how difficult it can be for someone to navigate the healthcare system especially when you add complex health conditions and lack of social support to the mix. Oftentimes, individuals do not just need care in the healthcare system but also in the social service system, such as help with securing housing and/or food sources, transportation issues, ability to afford medication, etc. All of these obstacles play a critical role in the wellness of the person. All these obstacles can create a “non-compliant patient.” If we take the time to find out the true root of the problem, we would find that a person is “non-compliant” for multiple reasons. And once we address those barriers, the patient can get the tools they need to succeed in managing their disease which leads to better patient outcomes and better compliance.
I won’t sit here and sell case management as a “fairy tale” because there are difficult cases with many obstacles, sometimes the patient being one. But even on my most challenging days, being a case manager has been extremely gratifying.
“Definition and Philosophy of Case Management.” Definition and Philosophy of Case Management | Commission for Case Manager Certification (CCMC), ccmcertification.org/about-ccmc/about-case-management/definition-and-philosophy-case-management.
Guest post from Jasmine Lucinda Alexis, RN, BSN, CCM, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!
My name is Jasmine Alexis and I live in Fort Lauderdale, FL. I graduated with my first degree from the University of Florida in Health Education and Behavior. I went on to get my BSN from Duke University. January 2021 will make it five years that I have been a nurse. And September 2020 will make it 2 years I have been a nurse case manager. When I am not working, you can find me watching some type of Disney movie (my favorite), traveling (pre-COVID), and spending time with family and friends.