One holiday afternoon, as I was arranging my things to get ready for work the next day, I came across an old “autograph book” or a scrapbook that I had completed when I was in elementary school. It was a hobby that my class did to have each and every one of us complete this to get to know each other. It has a section where you write your name, address, favorite class subject, and even some personal questions such as “Who is your crush?”, “Who is your favorite teacher?” or “What do you want to be when you grow up?” We even had our teachers complete them which may have caused awkwardness as a student, but it was a great amusement back then to know everyone on a more personal level. I remember that I wrote “Nurse” on my own entry. Back then, it was merely for fun, a tool that we used to help the class be comfortable with each other, but now that I am looking at it, it is somewhat similar to one of the assessment tools I am using in the field I have chosen which is Case Management. There are demographics, some “history and physical” portion, and even preferences.
In Case Management, we “get to know” a person from a different perspective, far more than a simple lab test or a physical exam. When a person works in the healthcare field, particularly the Case Management field, the aspects that go with it can be holistic, specialized, and focused. I remember when I first entered the Case Management profession, a lot of people were asking me what I do again. Even Registered Nurses that I meet for the first time who have worked in bedside nursing for a while wanted a further explanation of what I do because it creates curiosity within them. Defining what Case Managers do can both be simple and intricate depending on the audience and listener. In a simple definition, case managers can be translated literally, which means “a person managing a case”. A bigger and more in-depth connotation can be best described as aiding people who have the greatest need. These needs may come from high risk individuals, vulnerable populations, high utilizers of health care services, people who have been non-adherent to treatment, and people who need access to resources. Other times, the need may not arise from the individuals mentioned above but also from healthy individuals who need assistance in sustaining their health, wellness, and vitality. With the rising cost of health care and the global healthcare crisis, Case Managers are needed now more than ever.
So, what are Case Managers? Case managers offer a care delivery style that is dedicated to managing the components of care for patients within or across the range of care, with the goals of achieving quality care outcomes and financial suitability. Overall, the role includes the care components of patient assessment, planning of care, coordinating, and facilitating care plans for patients, working within and across the care continuum, evaluating care provided, reassessing mapping of care, evaluation, cost, and quality containment strategies, and patient advocacy. Case Managers are focused on health improvement. Every Case Manager has the power to help manage the health of an individual, community, or the people around them. What do I mean when I say improvement? Improvement can arise in healthcare needs. Say a member that a Case Manager has been helping may have some trouble with managing a chronic condition at home and needs weight monitoring. The Case Manager can provide assistance by developing a home monitoring program that allows the weighing device to transmit measured weights electronically in the doctor’s office and Case Manager’s portal on a daily basis, without having the member go to the clinic to perform this practice. This in turn will create constant communication between the healthcare provider, patient, Case Manager, and even the Interdisciplinary Care Team. How about for the community? Let’s say that a Case Manager specifically works for a Pediatric Population with special healthcare needs. A Case Manager will need to partner with public health offices to help improve the health of the pediatric population by having early screening to ameliorate any healthcare disparities.
Case Managers are proponents of health maintenance and wellness. Some people may think that Case Managers only focus on the “sick” or people with acute or chronic conditions. Case Managers are not solely confined to this type of setting. Case Managers are leading the drive to better wellness through health education, cost containment, and wellness checks. One such instance is working with a certain population whose main focus is the prevention of developing a certain type of disease. The individuals that the Case Manager may assist do not have any chronic conditions, rather, they have a family history that may make them highly susceptible to developing this type of condition. In this area, the Case Manager can work with the members by developing screening tests, health questionnaires, and referrals to other healthcare professionals such as dieticians, nutritionists, or even geneticists to assist in the quest for health improvement and maintenance. Classes for exercises, annual check-ups, and preventative tests that can ensure that the member may have a lesser chance of developing this certain condition can be arranged by the Case Manager to have some reminders or consistent follow-ups can be cultivated by the Case Manager in wellness or holistic manner to help ensure stability and quality of healthcare services.
Case Managers are not only focused on the physical aspect of a person’s health. One big component of health is mental or behavioral health, and Case Managers advocate for members of this population. While there may be advancements in the care being delivered to a person who is diagnosed with a mental health condition, we cannot deny that there may still be a stigma that encompasses this population when they seek care. In this instance, the Case Managers are patrons to promote equality for people with mental health conditions. Mental health conditions do arise either by a single diagnosis, a dual diagnosis, a co-occurring disorder, or even from being diagnosed with a life-changing condition. How many times do we hear that a member developed anxiety while also being a caregiver to an ailing mother? Or how about a member who developed depression after being diagnosed with heart failure? What about the time when a member is diagnosed with bipolar disorder and also has a current substance abuse disorder?
The situations presented will need the Case Manager to be an advocate, a voice when no one can hear these members with their plea, or a guide when the members do not know where to go. This is a crucial aspect of the Case Manager role so that this population will not be disregarded, bypassed, or simply “fall through the cracks”. If I will explain Case Management to the elementary-old me, I will simply say this: “Remember when you were at the doctor’s and nurse’s office, and they treated your wound from when you tripped while playing during recess? After that, you were sent back to the classroom where the teacher asked how you have been. But when you go back home, you were wondering who will help you aside from family and your brother. Then that is where the Case Manager will come in”—with a huge smile on my face.
I’m Rose Marie Alessandra, MSHS, BSN, RN, CCM, CMCN or Rose for short and I’m a Registered Nurse Case Manager here in California. I have been a Registered Nurse for 16 years, and have practiced Nursing for two different countries prior to working here in the United States. I’m a Board Certified Case Manager and Managed Care Nurse, with a BSN and Masters’s in Health Science Major in Public Health.