The Case Management Society of America (CMSA) issued revised Standards of Practice for Case Management in 2022. The Standards were first published in 1995 and revised in 2002, 2010, and 2016. The general purpose of the Standards is to identify important knowledge and skills for case managers, regardless of practice setting. CMSA decided to revise the Standards again in 2022 in order to emphasize the professional nature of the practice and role of case managers as an integral and necessary component of the health care delivery system.
According to the most recent revised CMSA Standards, the definition of case management is as follows:
“Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.”
The Standards go on to acknowledge that explaining case management to clients and the public can sometimes be challenging, so the revised Standards include a definition that can be used for clients and the public as follows:
“Case managers are healthcare professionals who serve as patient advocates to support, guide and coordinate care for patients, families, and caregivers as they navigate their health and wellness journeys.”
Revised Standards reaffirm that professional case management practice spans all health care settings across the continuum of health and human services. Occupational therapists, pharmacists, physical therapists, and speech therapists were added to registered nurses, physicians, and social workers as professional disciplines of designated case managers.
The revised Standards also include substantial revisions to the section on Professional Case Management Roles and Responsibilities with a new emphasis on advocacy as a central role and responsibility of case managers as follows:
“The role of a Professional Case Manager concerning the patient is that of advocacy. Advocacy is used to coordinate the influential factors that affect the patient or a group of patients’ ability to achieve their optimum state of health. The contributing factors to well-being include Financial, Ethics and Legal, Social Support, and Providers of care.”
According to the revised Standards, in order to effectively advocate for patients Professional Case Managers are responsible for being patient-centered and are held accountable to maintain the education and skills needed to deliver quality care. Professional Case managers should demonstrate knowledge of health insurance and funding sources, health care services, human behavior dynamics, health care delivery and financing systems, community resources, ethical and evidence-based practice, applicable laws and regulations, clinical standards and outcomes, and health information technology and digital media for effective, competent performance.
Future articles will cover other changes in the Standards.
Hats off to CMSA for developing and revising these important standards for the discipline of case management!
©2023 Elizabeth E. Hogue, Esq. All rights reserved.
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