(Review of the chat session with Dr. Catherine Garner, Dean of Health Sciences and Nursing, American Sentinel Univeristy.)
Dr. Garner: The recent Institute of Medicine report, "The Future of Nursing: Leading Change, Advancing Health" eloquently details the need for nurses to improve their academic and certification credentials. “To respond to [the] demands of an evolving healthcare system and meet the changing needs of patients, nurses must achieve higher levels of education and training. One step in realizing this goal is for a greater number of nurses to enter the workforce with a baccalaureate degree or to progress to this degree early in their career. Moreover, to alleviate shortages of nurse faculty, primary care providers and researchers, a cadre of qualified nurses needs to be ready to advance to the master and doctoral levels.”
NT.com: Where do you think the Case Management Degree will fit in with the Affordable Care Act?
Dr. Garner: Traditionally, case management has been a tool reserved for complex cases, usually hospitalized patients needing multi-disciplinary interventions. However, that scenario may change as accountable care organizations take center stage next year. One of the major revisions to come with healthcare reform efforts are mandated goals for cost containment and improved outcomes. Hospitals must demonstrate efforts to coordinate care among physicians, primary care, rehabilitation, home care, and other providers. Thus, health providers will be accountable for care across the continuum and will be paid accordingly. This has led many hospitals to purchase physician practices.
With their mandated goals of cost containment and improved outcomes, ACO's will likely find they need case managers to strategically manage services for all patients, even those in ambulatory care. It’s been said that case management, with its current emphasis on complicated cases, needs to evolve into care management, with a focus on wellness, prevention, and efficient care for entire populations of patients – both inside and outside the hospital. Tomorrow’s case managers will have to consider clinical, financial, and patient advocacy functions simultaneously, as they balance competing interests.
It also comes as no surprise that the Bureau of Labor Statistics in its 2010 Occupational Outlook Handbook identifies case management as a field projected to grow faster than other job categories. For nurses looking to be more competitive within the evolving marketplace of professional nursing practice, case management can be an excellent career choice. This “marketability” in the case management field will depend upon obtaining the credentials, education, and on-the-job experience that tomorrow’s employers will be seeking, so it’s crucial to identify the knowledge and skills you will need and began planning strategically to achieve them.
NT.com: Can case management coordinate with a medical home?
Dr. Garner: Absolutely. Someone will need to manage the patient and his or her family – a nurse.
NT.com: Many of us who do Life Care Planning are already doing that. What does this degree do for us?
Dr. Garner: Life Care Planning is a part of the curriculum, and you can challenge this if you have experience.
NT.com: How long is this course?
Dr. Garner: American Sentinel's MSN in Case Management is 36 credits or 12 courses. If you are already CMSA Certified, you are eligible for 9 credit hours towards your Master's in Case Management – leaving just nine classes to achieve your MSN at American Sentinel University. Visit americansentinel.edu for more information.
NT.com: How do you see the role of a clinical nurse leader in comparison to the case manager?
Dr. Garner: I think the CNL will continue to be hospital-based, whereas the huge growth for the case manager is based in ambulatory care settings, primary care, and alternative organizational settings. Organizations like Kindred Health (222 facilities) are positioning themselves as ACO's and are aggressively hiring nurse case managers.
NT.com: What is CMSA?
Dr. Garner: CMSA is the Case Management Society of America. For more information, visit cmsa.org.
NT.com: What are the duties of a case manager and what qualifications are required for this position?
Dr. Garner: Online nursing degrees such as American Sentinel’s MSN with a case management specialization can make you attractive to employers, provide you with case management knowledge and skills, and give you the academic background you’ll need to pass the credentialing exam.
It’s not only hospitals and group practices that will be employing case managers, but insurers as well. In a pilot program, Aetna pioneered the practice of embedding case managers into large physician practices that had at least 1500 patients enrolled in Aetna’s Medicare Advantage plan. The case managers worked side by side with clinical staff, helping to manage patients with multiple conditions and coaching patients with chronic diseases such as diabetes. The face-to-face interaction enhanced their ability to collaborate and develop trust with medical staff. Results were positive, and Aetna was able to control costs by avoiding unnecessary hospitalizations and complications related to chronic disease.
NT.com: Will having a master's degree be the norm in the coming years?
Dr. Garner: More and more companies are requiring the MSN because of nurses' many duties and responsibilities.
NT.com member comments: I work in long term care. I think our case managers are all about the care plan working towards Medicare reimbursement.
Dr. Garner: There is no question that case management is being promoted by Medicare and will become even more important with Medicare mandating Accountable Care Organizations.
NT.com: Where is American Sentinel University located?
Dr. Garner: American Sentinel is an online university based in Colorado.
NT.com: What do you see as the difference between a case manager and a care manager, or is there any?
Dr. Garner: Case manager and care manager are titles used separately, but they often mean the same thing. It's just that the semantics of "case" are very impersonal and what nurses do is more care-related, which involves a more holistic approach.