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Role of the Case Manager in 2020…And Beyond

by Mary Kay Thalken, RN, MBA on Jan 9, 2018

Case-Manager.jpegHealthcare is changing, and the changes brought about by legislative reform, payment restructuring and technology will touch every facet of the field. For people like me, I find this to be a very exciting time to be working in healthcare.

As I meet with hospitals around the country to bring our care transition services online at their facilities, I’ve interacted with dozens of case managers about their work. What’s become clear in speaking with them is how excited they are for the changes that are coming to case management in the near future. 

The old-fashioned tools that case managers once relied on (and many still do rely on) are going to start disappearing at an astounding rate. They’ll be replaced by an assortment of software-centric options that will have a notable and positive impact on patient care. This technology has the potential to not only transform the way that case managers do their jobs but, in some cases, will completely alter the job itself. I’m not suggesting that the role of case manager will go away and be replaced by technology. Rather, I believe the way case management is performed is about to undergo a very exciting and much needed transformation. 

Here’s what I believe the role of the case manager might look like in 2020 and beyond.

Technology to Revolutionize Patient and Provider Outreach

Case managers have always been somewhat limited by the very technologies that enabled them to connect patients to proper post-acute care in the first place.

Fax machines, telephones, paper filing systems; these have been the traditional tools of the case manager trade. Even as the world has evolved to Smartphones and apps and the ‘internet of things,’ these “old school,” cumbersome devices still persist in healthcare facilities around the country. But that’s about to change.

The advent of EHRs, wearable technology and the apps that power them means instant communication is set to overtake the majority of case managers’ lives in the coming years. Technology already exists to place a patient in the proper post-acute setting at the touch of a button, and these systems will only become more widespread. 

On the heels of placement, case managers will have more access to and connectivity with their patients once they leave the facility. Constant contact is going to become a critical function of the case manager not only to avoid the penalties a hospital can expect to face if a patient is readmitted within the 30-day window, but also to improve overall outcomes by helping patients receive the appropriate level of acuity at the right times.

You’re going to see a world in which a case manager’s job really only begins once the patient leaves the hospital. From there, the case manager will be able to interact with the patient via tracking technology and apps on the patient’s Smartphone. They’ll get a sense of the patient’s overall health and be able to immediately escalate potentially harmful situations to the appropriate member of the care team.

It’s not just patient communication that will be enhanced; case managers will also see a distinct evolution in how they interact with providers. 

Care coordination software has the ability to bring every member of the care team together like never before. If a case manager notices a patient has missed an appointment or their vitals aren’t within appropriate limits, he or she will be able to escalate the needed interventions to help that patient. This communication will happen instantly. 

Technology will evolve in the next couple years to bring patients and providers of all sorts into the same digital ecosystem. It will be the case manager’s job to facilitate communication between all necessary parties, identifying gaps in care that could trigger a readmission and uncovering creative solutions to get the patient the help they need to remain out of the hospital.

Social Services Become Part of the Care Team

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Among those creative solutions will be an increasing reliance on groups that haven’t traditionally been thought of as members of the care team.

With the push to embrace overall wellbeing and a greater understanding of the impact that the social determinants of health can have on a patient, you’re going to see the care team expand far beyond the walls of the hospital.

Teachers. Social workers. Police officers. Leaders of community organizations. All of these persons can play a role in the wellbeing of a patient, and it will be up to the case manager to connect them. 

This is going to take place at a micro level that goes beyond even an understanding of the patient’s city, in some cases even beyond their zip code. The case manager will develop profiles of a patient right down to the neighborhood they live in. Based on their condition and needs, they will proactively connect that person with appropriate services.

Imagine a patient who is discharged home but who doesn’t have access to transportation to a weekly appointment or to a pharmacy. The case manager will find the transportation options in that area and could go so far as to schedule them accordingly. They could arrange for delivery of prescription drugs, request a community volunteer group check in on the individual once per week, schedule delivery of dietary-appropriate groceries or connect them with a local food pantry.

The big differentiator will be software. These points of contact won’t be set up through phone calls and endless faxing; instead, the case manager will have a prepared list of health system partners throughout the community they can interact with via an app. They will send messages to these parties, and what’s more, those parties will send messages right back, asking questions of the physician and of the patient. 

It’s not unreasonable to assume that social services will become a part of the care team like any other, and it will be the case manager at the center of it all, coordinating the care plan like never before.

Big Data Has a Big Upside

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At the same time case managers take a micro look at each patient’s needs, they’ll be looking at the macro view of data to make overarching recommendations about that person’s care. 

Hospitals are sitting on an incredible amount of data, and once software begins to bring all that data together, we’re going to see some exciting developments in care. The case manager will use artificial intelligence and data aggregation tools to sift through the numbers and come up with conclusions that wouldn’t have been feasible even a couple years ago. 

In this way, case managers would do well to look into training and certification revolving around informatics, information technology and other forward-looking education paths. The future lies in taking the lessons of big data and applying them to patients at an individual level, and a case manager who possesses this skillset will find themselves in high demand.

The Future Is Now

I’ve mentioned the year 2020, but the truth is that many of these developments are happening right now. It’s just that, by 2020, you’re going to see them reach a critical mass wherein software, big data and innovative tech tools will become the rule rather than the exception. 

Technology is changing the role of the case manager, in ways that will make this occupation more rewarding than ever before.

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Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.

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