October 13-19, 2024, is National Case Management Week. It is an opportunity to reflect and celebrate case managers’ immense influence on healthcare, insurance, society, and the individuals we serve. The earliest history of case management services in the 1900s was in public health and social services. Case managers were instrumental during World War I in helping wounded American soldiers with complex injuries transition back into their communities. Today, case management services have expanded to every corner of the healthcare system, from hospitals and medical offices to home healthcare, rehabilitation facilities, long-term care facilities, and outpatient clinics. It is also not surprising to find case managers working within insurance companies; governmental agencies such as the Veterans Administration, Medicare, and Medicaid services; the legal systems such as law offices, fiduciaries, and trust services; and the criminal justice system, such as addiction or substance use treatment and rehabilitation centers. These are just a sampling list of the multitude of populations that case managers service.

While case management services are commonly seen in concert with medical services supporting individuals with injuries, chronic illnesses, or complex conditions by facilitating access to medical care, rehabilitation, and social support services, tangible utilization of such services exists in other areas.

Consider the statements in the first paragraph; case management services in substance use treatment centers are crucial for individuals transitioning out of inpatient care or incarceration. In the legal realm, particularly within substance use treatment and mental health courts, case management is essential for addressing the unique needs of individuals struggling with substance use disorders (SUD) and co-occurring mental health issues.

Fiduciary services for individuals with cognitive impairments or legal incapacities also benefit from case management. Here, case managers work with financial guardians and other fiduciaries to ensure that individuals’ economic and healthcare needs are met. This is especially important for older adults or those with disabilities who may not be able to manage their affairs independently. Case management services are also an intricate component in helping survivors of violent crime or domestic abuse.

One of the unique aspects of case management services, setting it apart from other healthcare services, is its commitment to the continuity of care. Typically, the same case manager works with the individual for the entire duration of care. This ensures a comprehensive understanding of the individual’s needs, leading to person-centered services across multiple sectors. The duration of services may span years, depending on the individual’s needs. The case manager also acts as a catalyst to motivate and educate the individual and their family to learn more about their condition and care, improve their healthcare literacy, and focus on what they have rather than what they have lost.

On a broader scope, case management services play a significant role in reducing healthcare costs. By ensuring that individuals receive timely and appropriate care, preventing hospital readmissions, reducing emergency services, and limiting the need for costly inpatient care, case managers contribute to cost savings in the healthcare system. This is particularly important for managing chronic conditions where early intervention and consistent follow-up can lead to better long-term outcomes and lower healthcare expenses.

Moreover, case management addresses social inequities by providing access to essential services such as housing, financial assistance, and legal support. Vulnerable populations, including those facing homelessness, unemployment, or legal challenges, benefit from the tailored care plans created by case managers to mitigate the effects of social and economic disparities.

Case managers are vital links between healthcare providers, social services, and community resources. Case management is an art combining evidence-based practices, knowledge in medicine, treatment, and social determinants of care. It also requires the case manager to demonstrate cultural competence, critical thinking to outcome-focused solutions, and strong interpersonal communication skills. The practice of case management is a process as described by the Case Management Society of America (CMSA); “…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.” (CMSA, 2024)

One cannot place a dollar amount on the impact and the value of case management services. Case management enhances the individual’s well-being, reduces healthcare spending, and enhances social health. This leads to a more efficient and compassionate healthcare system.

Cheers to all the case managers for your dedication, compassion, and relentless effort. Your work is truly invaluable and makes a profound difference in the lives of those you serve.

Case Management Society of America, 2024. https://cmsa.org/who-we-are/what-is-a-case-manager/

Author: Angie Jung, RN, BSN, CRRN, CCM