Shared Decision-Making: A New Frontier for Case Management Leadership.

PURPOSE/OBJECTIVES: Despite improved access to information, many people are neither engaged in their health care nor in the decision-making process. As the hub of care coordination, case managers are perfectly positioned to participate in and support shared decision-making (SDM) efforts. This article addresses SDM from a case management perspective.The objectives are to PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where professional case management is practiced. FINDINGS/CONCLUSIONS: Communication skill is an essential case management competency. Shared decision-making is a communication process in which a case manager and a client collaborate to make the best health care decisions based on what matters most to the client. Case managers must undertake education and training to become fluent in shared decision-making as a core feature of person-centered, professional practice. IMPLICATIONS FOR PROFESSIONAL CASE MANAGEMENT PRACTICE: Professional case managers must understand the concept and principles of shared decision-making as applies in their practice as well as their responsibilities to support care team colleagues using shared decision-making concepts. Organizations should incorporate shared decision-making language in program descriptions, individual performance plans, satisfaction surveys, and department/organization goals.

Long-Term Services and Supports: A Primer for Case Managers: Part 2.

PURPOSE/OBJECTIVES: The Centers for Medicare & Medicaid Services (CMS) announced that beginning in 2019, Medicare Advantage (MA) health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This 2-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. FINDINGS/CONCLUSIONS: Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum. IMPLICATIONS FOR PROFESSIONAL CASE MANAGEMENT PRACTICE: Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.

Long-Term Services and Supports: A Primer for Case Managers: Part 1.

PURPOSE/OBJECTIVES: The Centers for Medicare & Medicaid (CMS) announced that, beginning in 2019, Medicare Advantage health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This two-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. FINDINGS/CONCLUSIONS: Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum. IMPLICATIONS FOR PROFESSIONAL CASE MANAGEMENT PRACTICE: Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.