Q&A: Applying case management standards of practice to population health

February 6, 2019
Medicare Web

Q: Do the Case Management Society of America’s (CMSA) standards of practice still apply when using a population health approach to case management?

A: CMSA’s standards of practice (SOP) are not intended to serve as a prescriptive manual for case managers but rather as a guide for standardizing case management practice and informing case managers, professional colleagues, employers of case managers, legislators, policymakers, patients, and all stakeholders of the scope and practice of case management.

The SOP reflect the integrated health networks across disciplines, practice settings, and the healthcare continuum. The population health model will benefit from the philosophy and guiding principles found in the SOP. One key component is evaluating at-risk patients for case management services. These most vulnerable of the population include those with complex medical, behavioral, cognitive, and social needs. “Effective case management directly and positively impacts the healthcare delivery system, especially in realizing the goals of the ‘Triple Aim,’ which include improving the health outcomes of individuals and populations, enhancing the experience of healthcare, and reducing the cost of care” (Case Management Society of America, 2016).

The following action items are included in the SOP:

  • Client identification, selection, and engagement in professional case management
  • Assessment
  • Care needs and opportunities identification
  • Planning
  • Monitoring
  • Outcomes
  • Closure of professional case management services
  • Facilitation, coordination, and collaboration
  • Qualifications for professional case managers
  • Legal
  • Ethics
  • Advocacy
  • Cultural competency
  • Resource management and stewardship
  • Professional responsibilities and scholarship

For more information, see Case Management Guide to Population Health. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.