Vision... Visionary... Visioneering... each of these terms encompasses the idea of foresight – seeing the future. The Academy of Certified Case Managers and CMSA co-hosted an invitational meeting held December 11, 2002, in Chicago, IL, focusing on "Visioneering Case Management’s Future." Participants were leaders from all practice settings, organizations, press, disciplines, and certifying bodies in case management. A list of invitees and attendees is attached.

The vision and goals that kept case management going through the difficult and demanding first years – carving a knowledge base, forging new career paths, establishing standards, identifying legal and ethical issues, crafting various continuing educational and academic programs, growing professional organizations, realizing corporate healthcare recognition and utilization, developing certifications and organizational accreditation and beginning research – are being accomplished. Case management now stands at a new crossroad. A common vision and plan is needed to unite case management in reaching for the future and to enable case management stakeholders to address current challenges.

There are many trends impacting case management, some of which are:

• Healthcare personnel shortages create more opportunities for case managers through needs to address patient safety measures, while at the same time, decreasing the number of case managers available and increasing case management workloads.
• Healthcare’s double-digit inflation of 2001 and 2003 promises to continue intensifying the focus on cost containment.
• Increasing healthcare industry corporate focus is on cost savings only, while employer purchasers are talking publicly about patient safety.
• Escalating case manager employer pressure is to abandon the client advocacy role due to time constraints.
• Valuing of quality is decreasing.
• Dissonance is rising between the full case management role and real time job demands.
• Demoralization, burnout and discouragement are increasing over the inability to change the situation in some work settings.
• The spiraling decline of healthcare is escalating.
• Patient demographics are changing.
• The nature of disease is changing.
• Technology is impacting care delivery as well as diagnostic evaluation and cost.

The overall purpose of the meeting was to dialogue, discuss, and plan around the following meeting goals:

• To assemble primary stakeholders representing the case management profession
• To discover points of agreement surrounding current issues and recommended actions for case management practice
• To seek support of participating organizations for those issues and actions
• To envision ways to actualize the full potential of case management
• To explore collaborative efforts in support of activities to move case management forward around identified issues
• To make known the meeting and its outcomes
• To provide inspiration, insight and leadership to the case management community

The vision for this meeting is represented in the following statements:

• We believe case management holds a significant part of the solution to healthcare.
• We believe the time is now to assume leadership in those areas of healthcare we can address.
• We believe there is an urgent need to come together to establish discourse leading to consensus around the issues current to case management, to envision the future, and to seek collaborative ways to move case management from past success to future significance.
• We believe that while no one of us may see all of the path ahead, we believe that together, we can describe it and accomplish it.
• We believe that by collecting a group of leading-edge innovators with broad insights and accomplishments and by working together, case management practice and its professionals will be renewed with excitement and significance.

Prior to the meeting, participants were asked to draft three to four statements outlining the most urgent current issues for case managers and case management practice from their perspective and related recommended actions they could support.

The composite of the responses included:

• Clarify the Role and Function of CM
• Address the Business Case for Case Management
• Analyze Consumer Issues
• Upgrade CM Education
• Integrate Systems/Decrease Diverse State Mandates to Decrease Fragmentation
• Pursue Industry-Wide Collaboration and Promotion of CM
• Address Legislative Issues
• Continue Development of Practice-Setting Specific Data
• Examine Physician Relations
• Promote CM Leadership
• Address Emerging Ethical Issues

Facilitated work groups were used to address issues which had been identified. It was the focus of the work groups to be visionary, but practical, and to formulate doable outcomes for the immediate future.

Committee participants supported action within the next three to six months on the following items:

• Consumer Friendly Definition and FAQs about successful case management will be crafted for the purpose of building awareness and achieving external recognition among business/industry and consumers. This is a first step to future strategies which will support development of consumer expectations for case management.
• Data Mining of existing data about case management practices and work environment in leading organizations; some data exists to which access could be provided. URAC agreed to participate; AMS, Inc. and Qualis Health agreed to provide resources for the analysis efforts. Karen Chambers, CMSA President, agreed that CMSA/CCMA will share recent literature reviews and information about application of the Standards of Practice .
• Research Blue Print to serve as an organizing plan to promote and disseminate research that supports understanding of what case management is, how to do it well, what outcomes it produces and the value of case management in healthcare. A task force with representatives from CCMA, the University of Arizona, CCMC Foundation, and Michigan State University met to begin, and a draft is in production.
• Cost and Quality Outcome Metrics (CQOM) and Return On Investment (ROI) Tools can be gathered and shared to promote consistency in statement of cost savings and other case management outcomes. Three participants agreed to gather literature and existing tools as an initial step toward creation of a case management depository.
• Availability/Competency/Education (ACE) strategies will include definition of core competencies and means to enable case managers to reach them, such as training and outreach. The ACCM Leadership Council will develop an initial plan of action to be discussed further.
• "Case Management Leadership Coalition" (CMLC) will be formed by participants in the Visioneering meeting to create a voice for leadership among the broadest spectrum of case management practice. CMSA and ACCM will commit to continued leadership in the development of a virtual collaboration among the various case management stakeholders. A second meeting will be held in six months; HIAA issued an invitation to host the site.

Visioneering Case Management’s Future was underwritten by the following organizations: AMS, Inc, Lorraine Auerbach, President, Deborah Smith, Executive Vice President; CareManagement, Howard Mason, Publisher, Gary Wolfe, Editor-in-Chief; Continuous Learning, Gary Wolfe, President; Options Unlimited, Catherine Mullahy, President; P.R.I.M.E., Inc, Kathleen Moreo and Anne Llewellyn, Principals; The Case Manager/Mosby, Nathania Sawyer, Publisher, Catherine Mullahy, Editor; Case Management, Inc., Jeanne Boling, President, Cathy Crowell, Vice President.

The most inspiring consensus reached at this Visioneering meeting was that, by working together, case management practice and its professionals can be renewed with excitement and significance.

For more information about the Visioneering meeting or about CMSA, please call Tena Bolin at 501/225-2229 ext. 43.

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