Hospital Case Management: A Review: 2019-2022.

Area of Science:

• Healthcare Management
• Case Management
• Health Services Research

Background:

• The Case Management Society of America (CMSA) released a white paper in 2019 outlining hospital case manager (HCM) roles and recommendations.
• The COVID-19 pandemic significantly altered interdisciplinary work, necessitating remote capabilities for HCMs and highlighting their value in patient flow.

Purpose of the Study:

• To review the 2019 CMSA White Paper on the Practice of Hospital Case Management.
• To analyze the impact of the COVID-19 pandemic on HCM practices and identify future challenges and opportunities.

Main Methods:

• Review of the CMSA "The Practice of Hospital Case Management: A White Paper."
• Analysis of practice changes and adaptations in acute care hospitals during and after the COVID-19 pandemic.

Main Results:

• HCMs demonstrated value in remote care coordination during the pandemic, yet many remain resistant to moving away from traditional unit-based models.
• Separating HCMs from utilization management, as recommended, can lead to a loss of critical knowledge regarding regulatory compliance (e.g., CMS Conditions of Participation).

Conclusions:

• Hospital case management practice is dynamic, requiring leaders to navigate workforce changes, title protection issues, and the "Great Resignation."
• Effective HCM leadership is crucial for efficient, patient-centered care coordination, especially in the current healthcare climate focused on optimizing hospital bed capacity.
• Continuous education on government regulations is essential for HCMs to maintain proficiency in patient care coordination and financial well-being.