substance abuse ehr treatment

Case to Care Management

According to the National Council for Behavioral Health, the changing healthcare marketplace is requiring case managers to become care managers.

Is this happening? Is it a new concept? What’s the difference? Is it related to Health Homes? How important is this for the treatment of persons with substance use disorder? Spoiler alert! This article doesn’t provide the answers. It does provide some history, context and perspectives that could help you formulate thoughts on what the National Council’s proposed paradigm shift might mean for you and your organization.

History

The notion of “Case Management to Care Management” first gelled for the National Council sometime prior to March of 2013. By then they had already developed an integrated care training program titled entitled “Making the Transition From Case to Care Management”.

In March 2013 the National Council engaged Afia, a Michigan consulting firm which “works with health and human service agencies to generate ideas, implement solutions, and positively impact their futures”, to provide those trainings to behavioral healthcare organizations in more than 20 states.

The National Council’s BH365 blog post by Joan Kenerson King on November 10, 2015, which she titled “On the Road with Case to Care”, provided some context around the applicability of the concept and the purpose of the training.

Their BH365 blog on April 19, 2019 cemented the concept to substance use disorder treatment in their post titled “Introducing an Integrated Care Culture? We Can Help”.

In January 2020 the National Council’s sales and marketing team published an email blast promoting their “Case-to-Care” training.

Since then the COVID-19 pandemic has caused most organizations to refocus their energies on keeping their patients in treatment, providing all the services their patients need and navigating the revenue cycle process to get reimbursed for the services they provided.

Hopefully, we are on the downside of this pandemic and can again raise our gaze to what the future holds.

Context

According to AJ Case Management, the term “case management” has “been around longer and is a more established approach to rehabilitation”. Through their lens, they consider case management “broader” than care management because it “focuses on the care of the patient and creating a smooth transition between different treatments and stages of care”.

The National Council’s perspective, however, is that care management is the broader of the two concepts. They consider care management from the perspective of integrated care, where the paradigm is to manage both physical and mental health of the patient.

The Affordable Care Act (ACA) of 2010 established “Health Homes” to coordinate care for chronic conditions, which certainly includes persons who suffer from substance use disorders.

By 2012 both Rhode Island and Vermont had Health Home programs in place within substance use disorder treatment facilities. Since then, according to the Kaiser Family Foundation, at the end of 2015 there were 20 states reporting health homes in place and that continues to grow.

In November 2016 the Surgeon General’s Report on Alcohol, Drugs and Health mentions “substance use disorder” 137 times, which establishes that integrated care was already well entrenched in the field of substance use disorder treatment at the time

So, when considered in that context, it is understandable why the National Council’s perspective on care management is at a higher level than case management. And why AJ Case Management considers its case management to be at a higher level than the care management that focuses on coordination of individual services. The expertise needed, role responsibilities and tactics for each of these three roles are considerably different.

Perspectives

The Substance Abuse and Mental Health Services Administration (SAMHSA) established that “individuals with behavioral health needs may die decades earlier than those without, largely due to untreated and preventable physical, chronic illnesses like diabetes, high blood pressure and obesity”. We can infer from SAMHSA’s assertion that helping a patient manage their other chronic illnesses as well as their substance use disorder could substantially extend that patient’s life.

Joan Kenerson King, in her “On the Road with Case to Care” post in 2015 states it well: “We are experts at helping people find ways to live in the community in the face of potentially disabling symptoms and economic challenges. However, we often don’t recognize how successful we are, or that those same skills can transfer to the whole health model of care: helping someone manage both physical health issues and address some of the accompanying lifestyle changes that are needed.”

Anyone involved or familiar with substance use disorder treatment knows that a significant barrier to treating the “whole person” is the stigma associated with the substance use disorder treatment. The 42 CFR Part 2 regulations help to reduce the stigmatizing effect of exposing a person’s substance use disorder treatment by requiring the patient’s explicit consent to disclose specific data and by severely limiting those disclosures and disallowing re-disclosure.

This presents challenges, but they are not insurmountable. as Joan Kenerson King closes her blog post, “Upgrading case managers’ skills gives behavioral health organizations a competitive edge in promoting services across the health care system. One person, one team, one organization at a time – leveraging their own resources, working at what can be changed – we have more power than we know.

Conclusion

Having read this far, you are likely not surprised by any of the history or the perspectives. What you should still be pondering, though, is the National Council’s proposed paradigm shift of “Care versus Case Management”.

Afia asserts that “it’s not enough to transform case management – there has to be an agency culture in place to support whole health and wellness”. It truly is a change in paradigm shift for the entire organization, not just the case manager’s position. They offer an insight they title “5 Ways to Walk the Integrated Healthcare Walk”. To illustrate the organizational change, it calls for:

  1. An environment that supports quitting tobacco
  2. Getting rid of unhealth food (e.g. in vending machines)
  3. A professional waiting area that reflects the message of good health
  4. Clinical services that have embedded health strategies as a natural part of treatment
  5. People who provide behavioral health treatment practice good health strategies

While it would change how we work, making this paradigm shift might increase our potential to save lives, which is why we all do what we do.

Resources used:

https://www.thenationalcouncil.org/BH365/2015/11/10/road-case-care/

https://www.thenationalcouncil.org/wp-content/uploads/2019/08/031419_SupervisorCasetoCareManagement.pdf?daf=375ateTbd56

https://afiahealth.com/transition-case-management-care-management-people-behavioral-health-needs/

https://ajcasemanagement.com/care-case-management-differences-roles-need-rehabilitation/

https://www.kff.org/medicaid/state-indicator/states-that-reported-health-homes-in-place/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

https://www.ncbi.nlm.nih.gov/books/NBK424848/

https://afiahealth.com/walk-integrated-healthcare-walk/

© 2020 SMART Management, Inc.