1. Owen, Mindy RN, CRRN, CCM

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The biggest problem with communication is the illusion that it has been accomplished. - -George Bernard Shaw


Last November I was privileged to speak at the Michigan State University Annual Nursing Conference for Care Management. The theme of the conference was "Why Care Coordination Matters." My keynote topic was Why the Affordable Care Act Matters (ACA)... and How It Impacts Care Management.


As I reflected on the topic, I began to think of countless ways that the ACA has impacted health care, through patient engagement and the vital and valuable role we, as care managers, play in care coordination, compliance, and an organization's financial sustainability. Did we sign up for this when we accepted the position of a care coordinator, case manager, clinical coordinator, or any other titles given to the role we fill? (I think not.) Do we and the organizations we serve have a clear understanding of the dual expertise in fiscal responsibility and critical clinical thinking that we bring to the table? Is it agreed and accepted that we are accountable, not only for the clinical progression of the patients' care plan, in our role as a patient advocate, with the additional responsibility of providing guidance on the fiscal sustainability of the organization we represent?


The ACA allows for a broader, more inclusive role for care coordination than we have historically seen in health care. The expectation is that we provide leadership and support of the entire transitions of care process. We, in our dual clinical/financial roles, become responsible to:


1. provide access and transitions of care,


2. share accountability with the health care team, including the patient,


3. enable data transparency,


4. lead and coordinate the team that implements alignment of a quality plan, while


5. managing the fiscal incentives tied to health care outcomes.


In our roles as care managers, we have all felt the impact of fragmented care, a decrease in access to care, silos that have been developed, and the assumption of communication across those "silos." And on any given day, one of us is saying, "Help" ... How do we build a system that improves the process ... and one that we would like to utilize for ourselves or for our family and friends?


George Bernard Shaw once said, "The biggest problem with communication is the illusion that it has been accomplished." I believe that many times we leave an interaction with a patient, a colleague, or a team and believe that we have communicated clearly and that we were understood, only to find discover that we are far from accomplishing the desired end result or outcome. While communication is a critical tool, key to the success of care management, perhaps Mr. Shaw is right and we need to remember it is an ongoing process. One that we continually need to strive to improve, realizing it will never be accomplished.


While the ACA does not fix all the issues in health care, it does address:


* Expanding access to care


* Focusing on preventive interventions


* Health care delivery through the establishment of Medical homes, Accountable Care Organizations (ACO), Nurse Managed health Clinics, and primary care


* Modernizing and strengthening the health care work force


* Reduction in the cost of effective care


* Payment alignment that recognizes value in patient-centered care


* Utilizing health information technology for data sharing and reporting capabilities


The complexities of the model are substantial. To effectively discuss this, in the HeartBeat column, would need to become a novel. The intent of the ACA is to take a system that is in need of repair and begin to build a more encompassing approach that will benefit stakeholders, across all transitions of care and practice settings.


And now we come full circle-leading me back to the question of the role of care management in this new approach to health care. Within the definition and scope of care management rests care coordination, patient advocacy, and collaboration, all while providing quality, cost-effective health care outcomes.


The goals of the ACA include:


* Minimizing fragmentation and improving transitions. Care managers are trained and have expertise in achieving this goal.


* Focusing on patient safety and quality of care. Care mangers address this goal on every patient, every day as they manage the Plan of Care for the day ... and for the stay ... and beyond.


* Improving the patient experience. Care managers are the advocate, the "go to professional" who through collaboration and communication with the patient and the team, improve the patient experience.


* Expands access to care. Care mangers encourage and assist in the application process and implementation of health care resources.


* Reduce the cost of effective care. Care managers guide complex care planning, length of stay strategies, implementation of tools to reduce readmissions, and utilizing criteria in discussions with providers regarding the appropriate level of care; these all impact cost-effective care.


This new wave of health care delivery and reimbursement is evolving and moving quickly. It also arrives with significant challenges, reflective of years when change was not easily embraced. Yes, the ACA has an impact on hospital and system finances; it has brought a reduction in Medicare spending, as there is more of a focus on readmissions and rational for the readmission. Then there are the unintended consequences, such as providing health care for foreign nationals and other populations that are unable to access coverage and applicable resources, who we always find a way to provide care for, because it is who we are. These services and populations face greater limitations within the resources that we currently have available.


So while the old adage may apply ... "be careful what you wish for," today's care mangers are in the right place, for the right reason, and at the right time. We are coordinating transitions of care and acting as the patient advocate, as we strive in two key areas: clinical and financial. It is critical to develop our skill set to include software expertise, gain a financial acumen, craft the skills of listening, and show confidence in leading the team.


Do care coordination and care management matter? The answer is "YES!" Care management will provide the Leadership required to navigate the challenges and expectations presented in the ACA. Care management matters as it is the bridge between acute and community care while transitioning to a nonfragmented, holistic plan of care. Care management is accountable-and that always matters; it is how we work within our standards of practice and focus on the populations we serve.


It isn't easy ... and it isn't simple, but it is a great time to be a care manager.