1. Kornblau, Barbara L. JD, OT/L, FAOTA, ABDA, DAAPM, CDMS, CCM

Article Content

As case managers, we do not function in a bubble. Regardless of what venue we practice in-whether hospitals, insurers, employers, private practice, or other setting-everything that we do is affected to some degree by public policy. Therefore, with the stroke of a pen, something can be changed. For example, a program to which we have been referring clients can be changed, or it may disappear altogether.


Given the impact on our practice, case managers need to be aware of, and active in, the discussion surrounding public policy. This is especially important because of the aging of the population, which will put greater demands on healthcare resources, including case management. In the future, older baby boomers will require more care and assistance, but may not wish to go to nursing homes. This will create new scenarios in which care will be provided, and case management will, no doubt, be part of those solutions.


Furthermore, consider Medicare. Currently there are initiatives underway involving case management services delivered to specific segments of the Medicare population. It seems logical that for Medicare to expand these services, case managers must educate policymakers about the value we bring to individuals and their families.


As discussion around healthcare continues, case managers need to be at the table to help determine what that future of care delivery looks like. Among the ways this will occur is by case managers establishing relationships with policymakers-whether legislators or officials from specific agencies, such as state offices on aging or centers for autism and related disorders affecting children. It may be through large charities or other organizations that wield significant influence on the future of program funding.


Developing relationships with policymakers can be accomplished in small or large ways. An individual case manager may choose to work on a campaign for a politician, thus establishing an important connection when an issue or a proposed bill comes up for a vote. An occupational therapist I know volunteered for a state politician's campaign. Through that connection, this politician-who has since become very influential in the state-is well versed in occupational therapy. Case managers who deliver vital services to individuals and their families in a fragmented and complex healthcare system need to establish the same kinds of relationships.


The case management field, itself, should continue to reach out to policymakers. Organizations such as the Case Management Society of America have successfully lobbied on the national level. Case management companies and organizations should consider becoming more closely involved with an area agency, by serving on the board or joining private-public initiatives.


Beyond these activities, case managers need to be aware of their civic duty as individual citizens. I believe it behooves all case managers to go to their state legislature or Washington, DC, to make their voices known. It goes without saying how important it is to vote. As a Floridian, I can assure you that every vote counts. Find out who your representatives are, and when a bill comes before the legislature, write letters or call to express your opinion.


I have a personal passion for politics, which I can trace back to my parents, who showed by example the importance of expressing one's opinions to elected officials. Later, I became active with legislative affairs with professional organizations. From this experience, I can attest that it makes a difference when we educate policymakers about a particular aspect of healthcare, such as occupational therapy or case management.


Coordination of care is a hot topic now in Washington, DC. Policymakers need to know, for example, that case managers provide care and assistance to people, allowing them to stay in the community-and at lower cost-rather than going to a nursing home. Case managers can coordinate care for children and young adults to enable them to remain at home rather than facing hospitalization or receiving other forms of institutional care.


Whenever possible, case managers also need to encourage their clients to tell their elected officials how case management has helped them. Sharing their stories is important because it comes from recipients rather than providers of services who may be perceived as having a vested interest.


Case managers well know the value of the services we provide to individuals and their families. We know that case management can contribute positively to clinical, financial, and patient satisfaction outcomes, as well as to better utilization of care and treatment resources. Now it is time to spread the word, by letting policymakers know the importance of what we do so that case management is promoted in the future for the good of society in general and those individuals we serve.