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More Than Just a Change in Title: New Statewide Effort Supports the Move from Case Management to Care Management

How does one move from working as a Case Manager to a successful Care Manager?  The change in title is simply the exchange of one letter, the ‘s’ for an ‘r’.  However, the change from one role to the other is not so simple.

It’s been almost five years since New York State instituted the Health Home initiative with the overall purpose of helping people live healthier lives. As with the change of title, the change may seem simple yet the impact on population health has the potential to be life altering. In this case, the purpose of Health Homes is simple, straightforward, and even noble.

The Health Home integrated approach to care for people with disabilities moves us from our traditional siloed treatments to more holistic approaches. Finally, someone realized that treating the whole person is best. While a major goal of this initiative is to save healthcare dollars, its new focus and design will serve us all well.

The “Triple Aim” emerged in 2008 and has since served as the foundation for the federal Affordable Care Act and state reform efforts including New York’s Medicaid Redesign initiatives. The idea is that the healthcare system will provide better care, people will become healthier and the system will provide more effective care at lower costs. Traditionally, the healthcare system has used a fee-for-service billing structure. Now, with the system focused on improving health, it is changing in the direction of payment for value, over payment for volume – or per each contact.

With the advent of Health Homes and the changes that followed, silos are being eliminated and a uniform workforce is being created to assist people to achieve wellness with collaboration from all appropriate systems and supports. Case Managers have been transformed to “Care Managers” and tasked with working directly with the Health Homes. The new Care Management staff are now charged not only with assisting a person with their mental health needs but also with their physical health needs. To be successful, the Care Manager must serve as the conduit for all services and supports in a person’s life so that overall health and wellness can be achieved.

To help create an image to this concept of enhanced communication, let’s consider a spider’s web. The nexus of the web is the person accessing services and all their supports are the intersecting points of the web around them. All of these web points in turn connect to the nexus – the person – as all web points connect to each other. They can only do this through the silk web strand which creates the web.  Imagine the silk strand as the Care Manager. Each support, whether individual or system, is linked to the person and to each other through the Care Manager.

The transformation required of this new workforce is significant. For a workforce that historically only navigated one system, the mental health system, the challenge becomes how to navigate the physical health system as well and how to integrate each person’s needs and the services that can assist them. The systems are highly complex and the Care Manager must now become the ‘expert’ in understanding multiple systems – the person placed in the role of ensuring all people in this person’s support are tethered together, to continue the web analogy.

The broadened responsibilities of the new role of the Care Manager add a number of new competencies. Overall, the CM must be able to demonstrate competent engagement skills and knowledge of the Stages of Change (Prochaska, JO.; DiClemente, CC.; 2005.) to even begin to work successfully.

Other competencies include the ability to integrate physical health, mental health and substance use treatments for people with multiple chronic conditions; knowledge and understanding of health, the impacts on health and social risks; intervention strategies; assessment and care planning; collaboration and referrals; ability to communicate with various disciplines within varied systems; providing care that is recovery oriented, person centered and culturally relevant; possessing the ability to provide care that is proactive and focuses on prevention and diversion instead of reactive traditional care; demonstrating the ability to use electronic medical records; and tracking and reporting outcomes.

In recognition of the need to support the healthcare staff in the face of these broad-brush changes, the New York State Department of Health has funded a project that directly targets the healthcare workforce through their Health Workforce Retraining Initiative (HWRI). As the entire healthcare system is undergoing change, HWRI is intended to support the workforce to learn the new skills required for them to retain and thrive in their positions.

In order to support the newly created Care Management workforce, through this grant, the New York Association of Psychiatric Rehabilitation Services (NYAPRS) developed the Care Management Training Initiative (CMTI) for Care Managers and their supervisors across New York State.  Over the course of 4 years, NYAPRS has developed two CMTI trainings that have been provided to over 900 Care Management staff. Both training series were designed to enhance care managers’ skill sets so that despite the massive changes to our system, they can remain a successful workforce and continue to assist the people they work with to achieve and maintain wellness.

The first phase of the training consisted of 10 webinars and a series of face to face trainings and was successfully completed in 2013 with over 500 staff completing the training. The second phase of the training is currently underway and will be completed in March 2016. The training target for the DOH is 253 trainees, however, the need is so great that over 700 care managers have enrolled in the current training project.

NYAPRS collaborated with four organizations to implement these trainings: the NY Care Coordination Program, the Center for Practice Innovations, the NYS Council for Community Behavioral Health, and Tech Leaders. Over the course of 15 months, the training provides web-based learning for all staff with additional components specifically for the supervisors that included a telephonic learning collaborative and in-person learning sessions.  By creating these additional supports for the supervisors, the training teaches supervisory skills specific to the content covered in the webinars. The intent is to build the supervisor’s skill set so that they can support their staff as they implement what they have learned.

Topics include: Outreach, Engagement and Retention; Understanding Complex Needs; Navigating Complex Systems; Effective Outcomes Measurement and Management; and Workload Management and Using Technology to Enhance Productivity and Effectiveness. Each of the five content areas covers competency areas needed to be an effective, efficient and successful care manager.

The new Care Manager role will be essential to the success of this new approach to healthcare. To succeed, the system has created this special position in the helping profession – a person who must know all, sometimes, be all, but above all, be genuine, engaging, supportive and adaptable. That brings us back again to the spider’s web of silk strands. They have the unique requirement to provide tensile strength and yet be immensely flexible.

The efforts of the training collaborative are helping to support the framework for these webs of care and offer the resources for care managers to achieve the promise of the Triple Aim. For the participants of care, the training will assure that the staff they work with will understand and negotiate all the systems of care that make up the complex web of our health care system. And hopefully, with that added knowledge, recovery and wellness will prevail as the valued outcome.

 

     Ruth Colón-Wagner of NYAPRS can be contacted via email at ruthcw@nyaprs.org.

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