- Email: [email protected]
Case managers' effect on oncology outcomes
the~¢~ise manager~ once was as an optional participant in :h care, that role quickly is becoming redefined as i~he critical link~that connects quality careand cost containment in a positive, forward-thinking environment, particularly in disease management programs,
Disease Management Programs The concept of disease management (DM) is still evolving both in definition and in practice, not unlike the early days of managed care, whose policies and practices blindsided and bewildcred the populations that attempted to make this new iaa~chine work without anydirections. But the newest kid on the block, DM--initially launched as a value-add by the pharmaceutical companies to market their products more effectivelymnow has evolved to comprise a variety of concepts and strategies, some with better success ~hlm others. Although purveyors of many of" these new entrepreneurial ventures j~.~/l:~b~a,y ,997
TCM 45
claim they are all about improving the quality of health care delivery with lowered costs, it continues to be a leap of faith for most customers to take on word that increasing quality results in lower health care expenditures. Why is this such a difficult concept to swallow? Our history as savvy consumers might shed light on the answer. Most of us, who "shop 'til we drop" for the best bargains, have been indoctrinated to believe that quality is generally more expensive than a supposedly inferior product. On the other hand, we also have been taught that quality should be synonymous with longevity--whether it is a fine suit, a fax machine, or pots and pans. Unfortunately, what we know intuitively to be true about quality often has no effect on how we behave; this transcends to the purchasing and spending in health care. Immediate savings are much more easily seen by reducing or eliminating a health care line item with the stroke of a pen than by investing in additional services that might save money 1 or 2 years from now. However, realizing immediate savings on health care dollars in the current fiscal quarter is just a Band-Aid treatment for problems that will persist in the long term. The task of DM programs is to reshape this "bargain hunting" thinking with a longterm approach to quality and savings. The new DM services are designed to address the quality and expenditures of diseases that take the largest chunk of the health care dollar. Without question, oncology treatments are an incredible drain on those resources. Oncology DM programs are proving to be a good investment, but the best news is that the services of the case manager are being incorporated into the health care team right from the start. Although managed care organizations and their contracted employer groups are able to realize many financial benefits from oncology DM programs, such programs are targeted to first benefit the most important player in the pict u r e - t h e patient. "We have found that patients who don't do well, who are afraid, who have no education are the ones that have the poorest outcomes. They don't know what to expect, so their expectations are low, and as a result they don't do well," explains Sharon McCoy, a vice-president of Quality Oncology, a DM organization. "In contrast, the patient who has been educated from the first moment of diagnosis and receives a nurturing and supporting voice will know what to expect and, consequently, becomes a more active participant in his or her care, and outcomes are generally better."
Case Mancugers" Role in DM Quality Oncology (QO), based in south Florida, offers a compassionate and integrated approach to managing both the costs and the quality of care for cancer patients. McCoy says that Q O was founded to address the problems arising from the typical fragmented style of cancer treatment that resulted in poor outcomes and excessive costs. "Intervention by case managers at the very outset of our program is key to the long-term success of how patients respond to treatment," McCoy explains. "This caregiver immediately becomes the patient liaison to the health system and is available 7 days a week, 24 hours a day. The family is always involved every step of the way, and it becomes a win-win situation for everyone." TCM 46
j
.....
y/February1997
As an example, a patient diagnosed with cancer by his primary care physician, whose network is affiliated with QO, immediately will call the organization to set up an appointment with the nearest Q O facility. At that appointment the Q O staff assigns a "care manager," as they are called, who authorizes the most appropriate treatment plan and follows up with the patient before, during, and after the plan. The plan is compared with care guidelines to ensure the best outcomes. Throughout treatment, the assigned care manager is responsible for coordinating not only oncology service but also nutritional and depression counseling, assistance with home health needs, physical therapy, and more. Although McCoy stresses that they do not provide treatments, all Q O care managers are oncology certified nurses (OCNs) with at least 10 years' experience. McCoy believes this relationship maximizes the patient's quality of life, even in cases with poor prognosis. And she adds, as health care organizations become their customers, they see the value of specialized DM services that coordinate treatments, monitor pharmaceutical therapies, intervene within the system to minimize unnecessary treatments and physician visits--an exhausting routine for any cancer patient--and most importandy, provide follow-up support for 5 years. McCoy sums up the philosophy they have seen as proof positive: "Oncology disease management is different than asthma or other diseases because the diagnosis registers a tremendous shock to the patients. In seconds their life changes. Cancer is so much more than a disease; it is a stigma, a 'death sentence.' It can be disfiguring; the treatments are anything but pleasant to endure. "There is absolutely no question that the role of the care manager who intervenes at the outset can make all the difference in the world for these patients."
Oncology Case Managers In agreement with McCoy is Maura Lessard, health services manager of Spectrascan, an oncology DM program whose focus is the prevention and treatment of breast cancer. "The case manager has always been the person who has the tools and the resources to coordinate care, and we are now seeing that other members of the health care team, from administration to providers, recognize the value of this role, particularly in cancer cases." This Connecticut-based DM program is designed to be an integrated feature of health plans and managed care organizations. The goal is to provide the personnel, facilities, and equipment to raise awareness of breast health through early detection and appropriate treatments of breast cancer. Case management again plays a pivotal role in the success of meeting these goals. In its inception, Spectrascan believed that breast cancer incidence could be reduced through early detection by incorporating mammography as part of regular OB/GYN health examinations. After a decade of successfully implementing imaging to that environment, they launched their DM program. Lessard says, "Our organization works through outreach to the managed care organizations and health plans to spread the message of early detection as saving both lives and dollars. But it is the case manager in the trenches who pulls together the individual resources to maximize oncology treatments for breast cancer patients."
Sounds good, but what exactly can the case manager do in this DM approach to maximize the care? Quite a bit, says Lessard, whose description of the case manager's responsibilities is akin to the movie producer who coordinates every aspect of a production from location to actors to script. On receiving a positive diagnosis of cancer, the case manager becomes an immediate player. "Many managed care organizations opt out of a case manager's intervention early on and wait until there's too many claims, mistakes, high risk, and so forth," Lessard explains. "Then they call a case manager to come in and try and fix everything. Our belief is that being there at the start of the diagnosis to coordinate treatment, create a multidisciplinary approach, and truly manage the disease is what disease management is all about." The Spectrascan case manager helps the patient through clinical treatments and communicates within the entire health network. The role includes everything from knowing how to gain access for treatments to making sure side effects from oncology therapy are alleviated with the necessary but often expensive drugs to frequent communication with the oncologist and the primary care physician.
After Treatment Lessard offers another perspective as well. '[Another important function of the case manager is something we don't think about, and that is, after treatment is over and the patient is cleared clinically, he or she needs a method to reenter the healthy world with a realistic perspective." This means something different for each patient; some patients may never again "feel safe" from cancer, or having survived with a successful prognosis, some patients feel "invincible" from a recurrence. Both attitudes result in unrealistic behavior. The case manager helps close the loop of treatment by explaining what to expect, what follow-up is necessary, and recommending support groups or other communication to reassure the patient. "I really see the case manager as the clasp on the bracelet of this treatment," is Lessard's effective analogy. "We link the events at both the beginning and the end to provide a smooth, streamlined, and continuously flowing chain. This is what disease management is all about." Equally appreciative of the case manager's role in DM is Sandra Lowery, who calls the case manager the "one shining star" in the DM arena. Founder and past president of the Case Management Society of New England and current leader of Consultants in Case Management Intervention, Inc., Lowery speaks plainly when it comes to the need for case manager intervention in an oncology DM scenario. "Case management is that intangible service that incorporates so many factors of support, communication, and care coordination that it is difficult to assign an actual dollar value to. With case management the outcomes may be very measurable in terms of seeing use of appropriate services and so forth. But how do you measure the value of making the last months of a terminal patient's life the very best they might be?" Lowery says the psychosocial factors of case manager intervention are not always in line with the goals of managed health care orga-
nizations, whose inflexible clinical pathways often operate with blinders on. And the complexities of oncology treatment range far beyond the radiologist, so an appropriate D M program must address more than one set of clinical issues. "How many patients truly have just one disease?" Lowery questions. "If you have cancer, what happens if you also have diabetes? Certainly depression is a big player, and the possibility of presenting with osteoporosis, heart disease, and many other diseases is very real. What disease management program will cover all of these?"
Taking Charge According to Lowery, care integration that uses D M principles will best facilitate positive outcomes. When the case manager is allowed to be an integral and initial player in any disease, particularly lethal diseases such as cancer, that important "take charge" role of intervention can be the critical difference in outcomes. Taking charge is part of the D M mission of the Seattle-based biopharmaceutical company Immunex, a major researcher and manufacturer of oncology products. Dr. Michael Kleinberg, vice-president of professional services, says the role of D M is important to ensure a continuum of quality care. Immunex's active outreach programs teach hospitals, managed care organizations, and other health care providers the proper and effective use of their medications. Kleinberg says, "Just knowing that chemotherapy products exist is one thing; knowing how they work best in what kind of situation can be the critical difference in outcomes. An important mission is to educate people, and we believe that as better, more informed consumers, patients become empowered and take a proactive role in their care." The educational information Immunex supplies m consumers does not mention products, but it describes cancer, chemotherapy, side effects, and other concerns in user-friendly language. The company actively participates with the American Urologic Foundation, the National Alliance of Breast Cancer, the National Cancer Institute, and other organizations. On request, a patient receives a comprehensive package of information on managing his or her disease, with a professional service package designed for the patient's physician and other caregivers. However, it is unlikely most case managers are even aware of these and other free materials that can be that important link in the care coordination process. Kleinberg illustrates a compelling story on the value of education and information for case managers. "Last fall, our chemotherapy drug Novantrone ®was found to slow the process and decrease the pain of late-stage prostate cancer when used in combination with prednisone. Although it is an off-label usage at this time, and we do expect future FDA approval, here is a scenario where this kind of information can give case managers an extra tool to relieve the suffering of these patients. But first they have to know about it and be equipped with a source of proof to make that recommendation to the physician and payer." Prostate cancer, like breast cancer in women, is a disease in which the need for early detection cannot be overstated. It is the most frequently diagnosed malignancy and the second leading cause of January/February1997
T C M 47
death in men. The American Cancer Society estimates that by the end of 1996, 317,000 new cases of prostate cancer will be diagnosed, and 41,400 men will have died from this disease. Most patients, says Kleinberg, will experience metastasis of this cancer, which ultimately causes death when it spreads to lymph nodes and bones--a source of debilitating pain that Novantrone ® can mediate. At the 1996 National Managed Health Care Congress, another oncology-based organization, Integrated Oncology Networks (ION), sponsored a survey to learn more about the needs of providers and payers who manage and treat cancer patients. Director of Care Management Judy Sanoshy talks about those survey results. "What we found from the survey was that respondents rated coordination of patient care to be the most important factor in achieving high-quality, cost-effective health care. At ION, we provide that important coordination at the outset. From the first moment of diagnosis, our care manager steps in and becomes the coordinator of care. This evolves into a very individualized and personal relationship with that patient and may mean the difference in how he or she responds to the course of treatment." ION, a disease-specific management company affiliated with Cancer Centers of America, states its mission as one of"meeting the needs of cancer patients by providing access to the most appropriate treatment options." In the past 2 years I O N has implemented a software program that helps clinically support oncology management. The program interfaces with provider and payer networks to establish standards of care, including how the patient responds to prescribed doses of medications, testing results, chemotherapy requirements, and other quantitative and qualitative measurements that ultimately present the picture of how the disease responds to treatment.
The H u m a n Teuch Although technology is an important aspect of DM, Sanoshy says the human factor provided by the case manager cannot be replaced. "The I O N model is designed to be a partnership between the case manager and the physician. There are so many tragedies of patients lost to the system because no one was there to coordinate the care and take responsibility. We believe that the role of the case manager is not an option--it should be a standard--and with oncology patients it is an opportunity to make a huge difference." Although the standards of care for cancer patients can be remarkably improved through the programs of D M services, what about the independent case manager who does not have access to these resources? No magic is involved in assessing how information and intervention can play a vital role in determining the outcomes of cancer patients. Although independent case managers may play a less aggressive role in other types of cases, plenty of evidence exists for them to approach administrators, plan payers, and others they contract with to demonstrate the economic and psychosocial benefits of early intervention in oncology. Although it is certainly simplifying the task, DM is largely using common sense to see the whole patient picture with a sensitivity to individual needs and a willingness toward flexibility. The new integrated approach of DM guidelines and protocols has been proven to maximize outcomes, but through the humanistic approach of case managers, these outcomes truly can become meaningful.
Reprint orders: Mosby-YearBook, Inc., 11830 Westline IndustrialDrive,St. Louis, MO 63146-3318; phone (314) 453-4350; reprintno. 68/1/79425
ANNOUNCEMENT The Commission for Case Manager Certification is seeking candidates to serve as members of this voluntary credentialing body. Such individuals must be Certified Case Managers (CCMs). The appointment would be for 4 years, beginning at the 1997 annuaI meeting and running through the completion of the meeting in 2001. The primary role of the commission is to set policies and establish guidelines for the administrative staff to follow with respect to the CCM credentialing process. Commissioners are expected to attend two business meetings a year, serve on at least one committee (and attend two committee meetings a year), respond in a timely fashion to all items requiring input from commissioners, and represent the commission in an appropriate manner. Travel, accommodations, and meal expenses incurred by commissioners attending meetings will be reimbursed by CCMC. The standing committees on which an individual might serve include: • Appeals • Certification compliance review • Examination and research • Eligibility compliance • Public affairs and communications • Bylaws • Nominations Candidates will be reviewed by the CCMC Executive Committee. If you are a CCM in good standing and willing to serve as a commissioner, please send a letter describing your areas of interest along with relevant biographical information to Eda Holt, Chief Executive Officer Commission for Case Manager Certification 1835 Rohlwing Road, Suite D Rolling Meadows, IL 60008 The deadline for submissions is April 1, 1997.
TCM 48
j
.....
y/February1997
Disease Management Programs The concept of disease management (DM) is still evolving both in definition and in practice, not unlike the early days of managed care, whose policies and practices blindsided and bewildcred the populations that attempted to make this new iaa~chine work without anydirections. But the newest kid on the block, DM--initially launched as a value-add by the pharmaceutical companies to market their products more effectivelymnow has evolved to comprise a variety of concepts and strategies, some with better success ~hlm others. Although purveyors of many of" these new entrepreneurial ventures j~.~/l:~b~a,y ,997
TCM 45
claim they are all about improving the quality of health care delivery with lowered costs, it continues to be a leap of faith for most customers to take on word that increasing quality results in lower health care expenditures. Why is this such a difficult concept to swallow? Our history as savvy consumers might shed light on the answer. Most of us, who "shop 'til we drop" for the best bargains, have been indoctrinated to believe that quality is generally more expensive than a supposedly inferior product. On the other hand, we also have been taught that quality should be synonymous with longevity--whether it is a fine suit, a fax machine, or pots and pans. Unfortunately, what we know intuitively to be true about quality often has no effect on how we behave; this transcends to the purchasing and spending in health care. Immediate savings are much more easily seen by reducing or eliminating a health care line item with the stroke of a pen than by investing in additional services that might save money 1 or 2 years from now. However, realizing immediate savings on health care dollars in the current fiscal quarter is just a Band-Aid treatment for problems that will persist in the long term. The task of DM programs is to reshape this "bargain hunting" thinking with a longterm approach to quality and savings. The new DM services are designed to address the quality and expenditures of diseases that take the largest chunk of the health care dollar. Without question, oncology treatments are an incredible drain on those resources. Oncology DM programs are proving to be a good investment, but the best news is that the services of the case manager are being incorporated into the health care team right from the start. Although managed care organizations and their contracted employer groups are able to realize many financial benefits from oncology DM programs, such programs are targeted to first benefit the most important player in the pict u r e - t h e patient. "We have found that patients who don't do well, who are afraid, who have no education are the ones that have the poorest outcomes. They don't know what to expect, so their expectations are low, and as a result they don't do well," explains Sharon McCoy, a vice-president of Quality Oncology, a DM organization. "In contrast, the patient who has been educated from the first moment of diagnosis and receives a nurturing and supporting voice will know what to expect and, consequently, becomes a more active participant in his or her care, and outcomes are generally better."
Case Mancugers" Role in DM Quality Oncology (QO), based in south Florida, offers a compassionate and integrated approach to managing both the costs and the quality of care for cancer patients. McCoy says that Q O was founded to address the problems arising from the typical fragmented style of cancer treatment that resulted in poor outcomes and excessive costs. "Intervention by case managers at the very outset of our program is key to the long-term success of how patients respond to treatment," McCoy explains. "This caregiver immediately becomes the patient liaison to the health system and is available 7 days a week, 24 hours a day. The family is always involved every step of the way, and it becomes a win-win situation for everyone." TCM 46
j
.....
y/February1997
As an example, a patient diagnosed with cancer by his primary care physician, whose network is affiliated with QO, immediately will call the organization to set up an appointment with the nearest Q O facility. At that appointment the Q O staff assigns a "care manager," as they are called, who authorizes the most appropriate treatment plan and follows up with the patient before, during, and after the plan. The plan is compared with care guidelines to ensure the best outcomes. Throughout treatment, the assigned care manager is responsible for coordinating not only oncology service but also nutritional and depression counseling, assistance with home health needs, physical therapy, and more. Although McCoy stresses that they do not provide treatments, all Q O care managers are oncology certified nurses (OCNs) with at least 10 years' experience. McCoy believes this relationship maximizes the patient's quality of life, even in cases with poor prognosis. And she adds, as health care organizations become their customers, they see the value of specialized DM services that coordinate treatments, monitor pharmaceutical therapies, intervene within the system to minimize unnecessary treatments and physician visits--an exhausting routine for any cancer patient--and most importandy, provide follow-up support for 5 years. McCoy sums up the philosophy they have seen as proof positive: "Oncology disease management is different than asthma or other diseases because the diagnosis registers a tremendous shock to the patients. In seconds their life changes. Cancer is so much more than a disease; it is a stigma, a 'death sentence.' It can be disfiguring; the treatments are anything but pleasant to endure. "There is absolutely no question that the role of the care manager who intervenes at the outset can make all the difference in the world for these patients."
Oncology Case Managers In agreement with McCoy is Maura Lessard, health services manager of Spectrascan, an oncology DM program whose focus is the prevention and treatment of breast cancer. "The case manager has always been the person who has the tools and the resources to coordinate care, and we are now seeing that other members of the health care team, from administration to providers, recognize the value of this role, particularly in cancer cases." This Connecticut-based DM program is designed to be an integrated feature of health plans and managed care organizations. The goal is to provide the personnel, facilities, and equipment to raise awareness of breast health through early detection and appropriate treatments of breast cancer. Case management again plays a pivotal role in the success of meeting these goals. In its inception, Spectrascan believed that breast cancer incidence could be reduced through early detection by incorporating mammography as part of regular OB/GYN health examinations. After a decade of successfully implementing imaging to that environment, they launched their DM program. Lessard says, "Our organization works through outreach to the managed care organizations and health plans to spread the message of early detection as saving both lives and dollars. But it is the case manager in the trenches who pulls together the individual resources to maximize oncology treatments for breast cancer patients."
Sounds good, but what exactly can the case manager do in this DM approach to maximize the care? Quite a bit, says Lessard, whose description of the case manager's responsibilities is akin to the movie producer who coordinates every aspect of a production from location to actors to script. On receiving a positive diagnosis of cancer, the case manager becomes an immediate player. "Many managed care organizations opt out of a case manager's intervention early on and wait until there's too many claims, mistakes, high risk, and so forth," Lessard explains. "Then they call a case manager to come in and try and fix everything. Our belief is that being there at the start of the diagnosis to coordinate treatment, create a multidisciplinary approach, and truly manage the disease is what disease management is all about." The Spectrascan case manager helps the patient through clinical treatments and communicates within the entire health network. The role includes everything from knowing how to gain access for treatments to making sure side effects from oncology therapy are alleviated with the necessary but often expensive drugs to frequent communication with the oncologist and the primary care physician.
After Treatment Lessard offers another perspective as well. '[Another important function of the case manager is something we don't think about, and that is, after treatment is over and the patient is cleared clinically, he or she needs a method to reenter the healthy world with a realistic perspective." This means something different for each patient; some patients may never again "feel safe" from cancer, or having survived with a successful prognosis, some patients feel "invincible" from a recurrence. Both attitudes result in unrealistic behavior. The case manager helps close the loop of treatment by explaining what to expect, what follow-up is necessary, and recommending support groups or other communication to reassure the patient. "I really see the case manager as the clasp on the bracelet of this treatment," is Lessard's effective analogy. "We link the events at both the beginning and the end to provide a smooth, streamlined, and continuously flowing chain. This is what disease management is all about." Equally appreciative of the case manager's role in DM is Sandra Lowery, who calls the case manager the "one shining star" in the DM arena. Founder and past president of the Case Management Society of New England and current leader of Consultants in Case Management Intervention, Inc., Lowery speaks plainly when it comes to the need for case manager intervention in an oncology DM scenario. "Case management is that intangible service that incorporates so many factors of support, communication, and care coordination that it is difficult to assign an actual dollar value to. With case management the outcomes may be very measurable in terms of seeing use of appropriate services and so forth. But how do you measure the value of making the last months of a terminal patient's life the very best they might be?" Lowery says the psychosocial factors of case manager intervention are not always in line with the goals of managed health care orga-
nizations, whose inflexible clinical pathways often operate with blinders on. And the complexities of oncology treatment range far beyond the radiologist, so an appropriate D M program must address more than one set of clinical issues. "How many patients truly have just one disease?" Lowery questions. "If you have cancer, what happens if you also have diabetes? Certainly depression is a big player, and the possibility of presenting with osteoporosis, heart disease, and many other diseases is very real. What disease management program will cover all of these?"
Taking Charge According to Lowery, care integration that uses D M principles will best facilitate positive outcomes. When the case manager is allowed to be an integral and initial player in any disease, particularly lethal diseases such as cancer, that important "take charge" role of intervention can be the critical difference in outcomes. Taking charge is part of the D M mission of the Seattle-based biopharmaceutical company Immunex, a major researcher and manufacturer of oncology products. Dr. Michael Kleinberg, vice-president of professional services, says the role of D M is important to ensure a continuum of quality care. Immunex's active outreach programs teach hospitals, managed care organizations, and other health care providers the proper and effective use of their medications. Kleinberg says, "Just knowing that chemotherapy products exist is one thing; knowing how they work best in what kind of situation can be the critical difference in outcomes. An important mission is to educate people, and we believe that as better, more informed consumers, patients become empowered and take a proactive role in their care." The educational information Immunex supplies m consumers does not mention products, but it describes cancer, chemotherapy, side effects, and other concerns in user-friendly language. The company actively participates with the American Urologic Foundation, the National Alliance of Breast Cancer, the National Cancer Institute, and other organizations. On request, a patient receives a comprehensive package of information on managing his or her disease, with a professional service package designed for the patient's physician and other caregivers. However, it is unlikely most case managers are even aware of these and other free materials that can be that important link in the care coordination process. Kleinberg illustrates a compelling story on the value of education and information for case managers. "Last fall, our chemotherapy drug Novantrone ®was found to slow the process and decrease the pain of late-stage prostate cancer when used in combination with prednisone. Although it is an off-label usage at this time, and we do expect future FDA approval, here is a scenario where this kind of information can give case managers an extra tool to relieve the suffering of these patients. But first they have to know about it and be equipped with a source of proof to make that recommendation to the physician and payer." Prostate cancer, like breast cancer in women, is a disease in which the need for early detection cannot be overstated. It is the most frequently diagnosed malignancy and the second leading cause of January/February1997
T C M 47
death in men. The American Cancer Society estimates that by the end of 1996, 317,000 new cases of prostate cancer will be diagnosed, and 41,400 men will have died from this disease. Most patients, says Kleinberg, will experience metastasis of this cancer, which ultimately causes death when it spreads to lymph nodes and bones--a source of debilitating pain that Novantrone ® can mediate. At the 1996 National Managed Health Care Congress, another oncology-based organization, Integrated Oncology Networks (ION), sponsored a survey to learn more about the needs of providers and payers who manage and treat cancer patients. Director of Care Management Judy Sanoshy talks about those survey results. "What we found from the survey was that respondents rated coordination of patient care to be the most important factor in achieving high-quality, cost-effective health care. At ION, we provide that important coordination at the outset. From the first moment of diagnosis, our care manager steps in and becomes the coordinator of care. This evolves into a very individualized and personal relationship with that patient and may mean the difference in how he or she responds to the course of treatment." ION, a disease-specific management company affiliated with Cancer Centers of America, states its mission as one of"meeting the needs of cancer patients by providing access to the most appropriate treatment options." In the past 2 years I O N has implemented a software program that helps clinically support oncology management. The program interfaces with provider and payer networks to establish standards of care, including how the patient responds to prescribed doses of medications, testing results, chemotherapy requirements, and other quantitative and qualitative measurements that ultimately present the picture of how the disease responds to treatment.
The H u m a n Teuch Although technology is an important aspect of DM, Sanoshy says the human factor provided by the case manager cannot be replaced. "The I O N model is designed to be a partnership between the case manager and the physician. There are so many tragedies of patients lost to the system because no one was there to coordinate the care and take responsibility. We believe that the role of the case manager is not an option--it should be a standard--and with oncology patients it is an opportunity to make a huge difference." Although the standards of care for cancer patients can be remarkably improved through the programs of D M services, what about the independent case manager who does not have access to these resources? No magic is involved in assessing how information and intervention can play a vital role in determining the outcomes of cancer patients. Although independent case managers may play a less aggressive role in other types of cases, plenty of evidence exists for them to approach administrators, plan payers, and others they contract with to demonstrate the economic and psychosocial benefits of early intervention in oncology. Although it is certainly simplifying the task, DM is largely using common sense to see the whole patient picture with a sensitivity to individual needs and a willingness toward flexibility. The new integrated approach of DM guidelines and protocols has been proven to maximize outcomes, but through the humanistic approach of case managers, these outcomes truly can become meaningful.
Reprint orders: Mosby-YearBook, Inc., 11830 Westline IndustrialDrive,St. Louis, MO 63146-3318; phone (314) 453-4350; reprintno. 68/1/79425
ANNOUNCEMENT The Commission for Case Manager Certification is seeking candidates to serve as members of this voluntary credentialing body. Such individuals must be Certified Case Managers (CCMs). The appointment would be for 4 years, beginning at the 1997 annuaI meeting and running through the completion of the meeting in 2001. The primary role of the commission is to set policies and establish guidelines for the administrative staff to follow with respect to the CCM credentialing process. Commissioners are expected to attend two business meetings a year, serve on at least one committee (and attend two committee meetings a year), respond in a timely fashion to all items requiring input from commissioners, and represent the commission in an appropriate manner. Travel, accommodations, and meal expenses incurred by commissioners attending meetings will be reimbursed by CCMC. The standing committees on which an individual might serve include: • Appeals • Certification compliance review • Examination and research • Eligibility compliance • Public affairs and communications • Bylaws • Nominations Candidates will be reviewed by the CCMC Executive Committee. If you are a CCM in good standing and willing to serve as a commissioner, please send a letter describing your areas of interest along with relevant biographical information to Eda Holt, Chief Executive Officer Commission for Case Manager Certification 1835 Rohlwing Road, Suite D Rolling Meadows, IL 60008 The deadline for submissions is April 1, 1997.
TCM 48
j
.....
y/February1997