Nurse on the Move: Ann Marie Marks

In honor National Case Management Week, which is able to happen on October 9^vol – 15^vol, we present an achieved nurse on the move, Ann Marie Marks RN, BSN, CCM. Marks has over 36 years of nursing experience. She started off working within the intensive care unit and eventually moved into case management as the sphere grew.

Marks helped pave the way in which for the case manager role, including creating content for the primary Certified Case Manager (CCM) exam in 1990. She helped define what case management was and continues to serve patients by coordinating care across a big, interdisciplinary system of care health.

He currently serves as an RN case management consultant and speaker; she teaches on the Thomas Jefferson College of Health Population Health Academy and was the featured speaker on the NAHQ National Quality Summit in 2016. Most recently, she served as director of care coordination on the Delaware Valley Accountable Care Organization, where she continues to advise on post-acute services. Previously, she was director of business affairs management at Humana, Inc. in Louisville, Kentucky, and national director of integrated care management for Aetna’s Medicaid division. In 1999, the Governor of Kentucky appointed Marks to function deputy secretary of health, liable for overseeing the Commonwealth Primary Care Case Management Program (KenPAC) and programs throughout the Department of Medicaid Services, CSHHCN, and the Office on Aging.

I used to be fortunate to take a seat down with Marks in our Philadelphia office to debate what case management is, what it has been and the way it has evolved, including why it’s so essential in today’s healthcare world.

Read on to find the essential role case managers play and learn more about case management:

• Subscribe , the official journal of the Case Management Society of America (CMSA). Marks is a member of CMSA and a long-time subscriber to the journal and says, “For years, the journal has been a source of evidence-based research and peer-reviewed literature on case management. It is most frequently cited and is often a source of reading material in case management classes. For me, this journal is one of the places I like to return to when I confirm the value of case management or when I conclude that a program has not proven to be of value.”

• Check out these case management books from Wolters Kluwer.

CMSA Core Case Management Curriculum, COLLABORATE® for skilled case management, Case management

When I used to be 15, my father had a terrible automotive accident. He was taken to a bigger community hospital about 70 miles from our small town. He had a broken jaw, a broken chest tube, a feeding tube, and multiple injuries. He couldn’t be left alone, and his mother needed to return to her teaching position. Somehow I used to be nominated to “stay” with him. I slept on a cot in his room and inside a day the nurses and doctors began teaching me how one can take care of him. I learned so well that I used to be allowed to take him home three weeks sooner than expected! Three years later, I received a scholarship to a university that had a bachelor’s degree in nursing, and I knew that was what I wanted. However, the experience of eight weeks of living within the hospital and caring for an advanced patient like my dad actually influenced my selection of nursing as a profession. It was the boldness that the nurses instilled within the teenager.

It gave the impression of a few years passed before what I used to be doing was called case management. When I began working within the early Eighties, we were called rehabilitation nurses. This encounter with a “rehabilitation nurse” while working within the ICU inspired me to explore this field. A nurse got here to our hospital to debate the situation of a patient who had suffered a catastrophic accident at work. She was very all the way down to earth and wore a suit! What intrigued me was that she was a nurse who didn’t provide direct medical care (treatments, medications, etc.) but coordinated care. I learned that he worked for a corporation that provided services to large, self-insured employers and insurers. I finally managed to get my foot within the door. The president, Mary Gambosh, hired me part-time and gave me the challenge of expanding her company in Kentucky.

But more importantly, she trained me within the principles of fine case management and shared all the pieces she knew. Mary assigned me a big account within the coal fields of eastern Kentucky. This was the start of an exquisite profession for me in case management and nursing development and mentoring under certainly one of the legends in the sphere, Mary Gambosh, RN.

I feel the word “case” was at all times there because insurance firms would “refer you to a case”; I first heard the term “case manager” in various states’ insurance departments. For so long as I even have known about case management, I even have associated it with advocacy, care coordination, and resource management. Even after I began working on this field as a “rehabilitation nurse”, I knew that the case manager occupation was evolving and there was a necessity to distinguish the education and experience of the specialist who performed this work. In the late Eighties, there was a debate amongst rehabilitation nurses, certifying agencies, and other professions about who would qualify for the “case manager” exam. At the identical time, now we have begun to see a rise within the role of case managers in hospitals, amongst payers, and amongst insured employers themselves. Elements of utilization management, hospital bill auditing, and care coordination have change into demands of execs in the sphere. I’ve seen recent titles for care coordinators and navigators, and I’m pleased to see job descriptions that always say “CCM preferred.” The certificate confirms that you just meet a certain level of competence and experience to take the exam. We help patients and families navigate complex systems. We coordinate care. Case management is about making things occur!

In addition to clinical experience, case managers have training in the advantages and reimbursement systems that pay for services. Helping patients access and manage services effectively is usually critical to outcomes. Part of this advocacy is advocating for high-quality care, access to care, and even evidence-based care. Sometimes it is sufficient to simply ask those involved within the patient’s care to listen – to take a break and take into consideration what the patient desires to say or wish to say. In a world where there may be an emphasis on value-based care and performance metrics, the role of the case manager is becoming increasingly essential. We play a key role in providing high-quality health care, helping manage advantages at the appropriate time and place, etc., and ultimately managing costs for giant populations.

The victim of the mass shooting referred to as the Standard Gravure Shooting in Louisville, Kentucky in 1989 has at all times stuck in my mind. This is vital to me because gun violence and workplace violence have change into a weekly headline. But the event attracted nationwide publicity. A couple of hours after the shooting, I used to be called in to act as a case manager for a few of the victims. One of them was a gentleman who had worked within the factory for over 40 years. This was not only a patient with serious physical wounds, but a patient with emotional trauma. I remained a component of his case until the day he returned to work, which was his personal goal. I shadowed him for the primary yr at his recent job. But this patient, this case, modified my awareness of the importance of incorporating physical and behavioral health into care planning.

Building trust amongst patients. Today we speak about “patient experience” and “patient engagement” and this also applies to case managers. Many patients or families initially perceive you as someone who’s just coming to gather something. Skills are needed to assist a patient with complex problems understand that you just are there to evaluate the situation and may actually help. Challenges also relate to the reform of the health care system itself and the necessity for high-quality case managers.

When we began case management, the method was episodic. Up until the early Nineteen Nineties, one case can be admitted, then one other, and we considered a referral six months after diagnosis or three months after injury to be “early.” It was based on the idea that something will need to have already happened. Now I take a look at all the population, using information from predictive analytics, a couple of subset of those people in the neighborhood and check out to find out where to best place the case manager.

An additional change is the growing variety of certified case managers. Part of the evolution is recognizing case managers across the health care continuum. They are valued as key members of the team, no matter their environment. Case managers began to be recognized as a part of preventive services, reasonably than simply referrals after a catastrophic event.

National Case Management Week, like other specialty recognition weeks, provides a chance to satisfy the nurses and other specialists who make up the integrated care team. Gaining insight into training, different job roles, and what a case manager can “deliver” might help other nurses work with this key person on the team. It may even help nurses fascinated with specializing in case management find open doors.

I see that the role of nurses usually has returned to the first care model. We wish to coordinate end-to-end patient care, and I feel in the longer term, more case managers will take the lead in coordinating the patient across the continuum of care. I see limitless opportunities, but I actually see an increased needn’t just for nurses, but additionally for case managers. Technology may also proceed to play an enormous role. Skill sets have modified and over time I even have hired 2,000 case managers in various configurations and I can say that the skill sets needed to do that job require a wealth of data in documentation and reporting software. Additionally, a lot of our case managers work virtually, so settings will vary. An individual must survive within the virtual workforce.