REDEFINING CASE MANAGEMENT - HRSA HIV/AIDS Programs

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from the programs; geomapping case managementservices; and tracking changes and updates as thegroup moved through the process of revising draft standards,outcomes, and indicators. The work group alwaysremained client centered in its approach and gave carefulconsideration to specific actions that might affectclients if those actions were included as standards.With the development of new medical case managementstandards, the State Department of PublicHealth has developed and initiated several trainings toincrease the core competencies of current case managersto provide medical case management services.These trainings (which include a component on the newstandards of care) are now part of a mandatory comprehensivetraining curriculum for all new Part B medicalApril of this year, the grantee hosted a 1-day medicalcase management meeting to help providers of casemanagement services understand the new definitionand discuss the key activities now included in the definitionof medical case management. The grantee wantedto create a welcoming environment where providers feltfree to raise issues and concerns to foster an honestdiscussion of case management services.Process and ResultsA facilitator helped manage the meeting and move thediscussion forward. The meeting was not held at a serviceagency, nor was it held at the grantee’s office. Aconference room at a city-owned golf course was theselected venue. Taking participants out of their officesTwenty percent of [Indianapolis] respondents indicated that case management,including medical case management, was the single service most necessary toensuring good health.case managers. The plan is to provide training for allmedical case managers funded by Part B. Those fundedby Ryan White Parts A, C, and D are invited to attend.Workgroup discussions have included approachingthe AIDS Education and Training Centers regardingsome of the training needs.The Part A Planning Councilsin New Haven and Hartford have acknowledged thatthis paradigm shift requires education and training fortheir current case managers and clinicians who may notbe accustomed to working with consumers in this manner.Thework group also acknowledged that consumersneed training on how to use medical case managerseffectively. Many consumers may have to adjust theirassumptions or let go of past experience with case managerswith the change to a chronic disease managementmodel.Medical Case Management and theContinuum of Care in NashvilleThe Nashville TGA program recently completed its firstyear of operations. During FY 2007, everything—includinghiring staff, forming a Planning Council, developingcontracts, and learning the Ryan White HIV/AIDSProgram and legislation—had to happen quickly. Inhelped them focus more on the topics for discussion. Itwas also important that providers not feel that theywere being summoned to the grantee’s office to be reprimanded.Judi Grimes, the clinical quality manager forthe Nashville TGA, said, “I think the neutral territorychanged the climate, and then the timbre of the conversationbecame more acceptable for everyone.”In addition, the meeting opened with a panel ofthree Nashville consumers, who talked about their casemanagers, medical services, and the activities their casemanagers perform to help keep them in care. They presentedtheir impressions of case management andreminded the meeting participants of the importantrole these services play in the lives of clients.The session clarified the difference between medicaland nonmedical case management. Information onHAB’s intent and expectations regarding medical casemanagement was also shared with all participants.There was positive interaction between theproviders and a discussion of tasks that could be doneto move community- and clinic-based case managers inthe direction of HAB’s definition. Several good modelscurrently exist in the TGA, and future meetings will focuson the ability to replicate key components at otheragencies.6
Consumers need training on how to use medical case managers effectively. Many consumers may have to let go of their pastexperiences with case managers with the change to a chronic disease management model.The clinical quality manager shared a process fordeveloping standards of care. In addition, she discussedthe need for providers to assist the Planning Councilwith the development of standards as the granteemoves forward to define minimum expectations for thedelivery of all Ryan White HIV/AIDS Program Part Aservices.The need to continue meeting and working throughsome of the issues of medical case management, includingmodels for clinic- and non-clinic-based case managers,was clear. How medical case management shouldcoordinate with other HIV and non-HIV services stillneeds to be decided. Nashville is using the new servicedefinition as a catalyst to examine several of its HIV servicesby asking questions and collaboratively developingthe answers.Lessons LearnedThe session answered many questions, but PamSylakowski, Part A program director for the City ofNashville, says, “This is the beginning of a conversationregarding our continuum of care. The session raisedmany questions we have yet to explore—not only definingand understanding medical case management buthow it will coordinate with early intervention servicesand primary care to create a seamless system.”Sylakowski adds,“The answers to many of the questionsare obtainable, but only if we create the opportunitiesand the time to continue asking key questions inorder to distinguish the similarities and differencesbetween each of our providers of medical case management.The answers to the questions may also beaffected by the different populations each of the agenciesserves and whether the setting is urban, suburban,or rural”.Coordination and linkage with other services is animportant activity of medical case management, but theneed and level of coordination and linkage may varyaccording to the populations served by each agencyand locale.Participants agreed that having everyone togetherat the meeting, including consumers, nurses, case7
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REDEFINING CASE MANAGEMENT - HRSA HIV/AIDS Programs

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