BY DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
Several years ago, while in my DNP population health class, I had a “discussion” with my instructor regarding the intersection of population health and the practice of professional case management. Her position was that population health and case management had no intersection and that I should stop referencing the practice of case management in my weekly postings and assignments. My position was vehemently opposite of hers, and if you know me well, you know that I certainly did not back down from proving the intersection through my postings and projects. Indeed, other members of my cohort actually thanked me for broadening their perspective (and I received a B in the class from my instructor, who did not appreciate my efforts and maybe defiance?). Population health and case management are two important components of healthcare practice that aim to improve the well-being of individuals and communities. While they are distinct concepts, they often intersect and complement each other in the context of healthcare delivery.
1. Population Health: Population health focuses on the health outcomes of a group of individuals, considering the distribution of those outcomes within the population and the factors that influence them. It takes into account various determinants of health, such as social, economic and environmental factors. The goal of population health is to improve the overall health status and quality of life of a specific population or community.
Population health initiatives typically involve:
Assessing the health needs of a population: This involves collecting data, conducting surveys and analyzing health indicators to understand the health status, risk factors and health disparities within a population.
Implementing preventive measures: Population health aims to prevent diseases and promote health through interventions such as immunizations, health education and lifestyle modifications.
Addressing social determinants of health: Population health recognizes that health outcomes are influenced by various social and environmental factors. Initiatives may focus on improving access to healthcare, affordable housing, education, employment opportunities and other social determinants.
Collaborating with stakeholders: Successful population health initiatives involve collaboration among healthcare providers, community organizations, government agencies and other stakeholders to coordinate efforts and maximize impact.
2. Case Management: Case management, on the other hand, is a patient-centered approach that focuses on coordinating and managing the care of individuals with complex healthcare needs. It involves assessing, planning, implementing, coordinating, monitoring and evaluating the services and resources required to meet the individual’s healthcare goals. Key elements of case management include:
Comprehensive assessment: A case manager assesses the individual’s medical, social and psychological needs to develop a personalized care plan.
Care coordination: Case managers work collaboratively with healthcare providers, specialists and other professionals involved in the individual’s care to ensure effective communication and coordination of services.
Advocacy: Case managers serve as advocates for individuals, helping them navigate the healthcare system, access appropriate resources and address barriers to care.
Monitoring and evaluation: Case managers regularly monitor the individual’s progress, evaluate the effectiveness of interventions and adjust the care plan as needed.
Continuity of care: Case management ensures seamless transitions between healthcare settings and promotes continuity of care to avoid gaps and fragmentation.
Integration of Population Health and Case Management
Population health and case management practices often intersect and can be integrated to improve health outcomes. Case management can be considered a strategy within population health initiatives, particularly for individuals with complex health needs or those who are at higher risk of poor health outcomes. By applying population health principles, case managers can identify specific populations or communities that may benefit from targeted interventions and coordinate resources accordingly. Likewise, population health efforts can inform case managers about the broader context and determinants of health that impact individual patients, allowing for more holistic care planning and coordination.
Overall, population health and case management practices share the common goal of improving health outcomes and can work together to address the needs of both individuals and communities in a more comprehensive and coordinated manner. Within this issue, you will find examples of exactly that — population health and case management working hand in hand to create better outcomes. And isn’t that what it’s all about?
Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM, is the associate chief clinical operations officer, care continuum for University of Illinois Health System and the current president of the Case Management Society of America National Board of Directors. She has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management and social services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management.
Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her first book, A Practical Guide to Acute Care Case Management, published by Blue Bayou Press, was released in February 2022.
Dr. Morley has over 20 years of nursing experience. Her clinical specialties include med/surg, oncology and pediatric nursing. She received her ADN at South Suburban College in South Holland, Illinois, BSN at Jacksonville University in Jacksonville, Florida, MSN from Norwich University in Northfield, Vermont and her DNP at Chamberlain College of Nursing.
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