Stewardship: The Core of Case Management

Stewardship.  What is the relationship between stewardship and case management?  Is stewardship really the conceptual framework or philosophy of case management?

Merriam Webster defines stewardship as “the conducting, supervising, or managing of something especially:  the careful and responsible management of something entrusted to one's care”.  The last phrase is the key--“the careful and responsible management of something entrusted to one’s care.”(1)

The ACMA distinguishes case management as “a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The case management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of case management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient’s right to self-determination.”  I draw your attention to key phrases: “encompasses communication and facilitates care along a continuum through effective resource coordination”; “achievement of optimal health”; and “balanced with the patient’s right to self-determination.”(2)

In fact, I believe case management is stewardship. On a daily basis, the case manager is entrusted with facilitating and coordinating the patient’s care not just in the hospital but also to the transition of care whether it is to home or to a lower level facility.  An astounding responsibility.  This entrustment is evident in almost every case management activity.  Let’s pause a moment and think about some of those activities. 

One of the primary purposes of the initial assessment is to reveal any issues that could affect the course of the hospitalization and the safe transition.  By uncovering these issues, they can be explored and appropriately managed or eliminated by the treatment team or referrals.  For instance, on a basic level, the assessment looks at whether there are stairs at the patient’s residence.  Depending upon the patient’s answer, exploration of this one area can flow directly into other related considerations requiring a more in-depth assessment.  Such as, how many steps? Are the steps indoors or outside?  Will be patient be able to walk up the stairs post-hospitalization? Does the patient need physical therapy while in the hospital because of their diagnosis or possible deconditioning? Does the patient need rehabilitation post-hospitalization to help with their ability to walk or learn how to use a piece of medical equipment?   Once these or similar questions are answered, the case manager can develop the initial discharge plan with the patient/family and communicate with the treatment team. This is a perfect example of “careful and responsible management…”.  

Another illustration seen throughout the entire process of case management is stewardship of the patient’s benefits.  Case managers are aware of the patient’s health plan benefits and coverage to prevent extra out of pocket expenses for the patient.  They use this knowledge to assist them in developing the plan, making referrals, facilitating care coordination, etc.  This knowledge assists the treatment team in appropriate utilization of the patient’s health plan benefits.  Case in point, the patient’s health plan does not cover a particular medication the physician wants to prescribe upon discharge.  In this situation, the case manager discusses the coverage issues with the prescribing physician and the patient.  The three of them make an informed decision:  seek a benefit exception, look for an alternative medication, seek drug manufacture financial assistance, or patient agrees to pay for out of pocket.  All of these carefully thought through options are because the case manager is the steward of the patient’s resources.  Again, the case manager “supervised” the use of the patient’s benefits “entrusted” to them.

Hence, I believe adopting a philosophical framework of stewardship within a case management department makes sense.  It is demonstrated throughout the practice of case management and an easily embraced value which supports patient-centric care.  

Stewardship.

References

(1) Retrieved from https://www.merriam-webster.com/dictionary

(2) Retrieved from  https://www.acmaweb.org/section.aspx?sID=136