For minority nurses who have ever considered operating their own business, opportunities have never been better for starting a case management firm. Based on projections from multiple sources, demand for case management has been increasing steadily. Persistence Market Research forecasted an annual growth rate of 3.04% for the period between 2017 and 2021. An IBIS World report noted that case management’s steady growth over the past five years has brought the number of case management firms in the United States to over 7,800 and industry revenues to $7 billion. Understanding these market conditions and how they are opening the door for new case management practices is something any entrepreneurial minority nurse with key case management credentials (i.e., Certified Case Manager), and/or interest in gaining those credentials in order to pursue new opportunities, should understand. Also important to know are those areas where minority nurse case managers may have some distinct advantages.
Ideal Market Conditions for Minority-Owned Case Management Firms
In its report, IBIS attributed case management’s growth to expanded primary medical care and workers’ compensation claims, the heightened focus on medical cost containment, and the increased use of nurse case managers in new models of care such as patient-centered medical homes and Accountable Care Organizations (ACOs). These factors, along with our nation’s new administration and Department of Health and Human Services leadership, were also cited in a URAC® Trend Watch titled, “Case Management Experts Foresee Big Opportunities.”
The uncertainty surrounding the Patient Protection and Affordable Care Act, the graying of America, and higher incidences of chronic medical conditions (i.e., heart disease, cancer, stroke, chronic obstructive pulmonary disease, diabetes, and obesity), are other contributing factors for the greater demand for case management services.
Minority nurse case managers also are in a good position to serve individuals of different ethnic groups as our nation’s multiculturalism increases. The U.S. Census Bureau reported that all racial and ethnic minorities were growing faster than whites from 2015 to 2016. According to its findings, Asian and individuals of mixed-races represent the two fastest-growing sectors of the U.S. population with each group growing by 3% from July 2015 to July 2016. It provided this breakdown reflecting the size of the various minority and ethnic groups in our country:
- Non-Hispanic whites – 198 million.
- Hispanic whites – 57.5 million.
- Blacks/African-Americans – 46.8 million.
- Asian – 21.4 million.
- People who are of two or more races – 8.5 million.
- Native Hawaiians and Other Pacific Islanders – 1.5 million.
Not reflected in this data are all of the other ethnic groups present in the U.S. population—an estimated 150 ethnic groups. Case managers of various ethnic backgrounds can be extremely valuable when serving patients of their ethnic group. The barriers to communicating with these patients and their family members can be eliminated. Further, a case manager with an understanding of how a specific ethnic group views illness, medical professionals, medical treatments, technologies, end-of-life care, and medical directives can be extremely important in helping patients understand their conditions and treatment plans. This is critical in the patients’ overall well-being, treatment, and adherence to the prescribed plan.
Starting Your Own Case Management Practice
Minority nurses who have thought about starting their own case management firm need to consider what it takes to achieve a successful practice. In addition to having extensive case management experience, it is essential that you gain the CCM credential provided by the Commission for Case Manager Certification (CCMC). This credential is becoming increasingly important to those hiring case managers and/or contracting for case management services. To earn the CCM credential, candidates must first meet the applicant eligibility requirements and then pass a rigorous exam. All of the details can be found on the CCMC website at www.ccmc.org. Click on the “Get Certified” link.
To prepare for the exam, there are many robust education and training programs available. We at Mullahy & Associates, for example, have a two-day CCMC-approved “CCM Certification Prep Workshop.” It offers excellent preparation for the exam and also earns nurses, social workers, and mental health professionals 14 Continuing Education credits. It also has been acclaimed as one of the most informative workshops available on best practices for case management. Among the materials provided to workshop participants is The Case Manager’s Handbook, Sixth Edition, which is used in hundreds of universities, hospitals, and other practice settings across the country and abroad.
There is also a self-assessment that must be conducted to make sure you have the personality and skills to lead your own firm. Here are some of the key traits needed to effectively establish and maintain a successful case management business:
- An entrepreneurial disposition.
- The ability to recruit, train, mentor, and motivate others to provide high quality case management services.
- Leadership skills.
- Strong communications skills.
- Business management skills covering key operational areas (i.e., administrative, financial, marketing, and legal).
- A commitment to stay abreast of the latest market developments and health care trends affecting case management and generating new opportunities.
- An appreciation for the importance of continuing education for yourself and your staff.
At Mullahy & Associates, my partner, Vice President Jeanne Boling, RN, MSN, CRRN, CDMS, CCM, and I know what it takes to have a successful case management practice. In our current career stage, we are dedicated to helping case managers of all races and denominations succeed. We’ve developed continuing education workshops and seminars, as well as a suite of long distance and online learning tools to help case managers in their own firms or other practice settings. With the right education, training, and skills, we believe minority nurses can not only realize the professional fulfillment one achieves in their own business, but also will be helping to fill the growing need for high quality case management services.
A study conducted by the Commission for Case Manager Certification (CCMC) cites increasing demand for certified case managers. The CCMC’s 2014 Role and Function Study also found that employers are willing to pay higher salaries for professionals whose education, training, and certification demonstrates a higher level of knowledge, skills, and overall competency. Further, the study revealed that 40.2% of employers are now requiring their case managers to be certified. Contrast this figure to the 25.9% of employers requiring certification in 2004. The CCMC’s conclusion regarding a growing demand for well-trained and credentialed case managers is supported anecdotally by the actions of many health care organizations.
Clearly, case management presents a strong career path for nurses and even greater opportunities today. The opportunities can be even greater for minority nurses, including African Americans, Asians, Hispanics, Filipinos, and Native American and Alaskan nurses, for which there is already a concerted effort to recruit so that they can bring their cultural competencies to our nation’s increasingly diverse patient population. However, continuing education and training are musts for any nurse who truly wants to make a difference in his or her patients’ lives while also realizing his or her full professional potential and earning power. The education starts by understanding how the market is driving increasing demand for case managers and, the educational resources available to help them become key catalysts for the delivery of better health care in America.
Not Just a Personal Choice–Employers Demanding Higher Skills
While the Patient Protection and Affordable Care Act of 2010 (ACA) raised the bar on expected standards of care and paved the way for increased demand for case managers, market conditions were already driving the need up. The graying of America, coinciding with the increased incidence of chronically ill patients of various ages succumbing to diseases of the 20th and now 21st century (e.g., obesity, high blood pressure, and chronic pulmonary obstruction disease) all have placed greater demands on health care providers. This, in turn, prompted many to increase their hiring of case managers—also being called care coordinators, patient advocates, and a host of other titles. For example, back in 2012, the UCLA Health system in Los Angeles began hiring full-time care coordinators to work with doctors serving in its primary care clinics. By 2015, UCLA had 24 “Comprehensive Care Coordinators” serving in its ambulatory primary care clinics.
Other health care organizations across the country, including hospitals, accountable care organizations, managed care firms, and insurers were and are actively increasing their case management staff. Some examples are: Advocate Health Care, Bon Secours Health System, Banner Health, Mercy Health Select, Partners Healthcare and the University of Michigan Health System. Based on the CCMC’s figures, by 2015 there were 37,000 certified case managers serving in U.S. health care organizations versus 20,000 in 2010. An estimated 89% of the certified case managers are registered nurses. The balance is comprised of social workers (4.4%), vocational rehabilitation counselors (2.3%), and others.
Despite the growing demand for case managers, the profession is not without its challenges. Of the over 100,000 professionals involved in case management, their average age is estimated by various surveys to be 53 years old. The transfer of knowledge from these experienced professionals to their younger counterparts is essential as demand rises and many of the field’s most skilled are entering the retirement years. Through continuing education, training, and mentoring of newer case managers by experienced case managers, some of the deficits in skills and knowledge can be addressed.
The federal government is acutely aware of the importance of training for RN case managers. In fact, the government has established a fund of $20 million for training, specifically in the areas of data collection, reporting, and practice changes to help smaller health care practices improve. Many minority nurse case managers serve in smaller health care practices, in addition to large urban hospitals, so they may very well be beneficiaries of this federally-funded training. Employers too are hosting more educational and training programs for their case management staff and encouraging their personnel to participate in continuing education programs, not just for licensing compliance purposes, but for their own skill development and career advancement.
Based on current PayScale data, Certified Case Managers with the title of Nurse Case Manager are averaging annual salaries of between $60,514 to $89,132, depending on the employer and region of the country. Directors of Case Management are commanding average annual salaries within the range of $75,978 to $145,177, and those with the title of Registered Nurse, Utilization Management, are averaging annual $61,545 to $98,197.
Most RN case managers can aspire to become leaders in their departments, assuming they have earned their CCM designation and are committed to being continuous learners. Knowing the options in continuing education case management training programs and resources available and how to select wisely is tantamount to building best practices in case management and assuming leadership roles.
Continuing Education and Training Resources
StateCE, a part of Vista College, reported that nearly 76 million adults in the U.S. are enrolled in some form of continuing education. Many human capital development experts believe that training from outside continuing education providers offers a distinct advantage over in-house training programs. It is their contention that this education helps individuals gain a deeper level of knowledge—both theoretical and practical, as well as enhancing their problem-solving and collaboration skills. In addition to gaining higher-skilled employees, employers gain the added benefit of continuing education promoting staff retention. A study by Spherion Atlantic Enterprises reported that 61% of employees who receive continuing education remain with their current employers for at least five years.
Continuing education (CE) resources include independent organizations, colleges/universities, professional organizations, and internal training departments. Their offerings range from onsite CE-credit seminars and certification workshops, webinars, and various long distance e-learning programs. The best continuing education programs and resources for case management have certain traits in common. They are:
- Developed and provided by credentialed professionals with both clinical and business experience;
- Goal-oriented, whether the goals, for example, be: certification, gaining best practice skills, gaining knowledge about a specific medical condition and/or patient population, learning how to manage a case management department, or learning what it takes to start your own case management firm; and
- Have specific learning objectives clearly conveyed regardless of whether the program or educational resource involves an instructor or self-learning.
Along with meeting these criteria, there are other specifics which seem to be important in the effectiveness of a continuing education program. For instance, data uncovered in 19 studies and discussed in a Nurse Education Today article titled “Review of continuing professional education in case management for nurses” found that the “most appropriate program length appears to be at least 16 hours.” Further, the findings were that a combination of interactive lectures and small group discussions were associated with the most positive learning outcomes. What we know is that each type of continuing education program or resource has a valuable role to play.
Different Benefits of Different Educational Formats
Following are some examples of different continuing educational offerings, their various formats, and the benefits they deliver:
Onsite Seminars. These seminars are presented by qualified instructors with both clinical and business experience and are ideal for engaging case managers, giving them a direct line to an experienced professional whose insights into processes and nuances are without a doubt vital to professional growth and advancement. These events also give case managers an opportunity to share their experiences with and learn from their peers. On that level, they help to boost morale, build professional camaraderie, and instill a sense of professional pride.
CCM Certification Workshop. This workshop has a specific purpose in helping a case manager prepare for their certification exam. These workshops, especially those backed by the CCMC, deliver education and up-to-date information about best practices in today’s case management, while also imparting need-to-know information regarding the eligibility requirements and application process for the gold-standard case management credential—the CCM®—and how to prepare for the exam.
Setting-Specific Educational Programs. Setting-specific programs, such as a Hospital Case Management Seminar, are customized for a specific hospital’s needs and designed to help a hospital case management staff achieve improvement across key quality metrics, as well as overall health care efficiency and cost-effectiveness. Because the program is hospital-specific, it also has the residual benefit of instilling in each participant a renewed passion for their role and commitment to their organization.
Agency-Specific Educational Programs. These programs are for case managers serving with the Veterans Administration system or Indian Health Services organizations; both of which encounter very unique challenges both from a patient and administrative perspective and thus require continuing education that recognizes and helps case managers function at their best within the constraints of these settings.
Patient Population, Medical Condition, or Challenge-Specific Educational Programs. These programs, such as those tackling pediatric case management, obesity, our nation’s multiculturalism, the aging population, or health literacy problems, delve deeply into a specific topic to give case managers a broader, more comprehensive understanding of a medical condition or challenge they are likely to be handling already.
Seminars on DVD. These offer the best of both worlds. Case managers can gain access to a great seminar, perhaps being conducted in a city too far from their location, by simply purchasing the seminar on DVD. This gives the case manager a virtual seminar experience right from the convenience of their own home or office. It also enables case management department supervisors to have a “refresher course” right at their fingertips for easy access to continuous learning, and to provide to new staff members. Many of the profession’s best seminars on DVD come with handouts, video clips, and some even offer a phone consultation with the program instructor.
Seminar e-Workbooks. These are also ideal for case managers who can’t attend a seminar but recognize the importance of their learning the information presented at the seminar. Often, these e-Workbooks are provided on convenient flash drives and include PowerPoint presentations, case studies, and other resource materials.
Textbooks and Related Home Study Programs. These are perhaps the perennial continuing education resource for case managers. Every case manager’s personal library and every health care organization’s training room should be equipped with the profession’s best textbooks. Today, some of the most prolific authors, whose textbooks are used by nursing schools worldwide, also offer companion home study programs to their books and associated continuing education tests approved for CE credits. For instance, The Case Manager’s Handbook Home Study Program offers a continuing education test, which has been approved for 80 CE Credits. It can be taken online to prepare for the CCM exam or to help case managers meet their CE credit requirements.
Learning Management Systems. These are another option for personal learning growth and career advancement. They are typically module-based to make for easy, convenient learning and are organized in a sequence that promotes the best building of knowledge and acquisition of skills.
Continuing education should not be viewed by case managers as a necessary evil for maintaining their professional license, but rather as a valuable tool worthy of their investment. Continuing education is essential for building knowledge and skills, helping case managers become better patient advocates and better employees able to support their employer’s quality of care, risk management, and fiscal objectives. Moreover, through continuing education accessed through a multitude of options, case managers can take control of their own careers and position themselves for optimum advancement opportunities, salary gains, and potential leadership roles. It is incumbent upon minority nurse case managers to recognize that the investment they make in their continuing education and continuous learning is a clear path to gain a greater voice in our nation’s health care system. Through continuing education and the greater opportunities, it affords, they are in a better position to raise awareness of the value of high-quality case management, and in turn, make a greater difference in the lives of all patients across all communities.
Shifting demographics and other market conditions have created a greater need for minority nurses, particularly in certain roles. With a growing multicultural and aging population in the United States, the need for medical case managers to serve patients of various ethnic and minority groups has significantly increased. Regulatory reform—specifically, the enactment of the Patient Protection and Affordable Care Act, which ushered in new preventable readmission requirements for hospitals, along with new models of care (e.g., patient-centered medical homes and physician-hospital organizations) and more prevalent consumer-driven health care plans—has created new opportunities for minority nurses in case management. For minority nurses whose goals are to help serve these largely underserved patient populations and advance in their careers, it is important to understand the changing health care landscape.
Let’s look first at our nation’s changing demographics. The graying of America has resulted in more Americans living longer with more age-related, chronic medical conditions, ranging from arthritis, hypertension, and heart disease to hearing impairments and cataracts. According to the National Academy on an Aging Society (NAAS), almost 100 million Americans have chronic conditions, with millions more developing chronic conditions as they age. By 2040, the NAAS estimates that the number of people in the United States with chronic conditions will increase by 50%. The cost of medical care for Americans with chronic conditions could approach $864 billion in 2040—almost double what it was in 1995. While the most common chronic conditions are the same for blacks and whites, the conditions are generally more serious among minority populations, particularly individuals with lower incomes.
Another major factor in our changing health care landscape is the higher percentage of racially and ethnically diverse individuals. An AARP Bulletin article titled “Where We Stand: New Realities in Aging” reported that minorities are expected to comprise 42% of the American population by 2030. Currently, the United States has 150 different ethnic cultures represented within its population, with over 300 different languages spoken and a wide range of cultural nuances reflected. For health care providers, this broad spectrum of cultural diversity in its patients introduces higher incidences of certain conditions, while also posing challenges relating to care and communications.
Addressing Cultural Challenges
On the disease front, we know that certain ethnic groups are more prone to certain medical conditions. Many health care providers and insurers are responding with targeted initiatives, such as: the Chinese Community Health Plan’s Diabetes Self Management: A Cultural Approach initiative to enhance diabetes knowledge and management in the Chinese population; Excellus Health Plan’s Healthy Beginnings Prenatal Care program to decrease NICU admission rates for African American teens; and Med One Medical Group’s Adherence to Hypertension Treatment and Measurement project to educate English, Arabic, and Vietnamese-speaking hypertensive patients.
Beyond the obvious language and communication barriers that can prevent quality health care delivery and optimum patient outcomes, there are cultural issues that, if mismanaged, can also interfere with providing quality health care. For example, in Latin culture, religious healing, praying to certain saints, and relying on religious symbols to address health issues are not uncommon. Patients of African descent are inclined to believe in the healing power of nature and their religion. Within Asian groups, achieving balance between yin and yang, using certain herbs and foods, and relying on acupuncture to unblock the free flow of energy (chi) are common practices. Health behaviors also vary among ethnic groups. Armenians are tolerant of county health facilities, whereas the Vietnamese regard them and the related bureaucracy associated with government facilities as degrading. They, therefore, prefer receiving care in a physicians’ office, even if higher costs are incurred.
There also are differences relating to how certain minority and ethnic groups want to hear about their medical conditions. Did you know that the majority of African Americans and European Americans believe patients should be informed of terminal illnesses, while fewer Mexican Americans and Korean Americans agree? Family values relating to health care decisions also differ among minority and ethnic groups. Within the Mexican, Filipino, Chinese, and Iranian cultures, for example, there is the belief that a patient’s family should be first informed about a loved one’s poor prognosis so they can decide whether or not the patient should be informed. Obviously, these variables and many others are important for health care professionals to understand when caring for a patient. This is an area where minority nurses of different backgrounds and cultures can be a tremendous asset to their patients and to the overall health care system. Studies have demonstrated that case managers help strengthen primary care. This is particularly true when patients have complex or multiple medical conditions—as many elderly people do—or chronic conditions such as diabetes or chronic obstructive pulmonary disease.
Combating Disparities in Health Care
It is widely known that disparities exist in the care of minority patients. While this is more pronounced in rural primary care practices, it holds true across the board. An Institute of Medicine report found that “racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as insurance status and income, are controlled.” Other studies also have explored these disparities, including Aetna’s “Breast Health Ethnic Disparity Initiative and Research Study” and Health Alliance Plan’s “Addressing Disparities in Breast Cancer Screening.” Collectively, they further make the case for minority nurse case managers to advocate for minority patients.
Related research supports the fact that, where minority case managers are in place, there is a significant improvement in patient outcomes. This was evident in a study of rural African American patients with diabetes mellitus where it was found that they were able to better control their blood sugar levels with a redesigned care management model, which incorporated nurse-led case management and structured education visits into rural primary care practices.
From Public Sector to Hospitals, Physicians’ Offices, and Entrepreneurial Settings
There is no question that, given today’s health care landscape, minority nurses have a great opportunity to help make a difference in the care of minority groups and enjoy heightened career fulfillment and potential advancement. Among the settings minority nurses can consider are:
• The public sector—serving within the Veterans Health Administration system for our veterans, many of whom are minorities, or the Indian Health System for our nation’s native American populations;
• Hospitals—helping hospitals achieve lower rates of preventable hospital readmissions, caring for minority and ethnic patients, and serving as a patient advocate and liaison with family members;
• Physicians’ offices—facilitating patient-physician communications, assuring appropriate records are communicated between treating physicians, monitoring patients’ adherence to treatment plans, and identifying any family and/or home issues that might affect a patient’s well-being;
• Financial advisors and estate planning attorneys—working with these professionals who are becoming increasingly more involved in the financial aspects of their clients’ health care and the costs associated with their care, as well as protecting their clients’ estates;
• Independent practice—working for a case management firm or establishing your own practice.
Independent practices present an opportunity for minority nurses to shape their own destiny and financial reward. Through one’s own practice, a minority nurse can focus more fully on his or her patients’ well-being without the over-emphasis on cost containment we see in many other practice settings, especially hospitals. These nurses can decide that they want to specifically dedicate their practice to a certain minority and/or ethnic group. They can establish a truly patient-centered care management business model, performing health risk assessments, providing health coaching, disease education and management, assisting with patient transitions of care, coordinating health care resources on behalf of their patients, reviewing hospital bills, helping patients assemble their health records, and providing end-of-life care coordination.
Based on a 2013 survey by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, nurses from minority backgrounds represent 17% of the registered nurse (RN) workforce. Currently, the RN population consists of 83% white/Caucasian, 6% African American, 6% Asian, 3% Hispanic/Latino, 1% American Indian/Alaska Native, 1% Native Hawaiian/Pacific Islander, and 1% other. Given the increasing shortage of nurses, combined with the growing demand based on our shifting demographics, it appears that the time has never been better for minority nurses, while fewer in number, to take center stage in case management.
Catherine M. Mullahy, RN, BS, CRRN, CCM, is president of Mullahy & Associates www.mullahyassociates.com, and author of The Case Manager’s Handbook, Fifth Edition.