Disruptive Innovation: A Challenge to Physician Advisors and Case ManagersColleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM, RN, FCM I am honored to have taken on the reins as the National President of the Case Management Society of America in June of 2022. The theme for my CMSA presidency is ‘disruptive innovation.’ This term is usually defined in use of technology that “creates a new market by applying a different set of values which ultimately and unexpectedly overtakes an existing market” (Sensemeir, 2012, p. 13). I will presume to extend the premise of ‘disruptive innovation’ beyond technology, but rather looking at issues with an eye to creating simpler, perhaps more radical ways to use existing resources or developing new resources in response to the new perspective on the issue. Simply put, I believe and advocate that it is our right and responsibility to disrupt processes when they are not working and propose new and innovative solutions to the issues we identify. Change is not comfortable. It makes us stretch, it challenges us and makes demands. We seek comfort in the “ways things have always been,” but how is anything, especially healthcare, supposed to grow if we stay in what is comfortable? Physician Advisors are in a key role to foster an environment of disruptive innovation. Just as case managers, regardless of discipline, have been the experts in patient centered care and the social determinants of health long before they became fashionable and buzzwords; physician advisors have long had an enhanced insight into the gaps within continuum of care. “The physician advisor role initially grew out of a staffing need—a role with clinical knowledge that also understands government and commercial payer regulations in order to assist with administrative functions, such as conducting peer-to-peer reviews for medical necessity denials, reviewing inpatient versus observation status, and more. Over time, healthcare leaders have leveraged this role to relay crucial nonclinical information to the provider community and also to drive targeted education efforts” (ACPA, 2021). As the experts in care management, it is our joint responsibility to identify these gaps, provide the disruption and take a leadership role in the in the development of the innovative solutions to these care gaps. Evolving the partnership between case managers and physician advisors to include disruptive innovation opportunities is the natural “next step” Examples of this “disruptive innovation” are demonstrated in the CMSA Standards of Practice and publication of Case Management Adherence Guidelines (CMAG). CMSA was the 1st case management professional organization to publish Standards of Practice, the very backbone of the case management profession. The 2022 updates were unveiled at the CMSA National Conference to include a new standard for Health Information Technology. This standard addresses not only HIPAA but also the need to assess our patients for the ability to use technology to manage their healthcare journey. The CMAG for C.Difficile, in collaboration with CMSA partner, Ferring Pharmaceutical, also premiered at the Conference. The presentation gave me new insight to new ways of thinking about the role of case management with this patient population. From a personal perspective, I have partnered with Physician Advisors on disruptive innovation process improvement projects, including the 2020 CMSA Foundation CMPI Award winning project to address health literacy and health confidence to reduce readmissions. The sky is the limit on how Physician Advisors and Case Managers can work together to create these opportunities for innovation! American College of Physician Advisors (ACPA). (2021). Physician advisors: bridging the gap between revenue cycle and clinical care. May 2021. https://www.acpadvisors.org/docs.ashx?id=830509 Sensmeier, J. E. (2012). Disruptive innovation and the changing face of healthcare. Nursing Management (Springhouse), 43(11), 13–14. https://doi.org/10.1097/01.numa.0000421681.71712.86 Dr Morley is Associate Chief Clinical Operations Officer-Continuum of Care at UI Health and president of the CMSA national Board of Directors |