Supporting Patient-Centered Care with Interprofessional Collaboration: The Case Manager and Physician Relationship

Rebecca Perez, MSN RN CCM

Healthcare delivery and reimbursement have evolved, moving from fee-for-service models to those based on quality and value. Most providers and clinicians have been trained to focus on diagnosing and treating illnesses, injuries, and diseases but now must transition to caring for the whole person- the individual with a unique story and situation. To care for the whole person, comprehensive, multifaceted, seamless care may be delivered by health care professionals from differing disciplines. These professionals include physicians, nurses, social workers, therapists, dieticians, and community resource providers, all creating a culture of interprofessional collaboration. 
While this may seem like a simple concept to implement, many professionals are baffled about how to begin. Professional collaboration requires providers and clinicians first to recognize and understand the role, function, and responsibilities of and demonstrate respect for their colleagues. Traditionally, the hierarchy of medical professionals had physicians situated at the top of the pyramid, with other disciplines descending from that dominant position. Those uppermost in the hierarchy may or may not have been open to collaborating with other professionals beyond giving or writing orders. 
The current shortage of health care professionals, a focus on improving health equity, new requirements and expectations related to quality measures, patient-reported outcomes, reimbursement models are more or less dictating the need for professionals to put aside old practices and embrace a new culture of collaboration (Folkman, 2019). A culture change must be supported to develop and deploy education related to interprofessional relationships and cooperation. According to Zechariah et al., to be successful, qualified, and competent, health care professionals must develop collaborative working environments before delivering high-quality care (Zechariah, 2019). Zechariah also shares that nurses, social workers, and other professional are usually better prepared for interprofessional collaboration than are physicians (Zechariah, 2019). Interprofessional education (IPE) fosters that collaborative spirit, nurtures the team approach, resulting in improved quality of care and decreasing hospital length of stay. (Zechariah, 2019). Working with teams is seen in nursing and social work curricula. 
Medical schools in the U.S. have not routinely included IPE in their curricula, but medical schools outside of the U.S. often do. The majority of medical students offered IPE with other disciplines reported positive experiences (Zechariah, 2019). IPE primarily focuses on communication as an essential competency. If included in medical school and other allied health programs would ensure medical professionals entering the workforce are well-equipped and prepared to function as part of a collaborative team. 
Cooperation and collaboration among health care professionals have been shown to improve the quality of services delivered, improve patient outcomes, and increase job satisfaction among the various professionals (Eman, 2021). The following are practices that support interprofessional collaboration (Brennan, 2018): 
  1. Put patients first by asking, "what is best for this patient?" The question and subsequent answer unite and align the team members. All organizations should have a mission and vision dedicated to patient-centered care. 
  2. Demonstrate leadership commitment to interprofessional collaboration by establishing partnerships between and among all team members and include Chief Medical Officers and Chief Nursing Officers. 
  3. Create a level playing field by removing obstacles and siloes among and between professions. 
  4. Cultivate effective communication channels with and among team members by establishing standards, policies, and protocols that all understand and follow. 
  5. Hardwire practices using organizational structure to prevent the preference for autonomy. A culture of interprofessional collaboration only exists when leadership supports the team's ability to work together. 
  6. Train the different disciplines together by incorporating proven methods of team building. 
Case managers are found in nearly every healthcare setting and often are the team member chosen to lead an interprofessional team. In most cases, the professional case manager is the primary care coordinator and is well-equipped to function and collaborate with all team members and stakeholders. Care plan development and execution are primary case management functions developed with the patient as the primary focus. Interprofessional collaboration allows for robust care plan development with input from patients and team members. The result is a document that is then shared with everyone involved in the patient's care. Case managers have long been unrecognized for their ‘behind the scenes’ work. The ability to coordinate care from multiple providers and settings, make sure it is delivered as ordered, find resources no one else has found, and then communicate the results is not something every professional can handle. But because they are used to working with so many different pieces and parts, case managers can bring it all together, incorporating everything the team has identified as important to the patient or important to their health and recovery. 
The case manager – physician relationship is one that can significantly impact care plan development, implementation, and adherence. The case manager has a relationship with the patient and support system that differs from that of a treating provider. The case manager brings the patient perspective to the physician which enhances what and how care is delivered. Case managers and physician advisors similarly collaborate to determine the best way to impact care and outcomes by sharing of their perspectives. This collaboration benefits the patient and improves the satisfaction of both the physician and case manager. 
Case managers often lead these initiatives, but regardless of who leads a team, each plays an important role and deserves the respect of the others. Physicians often lead but perhaps may co-lead with another team member. Regardless of team leadership, the patient must remain central to all of the team's activities and include family, support system, and any other stakeholder (e.g., employer, school). Together, goals are developed, reasonable initiatives are implemented, and success is measured as the patient moves through the continuum of care. If the patient's interprofessional team is functioning as anticipated, the patient will experience success, maximized outcomes, and team member's job satisfaction. 
Rebecca Perez, MSN RN CCM is Sr. Manager of Education and Strategic Partnerships for Case Management Society of America/Parthenon Management Group.