Tag: Quintuple aim

ERCI’s 2025 Top 10 Patient Safety Issues and Heeding Case Management’s Professional Obligations

ERCI’s 2025 safety issues represent a clear and present danger for patients with opportunities for all healthcare professionals. Yet, these quality missteps also yield concern for how case managers understand their professional obligations to the practice principles that underlie our licensure, certification, and organizational accreditation. 

I am a quality warrior! This fact means that my brain goes into overdrive when certain reports cross my radar.  The latest intel to have this impact was ERCI’s 2025 list of Patient Safety Threats. My focus immediately focused on the #1 issue, “Dismissal of the Patient and Caregiver Voice”. As a social worker by education and licensure and board-certified professional case manager, I am responsible for mitigating this quality gap. I also happen to be a fierce industry disruptor courtesy of my Doctorate in Behavioral Health. My DBH colleagues and students will get this one,  but I digress. 

I am an enduring ethical, legal, and regulatory champion to my core. I have been digging deep into the research, writing about, and presenting on medical gaslighting and invalidation for the past year. The dismissal and devaluing of any patient and caregiver voice is clearly associated with this obstructor to care. Medical gaslighting’s connection to increased costs of care is significant with billions of dollars lost from delayed and missed diagnoses. Increased healthcare utilization has come from unnecessary hospitalizations, readmissions, treatment missteps, yielding poor health outcomes. Mortality rates are equally higher when a patient’s voice or that of their caregiver is ignored.

Yet, two other areas of concern stood out to me as I reviewed the list of other patient safety priorities on the ERCI list:

  • #5. Caring for Veterans in non-military health settings
  • #9. Inadequate coordination during patient discharge

These two issues speak loudly to all of my colleagues, but particularly those in my professional case management world.

Professional Obligations Matter

Colleagues frequently ask me, why I get so hot about our established resources of guidance (e.g., accreditation and credentialing requirements, standards of practice, codes of ethics) ”. Yes, the hashtag or #EthicsMatter has become my hallmark. However, the list of 2025 safety issues represent a clear and present danger for patients. Quality missteps and patient safety concerns mean case managers are not heeding their professional obligations to the practice principles that underlie our licensure, certification, and organizational accreditation. This action represents potential professional sanctions for breach of the very requirements that bolster our case management profession. 

Standards of Practice

Those professionals who walk in the world of case management are accountable to assorted standards of practice and codes of professional conduct. The Case Management Society of America (CMSA) set the tone for these seminal documents, crafting the initial version in 1995. Updating of each version of the standards occurs through a formal vetting process that was completed in 2002, 2010, 2016, and 2022. The addition of Standard Q: DEIB and Health Equity yielded a revised version of the document in 2024. 

The intent of the standards are simple: to “serve as a compass for all who practice case management. They stand as a blueprint for excellence in practice”. They are not meant to be prescriptive in intent. Instead, they serve as a guide for professional case managers and their organizations to define optimal practices for the industry that meet ethical, legal, and regulatory guidelines and requirements. The relevant standards of practice by CMSA that address these patient safety realities include: 

D. Ethics

E. Advocacy

G. Resource management

I. Client selection

J. Client assessment

K. Identification of care needs and opportunities

L. Planning

M. Facilitation, coordination, and collaboration

N. Monitoring

O. Outcomes

P. Closure of professional case management services

Q. DEIB and health equity

Each standard details clear guidance for the workforce in each of these critical areas of case management practice. 

Licensure and Certification Requirements

Case managers have a primary responsibility to the licensure and scope of practice that underlies their professional discipline, whether in counseling, medicine, nursing, occupational, physical, respiratory or vocational therapy, social work or other qualified disciplines to practice (CMSA Standard A. Qualifications).  Yet, we are then responsible to our case management credentialing, which is often dependent on this primary licensure. 

Our credentialing entities prioritize the importance of critical competencies for their certificants through dedicated resources. The Code of Professional Conduct for Case Managers authored by The Commission for Case Manager Certification (CCMC) details keenly defined ethical standards, rules, procedures, and penalties for the workforce. The document’s Preamble sets a critical tone by defining case management as “a professional, collaborative, and interdisciplinary practice guided by the Code of Professional Conduct (the Code)”. The resource goes on to further denote the main purpose of the code; “to protect the public”. While the guidelines provided are advisory in nature, they still set a professional standard to which all board-certified case managers are held accountable.

The American Case Management Association (ACMA)’s Scope of Services and Standards of Practice also define clear competencies for practice. This resource also aligns with the association’s Accredited Case Managers Credentialing Exams, which have oversight by the National Board for Case Management:

Relevant Scope of Services, including but not limited to::

  • Assessment
  • Care coordination
  • Facilitation
  • Transition management  competencies 
  • Longitudinal care management
  • Identification
  • Implementation

Relevant Standards of Practice, including but not limited to:

  • Accountability
  • Advocacy
  • Resource management

Organizational Case Management Accreditation

Attention is also paid to these critical domains of practice by each of the entities that are tasked with providing, regulating, and monitoring of organizational case management accreditation. These include NCQA, URAC, and ANCC’s Magnet Recognition Program. The agencies define strict compliance requirements and standards for case management practice, as well as for the entities by which they recognize certification through. 

The workforce should remain aware of the following: 

Note: As of January 1, 2024, Magnet Status Recognition only accepts certifications accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC) or the National Commission Certifying Agencies (NCCA). Included are  ANCC’s Nursing Case Management board certification (CMGT-BC) and the Commission for Case Management Certification’s Board-Certified Case Management Credential (CCM).

The Bottom Line

Case managers have a critical role in ensuring compliance with the ethical, legal, and regulatory  standards and requirements that underlie our practice. Each one of the established resources of guidance for case management prioritize our professional obligations to advocate for, monitor, and ensure patient safety; public protection remain a priority. They also heed every case manager’s accountability to the industry’s Quality North Star of the Quintuple Aim: patient- and family-centric care rendered at the right time, for the right cost, by professionals who embrace the work, and delivered in a way that is equitable and accessible for all.

ERCI’s Top 10 Patient Safety List for 2025 should be a call to action by every healthcare organization with attention from every case management leader and their teams. How will you and your organization step up to mitigate these gaps in quality and care? 

Working Around the Words to Ensure Health Equity

Considerable time, effort, and energy is being spent on reframing word use in response to Federal mandates and their ripple-effect across the industry. Shifting words should not negate our professional commitments and obligations to the patients, their families, and the workforce. Our actions must continue to advance the Quintuple Aim and what matters most.

Much has been written lately about reframing word use in response to the latest generation of Executive Orders (EO) and other actions by the Federal Government. Yet, what happens when most of the words at issue are aligned with population health funding priorities as in accessibility, health equity, inclusion, or vulnerable populations? What happens when the words are commonly used in daily language, like advocate, expression, gender, or status? What happens when the words inform competencies for public health professions, as in cultural competence, implicit bias(es), oppression, or social justice? What happens when the words speak to evidence-based interventions that support populations across healthcare settings, such as anti-racism, cultural responsiveness, feminist, social justice, and trauma-informed? What happens when the words align with ethical codes of conduct and standards of practice for healthcare professionals whether discrimination, person-centered care, underserved, and vulnerable? What happens when shifting the words eliminates populations, persons, and their identities as in gender affirming, LGBTQIA, pronouns, Trans, or other terms. What happens when the list is ever-expanding and unpredictable? It is an understatement to say resolution is complicated. 

How many ways are there to say, equitable, accessible, and quality-driven whole person healthcare? It presents there are many ways. Of course, the mantra remains that the more things we call these drivers and influencers of poor health outcomes and the persons who experience these factors the most, the less people will know what they are. These words have specific meanings; using so many different terms can invoke unintended misunderstandings. While the explicit intent of this new macro-focus is “to help Americans lead healthier lives” there is a clear and present worry that all populations may not be included in this mix. 

Managing The Latest Information Flow

The constant attack on words is exhausting and frustrating to already weary professionals, practitioners, and providers, but most definitely patients and populations. This is an equally troublesome effort to those in higher education preparing future generations of the workforce. 

The latest funding and programming shifts have left many reeling, including the March 2025 announcement to cease funding on four critical value-based care models: Primary Care First, End Stage Renal Disease Treatment Choices, the Maryland Total Cost of Care, and highly-anticipated Making Care Primary model. These shifts will impact millions of Medicaid and Chips recipients, plus Medicare beneficiaries with complex, costly chronic illnesses and the primary care practices that care for them.

This week saw Joint Commission reframe their highly coveted Health Equity Resource Center to reflect new verbiage of, The Optimal Delivery of Care for All; yes, the familiar language of “page not found” now appears when you one goes to the original website. History of Joint Commission’s focus in the health equity space is provided with emphasis on the entity’s ability to provide individual consultations to meet the new industry framing. In addition. CMS’s Health Equity Framework has been reframed as CMS’s Framework for Healthy Communities. The five pillars have also been reframed. In edition, their Health Equity Index used for Medicare Advantage Star Ratings has been rebranded as…..wait for it….The Excellent Health Outcomes for All Reward ((EHO4all). There is concern that the coveted 1115 Waivers might be next on the chopping block; time will tell.

Valuable time is being spent daily by colleagues to review, consider, and revamp programming to stop the ongoing rise of National Health Expenditures, expected to hit $5.3 Trillion. Much of my current bandwidth is spent staying current on policy and EO interpretations, but also supporting colleagues through job losses, or their fear of potential job losses. My students are coping with a constant flurry of issues from disappearing funding for their education and work-study programs to general concerns for their chosen career trajectory. 

Here’s the Real Deal

Changing the terminology will not eliminate the wrath of health disparities and inequities experienced by historically minoritized and marginalized populations. Shifting words alone will do little to improve the poor clinical outcomes experienced by some populations more than others. Adjusting how populations are addressed will not decrease healthcare utilization or improve fiscal outcomes. Eliminating some populations from the conversation or funding will not dismiss the persons from those communities who experience worse illness morbidity and increased mortality rates. Reframing new initiatives will not identify the drivers of systemic racism, political determinants of health, and other social influencers of poor health for populations. In fact, each of these actions will further deteriorate the outputs of our current healthcare system. The US will continue its downward spiral of having the highest healthcare utilization and costs, along with the worse outcomes compared to other developed nations.

While we reconcile our fury about having to change longstanding terminology, the work to address the true priority at hand must continue. We must work to implement actionable strategies that heed our ethical obligations as healthcare professionals and providers. We must continue to advocate for ALL patients and their families so they receive access to the highest quality care available. That care must also be delivered to all in a fair and equitable way. 

Strategies to Advance the Health Equity Equation

Emphasis needs to focus on defining, measuring, and incentivizing progress to improve access to quality care. A recent article in Health Affairs Scholar, posed clear direction with examples for each element provided. I encourage all to take a deeper dive into the piece to integrated these steps within your organization or practice:

  1. Define clear measures of equitable access and tracking progress at both organizational and national levels.
  2. Develop and implement equity-focused quality measures and aligned incentives to support progress and create accountability for addressing barriers in access to care (e.g., quality metrics, outcomes data).
  3. Health care leaders should undertake efforts to measure the availability and quality of health care services for people who experience inequitable access to health care and track progress towards addressing barriers to access (e.g. dashboard).
  4. Build and leverage cross-sector partnerships that allow collaboration on investing to address shared patient and community needs.

My daily dialogues with valued colleagues are a reminder to continue prioritizing ourselves and our energy. This will fuel our focus on the critical work at hand. Here are a few of my own strategies to push through this muck!

  • Stay informed through your valued sources of intel but limit the amount of time spent viewing the information each day. While old habits have me check CMS Newsroom Posts weekly, there are other personal favorites: The Commonwealth Fund, Peterson/KFF System Tracker, Epstein Becker Green, and others.
  • Explore what actionable strategies are up your sleeve
  • Don’t silo your efforts: continue to discuss and strategize with colleagues who share your passion. Those relationships and conversations will continue to nurture and motivate your efforts.
  • Try not to get lost in the alphabet soup of verbiage! Yes, it is toxic and traumatizing and will get the best of us if we let it! Instead, focus on actions to advance past the toxic energy around us. This may mean using alternative words or language, as posed in the list provided in the Federal Grant Trigger Words Replacement Workbook (yes, many alternatives were provided by ChatGPT).
  • Stay up to date; the 4/3/25 document published by the EEOC and DOJ, What You Should Know About the Recent DEI-Related Discrimination at Work is a must read. 

In the end, it is our actions that matter most to achieving the industry’s quality north star of the Quintuple Aim: patient- and family-centric care delivered at the right time, for the right cost, delivered by those who embrace the work, and assuring equitable access for all. Shifting words should not negate professional commitments and obligations to our patients, their families, and the workforce.

The DEI Crackdown in Academia Will Further Harm Patients and the Quality of Their Care: No “Could” About it!

There is no “could” about it; the current DEI crackdown in academia will yield negative outcomes for the workforce, but also worsen the quality of care rendered to patients, their families, and the communities we serve. 

A recent article published by MedPage Today and KFF Health News sent my brain into orbit. Entitled, Amid Falling Diversity at Med Schools, a Warning of DEI Crackdown’s Chilling Effect, the sub-title noted, “Education and health experts say this could ultimately harm patient care”. Use of “Could” in light of overwhelming evidence infuriates me. There is no “could” about it; the current DEI crackdown in academia will yield negative outcomes for the workforce, but also worsen the quality of care rendered to patients, their families, and the communities we serve.

The Value of Concordant Care

Concordant care involves aligning treatment with patient values and preferences. It is demonstrated in many ways, from open communication to having providers of the same race, ethnicity, sexual orientation, as well as gender identity, or gender expression. As a result, patients and their families feel psychological safety within a practice setting. Empathy is a vital competency for every healthcare professional that should be demonstrated toward every patient. But the ability to do so does not always assure concordant care. This is especially true when practitioners are employed by larger healthcare systems and organizations.

A patient’s need for health and behavioral health treatment brings them to practitioners for care. Yet, it is a patient’s trust in these practitioners that fosters their engagement in the care process. In addition, a patient’s comfort with providers of the same ethnicity, gender, race, or life experiences promotes their ability to feel safe, seen, heard, valued, and respected in the treatment space. In tandem, the practitioner’s knowledge of a patient’s culture, values, and beliefs inform their awareness of patient health literacy opportunities. This might translate to addressing spiritual and cultural differences in care, such as the need for prescription medications or treatments for chronic illness or even behavioral health. 

Discordant care contributes to medical gaslighting and invalidation. Dismissal of the patient and caregiver voice is the top patient safety issue for 2025, and a frightening fact. Increased numbers of Black primary care physicians are associated with longer life expectancy and lower mortality rates among Blacks. Similarly, when providers can identify with their patients, there are higher degrees of patient engagement, patient satisfaction, and treatment adherence for women, members of the LGBTQIA+ community, and other traditionally marginalized groups.

Healthcare utilization is higher and care costlier for these populations due to a trail of ignored complaints and symptoms and missed diagnoses. Their mortality rates are upwards of double that of numbers for less marginalized groups. These figures will only worsen as the patient voice is reduced, and particularly for traditionally marginalized populations and communities. My prior articles have detailed these abysmal numbers, with an upcoming article on this topic to be published in the May/June issue of Professional Case Management.

Systemic Bias

Countless thought leaders have emphasized the need for attention to treatment bias in healthcare. The Institute of Medicine’s seminal 2003 report, Unequal Treatment noted how African Americans and those in other minority groups receive fewer procedures and poorer-quality medical care than Whites. Stereotypes and stigma have impacted care across every cultural nuance encompassing ethnicity, gender, disability, race, and sexual identity to name just a few. These faulty beliefs have impacted every aspect of care from inaccurate treatment algorithms that fail to account for gender, race, and ethnicity to effective pain and other symptom management. Proper prescription medication dosing and other treatment is also at issue with condition not properly addressed. Patients are unnecessarily blamed for their symptom presentation rather than being fully assessed for individualized care.

The Mandate for Workforce Diversity and DEI Programs

A series of professional reports have identified opportunities to advance diversification of the healthcare workforce. The Council on Social Work Education revealed while 90% of social workers graduating with their MSW were women, opportunities for enhancing diversity continue to present. Only 22% of these same students were Black and 14% were Hispanic or Latino. The National Council of State Boards of Nursing revealed similar numbers with nurses from minority backgrounds representing under 20% of the RN workforce. Composition with respect to racial backgrounds is: 

  • 80.6% Caucasian
  • 6.7% African American 
  • 7.2% Asian
  • 5.6% Hispanic
  • 0.5% American Indian/Alaskan Native
  • 0.4 Native Hawaiian/Pacific Islander 
  • 2.1% two or more races; and 
  • 2.5% other

The Physician workforce also fails to reflect the inclusive nature of patient populations:

  • White: 56.5%
  • Asian: 18.8%
  • Hispanic or Latino: 6.3%
  • Black or African American: 5.2%
  • Multiracial (non-Hispanic): 1.3%
  • Other: 1.1%
  • American Indian or Alaska Native: 0.3%
  • Native Hawaiian or Other Pacific Islander: 0.1%
  • Unknown: 10.4% 

Gender composition notes a greater percentage of those identifying as male vs. female: 60.5% compared to 39.5%. 

There is growing availability of health and behavioral health professionals who provide affirming, accepting, and inclusive care to all patients, yet access remains challenging. Outcare and FOLX health provide directories of LGBTQIA+ friendly providers. Data detailing workforce composition for this community remains limited, though one report notes barely 14% of all medical students identify within the community.

In direct response to the percentages above, professional schools advanced DEI programs. Academia has worked for the better part of the last decade to shift from a curriculum of racial bias and develop antiracist and anti-oppressive programming. New coursework was developed with expansion of learning experiences, practicums, residencies, and specialized learning forums. These approaches prepared clinicians to better understand the patients they treat. Deshazo et al. (2021) identify how “deeply rooted bias is within the infrastructure of American Medicine, based on skin color, religion, immigrant status, gender, and ethnicity are deeply rooted, and taught as scientific racism medical schools from their earliest points in history.” This new societal playbook is a return to those times where fear of segregation and rampant inequities in access to quality care are the norm, along with putting minorities and women “back in their place”.

The UC Davis School of Medicine initiated a “race-neutral, holistic admissions model”, which tripled enrollment of Black, Latino, and Native American students. Assorted other efforts increased funding and entry to healthcare career pathways for students unable to otherwise afford or access them. There are an endless list of merits for the communities served by these new clinicians, including growth of diverse workforce that matches the patients served. 

Communities Take Care of Their Own

I’ve long said that communities take care of their own and this reality can’t be overstated. Practitioners of color are more likely to build their careers in medically underserved areas, from rural communities to lower socioeconomic areas.  The 2024 report by AAMC is clear: a shortage of >40,00 primary care doctors is expected by 2036 unless dramatic changes occur.

One way to assure workforce intercultural effectiveness has been through CEU-requirements for licensure and renewal. Yet even these requirements are now at risk. The Texas Behavioral Health Executive Council voted for removal of language requiring cultural competence as a CEU-requirement for licensed mental health professions with other states working to advance similar actions. This move de-emphasizes cultural context as a critical element of providing and assuring ethical and responsible care and intervention to each person. These shifts will create gaps in the knowledge and skills needed for the workforce to effectively engage with and serve patients from diverse backgrounds, cultures, and genders. Respect for the unique experiences, beliefs, and values that distinguish populations and communities will surely be at risk.

Moving Forward

As my colleagues in this space know, strategic action remains a moving target. We stay informed, yet angry at the daily assault on inclusion. Yet, that anger drives my actions, which are absolute: 

  • I stay committed to the Quintuple Aim: providing patient- and family-inclusive care at the right time, right cost, rendered by those who embrace the work, and ensuring equity and accessibility for all. 
    • I continue to heed my professional ethical obligations to patients, their families, and colleagues. Every day, I define one tangible way to step up in this shifting space to advance diversity, equity, inclusion, accessibility, belonging, and social justice, and through my every action, whether by:
      • Use of my professional voice through teaching, training, or authorship.
      • Supporting the workforce through ethical challenges faced in their workspaces.
      • Mentoring newer practitioners on clear strategies for their own sustainability.
      • Advocacy through my assorted roles across the industry 

How will you step up and into this space today?