Achieving quality healthcare in the United States remains an important goal for Congress, public and private stakeholders, and healthcare consumers. In a recent GAO Report to Congress, $429.9 million was authorized through appropriations from 2009-2018 to fund CMS quality measure activities. The Centers for Medicare & Medicaid Services (CMS) which oversees the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) covering over 140 million beneficiaries along with the U.S. Department of Health and Human Services (HHS) promotes quality healthcare and improved outcomes through various initiatives that incentivize providers to achieve quality outcomes. CMS uses quality measures endorsed by the National Quality Forum (NQF) in its various initiatives that include quality improvement, pay for reporting, and public reporting. The background on the quality movement spans over a century in the United States. National stakeholder organizations over the past half century have emerged along with Congressional mandates as a Call to Action to achieve quality, efficient healthcare. In 2011, the National Quality Strategy (NQS) emerged to align public and private sectors to achieve the Triple Aim. In 2017, CMS launched the Meaningful Measures Framework which identified high priority areas in healthcare for quality measurement and improvement to achieve quality outcomes for patients, families, and providers. CMSA’s Standards of Practice for Case Management align well with the CMS Meaningful Measures overarching goals and quality categories. Professional case managers working in all healthcare settings contribute to the National Quality Strategy by supporting patients, families, and providers to achieve quality, patient-centered goals. Professional case managers are perfectly positioned to achieve quality patient outcomes led by guiding principles: The Standards of Practice for Case Management and Code of Conduct for Case Managers. Professional case managers have the ability to impact health policy through the development of a National Registry for Case Management Outcomes that can serve as vital communication to Congress on professional case management’s role and contribution toward the National Quality Strategy. In doing so, case managers are STAKING OUR CLAIM IN A NEW WORLD.

OBJECTIVES:

1. The participant will describe the background of the National Quality Strategy in the United States and the significance to professional case managers
2. The participant will identify how CMSA’s Standards of Practice for Professional Case Management align with the CMS Meaningful Measures Framework.
3. The participant will discuss how case managers can impact health policy through the development of a National Registry for Case Management Outcomes that can serve as vital communication to Congress on case management’s contribution toward the National Quality Strategy.