At the heart of case management is the patient whose health needs to be ensured while keeping the costs low. Case managers strive to achieve a patient-centered approach in addressing the patient's needs. Yet the role of the case manager may not be fully understood by some patients. For example, a patient may view the case manager as the person who keeps him from being eligible for a good health insurance benefit package. An adversarial relationship between the case manager and patient hinders the effective delivery of services. Patient and family education, therefore, plays an important role in ensuring the delivery of effective case management.
The collaboration between case managers and physicians is essential in ensuring that effective case management is achieved. Sometimes case managers seek to work with the patient-client without consulting the physician or nurse in charge of providing care. Similarly, a physician may resist the attempt of a case manager to influence how she administers care to the patient-client. A lack of understanding between the two parties is an internal health care factor that can compromise the health and human services needs of the client.
Health care reforms are still very debatable in the country. Promoting efficiency and reducing the costs of health care are some of the imminent issues in this debate. Case managers had been previously sidelined in the health care debate. Admittedly, the role of the case manager in bringing efficiency to the health care system was not taken seriously. This was until the passing of the Patient Protection and Affordable Care Act in 2010 which seeks to empower case managers and their role in the health care system. Case managers will have a stronger role in ensuring patient safety. This shows that external factors, such as health care policies, can hinder or help in the effective administration of case management.
Certification for case management is not nationally required. But according to the Commission For Case Manager Certification (CCMC), quality case management requires case managers to be clinical professionals. The CCMC argues that the area of case management should be left to professionals with certification and with a clinical background. This is a challenge to the current situation in which para-professionals with no case management certification can still practice as case managers.