Preparing for New Primary Care Models: The Role of Professional Case Management

PURPOSE AND OBJECTIVES: This paper aims to raise awareness of the case management community about innovative primary care models, like the Making Care Primary (MCP) which has potential to become the foundation for future primary care reform. It provides professional case managers (PCMs), case management leaders, and primary care providers with examples of evidence-based best practices to apply in primary care settings and programs. PRIMARY PRACTICE SETTINGS: Primary care practices and organizations, ambulatory clinics, community-based primary care. FINDINGS/CONCLUSIONS: The authors share examples of findings from case management research published over the last 10 years as they pertain to the 3 main domains of MCP-care management, care integration, and community connections-to show the impact case management interventions may have on key outcomes in value-based primary care. The systematic, narrative, and scoping reviews summarized in this paper suggest a set of important case management structures, processes and outcomes relevant to care management, care integration, and community connections that help manage the diverse needs of patients. This evidence is also important in identifying essential case management interventions that ensure person-centered and holistic care and improve patient outcomes especially as they pertain to personal health and wellbeing. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The authors of this paper draw attention to the importance of PCMs and their roles in evolving primary care models in the context of teams and effective teamwork. The contributions of PCMs on primary care teams can be extensive and critical to the successful achievement of desirable primary care outcomes for individuals with complex chronic illness and health-related social needs and thus to the overall success of value-based models of primary care. The evidence the authors summarize provide important guidance on best case management practices in primary care that contribute to better health outcomes.