BY MICHAEL GARRETT, MS, CCM, DR. ELLEN FINK-SAMNICK, DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM, AND DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMGT-BC, CMCN, ACM RN, IQCI, FCM, FAACM
As the healthcare landscape continue s to evolve, the role of case managers in ensuring equitable, patient-centered care becomes even more critical. The Case Management Society of America (CMSA) has long been at the forefront of defining and upholding the highest standards for professional case management. With the release of the latest edition of the CMSA Standards of Practice, a significant new addition—Standard Q: Diversity, Equity, Inclusion, and Belonging (DEIB) and Health Equity—has been introduced, underscoring the profession’s ongoing commitment to eliminating health disparities, achieving health equity, and fostering inclusive healthcare environments.
THE NEED FOR STANDARD Q
Incorporating principles of diversity, equity, inclusion and belonging (DEIB) into case management practice is no longer optional—it is essential. Healthcare disparities persist across multiple dimensions, such as race, socioeconomic status, disability, language, sexual orientation, gender identity and geographic location. Standard Q recognizes that achieving health equity requires intentional, systemic change, ensuring that all individuals receive fair and just opportunities to attain their highest level of health.
This new standard aligns case management practice with broader efforts across the healthcare sector, including those championed by regulatory and organizational accreditation entities encompassing the Centers for Medicare & Medicaid Services (CMS), ANCC’s Magnet Status, NCQA, URAC, The Joint Commission and the NQF. The content leverages industry standards for patient-inclusive language, including the seminal work by the American Psychological Association (APA) (2023). Standard Q further acknowledges the pivotal impact of the social determinants of health (SDOH) and political determinants of health (Dawes, 2022) on patient outcomes; their combined micro, mezzo and macro influence contributes to increased illness morbidity, higher healthcare utilization and cost, and ultimately worsening mortality rates. With advocacy at the core of their actions, professional case managers must actively work to mitigate and eliminate these barriers in care and for every patient, family member and community served.
BREAKING DOWN STANDARD Q: CORE PRINCIPLES AND IMPLEMENTATION
Standard Q provides a comprehensive framework guiding case managers in integrating DEIB principles into their daily practice. The standard is divided into several key sections:
1. COMMITMENT TO DEIB AND HEALTH EQUITY
Case managers must demonstrate a foundational commitment to DEIB principles by recognizing and addressing biases that may affect access to care. This includes being responsive to clients’ preferences, values and beliefs, ensuring culturally competent services, and advocating for policies that promote health equity.
2. THE CLIENT RELATIONSHIP: FOSTERING INCLUSION AND TRUST
A key element of this standard is the promotion of an environment where all clients feel valued and included. Case managers are expected to:
Honor clients’ preferences regarding care and providers.
Avoid imposing personal biases on clients.
Recognize the intersectionality of clients’ identities and how these influence their healthcare experiences.
Build trust and promote a sense of belonging.
3. THE HEALTH EQUITY FRAMEWORK
Health inequities often stem from systemic injustices. Standard Q encourages case managers to:
Identify and address disparities in healthcare access and outcomes.
Advocate for legislative efforts and public policies aimed at reducing disparities.
Implement strategies for screening and addressing social determinants of health.
Utilize evidence-based frameworks to understand and mitigate health inequities.
4. COMMUNICATION: ENSURING ACCESSIBLE AND INCLUSIVE INTERACTIONS
Effective communication is a cornerstone of equitable healthcare. Under Standard Q, case managers must:
Conduct assessments of clients’ communication needs and tailor interactions accordingly.
Use culturally appropriate and accessible communication methods.
Recognize the role of health literacy in care outcomes and adjust education efforts accordingly.
Respect clients’ identities, preferred names and pronouns to promote dignity and inclusion.
5. ASSESSMENT AND EVALUATION: EMBEDDING DEIB INTO CARE PLANNING
Case managers must use assessment tools that are culturally responsive and free from discriminatory biases. This includes:
Conducting biopsychosocial assessments that account for SDOH and cultural influences.
Ensuring assessments are linguistically accessible and, when necessary, utilizing professional medical interpreters.
Adapting care plans based on clients’ evolving needs and lived experiences.
6. SUPERVISION AND PROFESSIONAL LEARNING: CULTIVATING INCLUSIVE LEADERSHIP
For case management leaders, Standard Q establishes expectations for fostering inclusive teams. Supervisors must:
Promote workforce diversity across recruitment, mentoring and advancement.
Create professional development opportunities focused on DEIB education.
Encourage continuous learning and self-reflection to address implicit biases.
7. TEAMS, ORGANIZATIONS AND COMMUNITY ENGAGEMENT
Case managers play a vital role in influencing their workplaces and communities. Standard Q calls for:
Advocacy for fair and inclusive workplace policies.
Collaboration with community organizations to connect clients with culturally competent resources.
Commitment to interdisciplinary respect and teamwork, ensuring equitable treatment of colleagues and clients alike.
A CALL TO ACTION FOR CASE MANAGERS
With the addition of Standard Q, CMSA has set a new benchmark for the profession, reinforcing that case management must be actively inclusive, equity-driven and culturally responsive. Implementing this standard is not merely about compliance—it is about elevating the profession and making a meaningful impact on the lives of clients who face systemic barriers to care.
Case managers are encouraged to:
Reflect on their practice and assess how they can integrate DEIB principles into their daily work.
Engage in ongoing education on health equity and cultural competency.
Advocate for policy changes within their organizations to ensure fair and just healthcare access for all.
The addition of Standard Q signals a transformative step forward in case management practice. By embracing these principles, case managers can help create a healthcare system that truly works for everyone.
CONCLUSION
As healthcare continues to shift toward value-based care and population health management, ensuring equitable, inclusive and patient-centered case management is more important than ever. Standard Q provides the framework and expectations for professionals to lead the way in dismantling health disparities and building a more just and inclusive healthcare system.
For more information on the CMSA Standards of Practice and to explore the full details of Standard Q, visit CMSA’s website at https://cmsa.org/.
REFERENCES
American Psychological Association. (2023). Inclusive language guide (2nd ed.). https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf
Dawes, D. (2020). The political determinants of health; Johns Hopkins Press, Baltimore, MD.
Michael B. Garrett, MS, CCM, has more than 40 years of experience in case/care management with public and private sector health and benefit programs. For the last 10 years, he has focused on improving health equity for historically underserved communities, including assessing how organizations can better support diversity, equity, inclusion, and belonging (DEIB). He serves on the editorial board of Professional Case Management, the URAC health equity council, and he is the current chair of the CMSA DEIB committee. He holds a Bachelor of Arts in psychology and religious studies, and a Master of Science in clinical psychology. He is board certified in case management and vocational evaluation.
Dr. Ellen Fink-Samnick, DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM, is an award-winning industry entrepreneur. Her focus is on interprofessional ethics, wholistic health equity quality, trauma-informed leadership and competency-based case management. She is a content developer, professional speaker, author and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies, George Mason University, and the University of Buffalo School of Social Work. Ellen serves in national leadership and consultant roles across the industry. Further information is available at www.linkedin.com/in/ellenfinksamnick/ and www.efssupervisionstrategies.com/.
Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMGT-BC, CMCN, ACM-RN, FCM, FAACM, is the associate chief clinical operations officer, care continuum for University of Illinois Health System and the immediate past president of the Case Management Society of America National Board of Directors and president-elect of CMSA Chicago. She has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management and social services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management. Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her first book, A Practical Guide to Acute Care Case Management, published by Blue Bayou Press, was released in February 2022. Her second book, Practical Guide to Hospital Readmission Reduction, published by Blue Bayou Press was released in February 2024. Her third book, Practical Guide to Acute Care Case Management Leadership, is in the works, targeting publication in 2025. Dr. Morley celebrates 25 years of nursing experience and 20 years in case management in 2024. Her clinical specialties include med/surg, oncology and pediatric nursing. She received her ADN at South Suburban College in South Holland, Illinois; BSN at Jacksonville University in Jacksonville, Florida, MSN from Norwich University in Northfield, Vermont, and her DNP at Chamberlain College of Nursing.
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