I'm going to close with some of my ideas about the characteristics that case managers exhibit. I have a great deal of professional respect for case managers. I think that you are a tenacious lot. One of the major things that case managers do is help create new alternatives to problems. You open doors; no ... you first build the door and then you open it. You're creative, persistent, and resourceful. You are sometimes asked to solve all of an organization's problems. I think that is a tremendous burden, and that you can get confused because of that role conflict and confusion. What model is best for my organization? Within that is my patient population. What is it that they need? What are the current issues that you are seeing? How is my case management role different from other roles? How large a scope of practice can I handle and be reasonably successful with the patients with whom I'm dealing? How many different kinds of approaches and models are needed within my organization? Look toward the future; think about the future in terms of your crystal balls. What trends do you see building in either the demographics or the health and social environments that are going to influence health care in the future? What effect will the aging of our population have on you and your case management practice? What issues are going to be related to those trends? How many more people do we have living in fragmented families? What's going to happens in terms of resources available for patients? How can case management influence those changes? I don't think we're going to see the pace of change in the health care industry slow down. We will continue to have health care organizations address social issues in addition to pathophysiologic ones. No matter what the role and how it evolves, case management will always be at the junction of change in health care. This will be difficult at times to deal with. It will also be a source of satisfaction for those in the role because of the tremendously positive effect case managers have on the lives of patients and their families.