What is Case Management?

1. What is Case Management?

2. Objectives • Define case management and care management and compare the differences. • Discuss the purpose of case management services. • Identify the purpose of care management. • Incorporate case management concepts into clinical practice with use of case study. • Identify educational requirements and skills essential for the case manager.

3. Key terms • Case management • Care management • Client-centered case management • Continuum of care • Discharge planning • System-centered case management • Utilization review

4. Case Management … “… is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.” – The Case Management Society of America (2002) Nursing Case Management … … is “a health care delivery process whose goals are to provide quality health care, decrease fragmentation, enhance the client’s quality of life, and contain costs.” – American Nurses Association (1992)

5. Care Management Programs that apply systems, science, incentives & information to improve medical practice and allow clients and their support systems to participate in a collaborative process with a goal of improving medical, social, and mental health conditions more effectively. Overall goal is to improve the coordination of services provided to clients enrolled in a care management program and to minimize or eliminate duplication. – CHSC (2007)

6. Purposes of Case Management Assist the client through a complex, fragmented, and often confusing health care delivery system and achieve specific client-centered goals. Promote cost-effective, quality care. Assist clients and families who need care coordination to access necessary resources in a time-efficient manner.

7. Possible Case Management Functions Identifying the target population Determining screening and eligibility Arranging services Monitoring and follow-up Assessing Planning care Reassessing Assisting clients through a complex, fragmented health care system Care coordination and continuity

8. Case Managers Must have appropriate educational background. A minimum skill level is needed to ensure success in the role. Certification as a case manager is available through the Case Management Association of America (CMSA) and the American Nurses Credentialing Center (ANCC).

9. Role Functions of Case Managers (CMSA, 2002) Essential activities of case management Assessment Planning Facilitation Advocacy Collaboration

10. Nurse Case Managers(ANCC, 2009, www.nursingworld.org) Actively participate with clients to identify and facilitate options and services Provide and coordinate comprehensive care to meet client health needs Work to decrease fragmentation & duplication of care Enhance quality, cost-effective clinical outcomes Evaluate each individual’s health plan & specific challenges Use roles of advocate, collaborator, facilitator, risk manager, educator, mentor, liaison, negotiator, consultant, coordinator, evaluator, and/or researcher.

11. Case Management Models Hospital-based case management New England Model Discharge Planner and Arbitrator Case Management Model Geriatric Clinical Nurse Specialist Model

12. Case Management Models (cont.) Case management models across the health care continuum Arizona Model Private Pay Care Management Pharmacy Model of Case Management

13. Case Management Models (cont.) Community case management Denver Case Management Model Indianapolis Case Management Model

14. Case Management in Community Health Public health clinic settings Occupational health settings High-risk clinic settings Clients with chronic diseases Home health and hospice International settings

15. CaseStudy & Candy