Complex Case Management Criteria

  complex case management criteria: Case Management Shilpa Ross, Natasha Curry, Nick Goodwin, King's Fund (London, England), 2011
  complex case management criteria: Definition of Serious and Complex Medical Conditions Institute of Medicine, Committee on Serious and Complex Medical Conditions, 1999-10-19 In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.
  complex case management criteria: CMSA's Integrated Case Management Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN, Rebecca Perez, MSN, RN, CCM, FCM, Corine Latour, PhD, RN, 2018-01-28 Written by case managers for case managers, this reference manual for nurses and other health professionals presents a CMSA tested approach towards systematically integrating physical and mental health case management principles and assessment tools. Since the health care field has undergone major changes such as the passing of the Patient Protection and Affordable Care Act, Mental Health Parity, Transition of Care & Chronic Care Management and the Medicare Act and CHIP Authorization Act (MACRA), health care workers must competently know how to integrate those new regulations, describe alternative payment options, and implement requirements for greater patient and family assessment, care planning, and care coordination in their practice. CMSA’s Integrated Case Management delves into the role of the case manager and unpacks how case managers assess and treat complex patients. These are patients who may be challenged with medical and behavioral conditions, poor access to care services, as well as chronic illnesses and disabilities, and require multidisciplinary care to regain health and function. With a wealth of information on regulatory requirements, new models of care, integration of services, digital and telemedicine, and new performance measures that are clearly defined for nurses in nursing terminology, chapters outline the steps needed to begin, implement, and use the interventions of the Integrated Case Management approach. All content aligns with the newly revised 2017 Model Care Act, CMSA Standards of Practice 2016 as well as the CMSA Core Curriculum for Case Management Third Edition.
  complex case management criteria: Managing care pathways for patients with complex care needs Magdalena Smeds, 2019-05-15 One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
  complex case management criteria: Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies OECD, World Health Organization, 2019-10-17 This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
  complex case management criteria: Health and Human Services Issues United States. General Accounting Office, 1993 Discussing major policy, management, and program issues facing Congress and the Clinton administration in the area of health and human services, this pamphlet provides recommendations for the Department of Health and Human Services (HHS) regarding the social security system, the welfare system, preventing child abuse, and safeguarding the nation's food supply. Following an overview of important issues facing the nation, the second section suggests steps to bolster public confidence in the social security system, including building the system's trust fund by increasing contribution levels and modernizing computer systems. The next section provides recommendations for continuing the welfare reform movement and the implementation of the Family Support Act, such as developing automated data systems to effectively manage caseloads, setting goal-oriented program performance standards, and identifying and sharing effective initiatives between states. The fourth section suggests that HHS provide states with greater flexibility in using government funds to prevent child abuse through early intervention and that a national foster care system be developed to provide outcome-oriented data on child welfare services. The final section proposes that an agency-wide system for tracking regulation development be implemented in the Food and Drug Administration to improve agency effectiveness and better allocate existing resources. Includes references for 22 related GAO products. (BCY).
  complex case management criteria: Essential Readings in Case Management Catherine M. Mullahy, 1998 Bullets in Emergency Medicine: Review and Reminders in Pursuit of Evidence-Based Decisions is a concise guide to the diagnosis and treatment patients in the Emergency Department. Arranged by signs and symptoms as well as by system, this accessible handbook is an ideal reference for use in the Emergency Department and a perfect review for the ACEP boards.
  complex case management criteria: The Integrated Case Management Manual Roger G. Kathol, MD, Janice S. Cohen, PhD , CPsych, 2010-06-03 Designated a Doody's Core Title! An ideal reference guide for case managers who work with complex, multimorbid patients, The Integrated Case Management Manual helps readers enhance their ability to work with these patients, learn how to apply new evidence-based assessments, and advocate for improved quality and safe care for all patients. This text encourages case managers to assess patients with both medical and mental health barriers to improvement in order to coordinate appropriate integrated health interventions and treatment planning. Built upon the goals and values of the Case Management Society of America (CMSA), this manual guides case managers through the process of developing new and important cross-disciplinary skills. These skills will allow them to alter the health trajectory of some of the neediest patients in the health care system. Key Features: Tools and resources for deploying an Integrated Health Model (physical and mental health treatment) to the medically complex patient Complexity assessment grids: a color-coded tool for tracking patient progress and outcomes throughout the trajectory of the illness Methods for building collaborative partnerships in emerging models of care delivery within multidisciplinary health care teams Strategies for using an integrated case management approach to improve efficiency, effectiveness, accountability, and positive outcomes in clinical settings Guidance on connecting multi-disciplinary teams to assist with health issues in the biological, psychological, and social domains to overcome treatment resistance, reduce complications, and reduce cost of care
  complex case management criteria: Social Work Case Management Betsy Vourlekis, 2017-07-05 This new practice text provides a series of readings focusing on case management in a number of fields and in a variety of settings with different client populations. Each chapter examines a major component of case management practice by presenting information about an innovative program from a different location around the country. In conjunction, these readings provide a road map to social work case management.In addition to offering up-to-date practice approaches and examining the functions and skills of case management in depth, the authors provide the policy information needed for putting this traditional form of social work practice into today's service delivery context.
  complex case management criteria: The Integrated Case Management Manual Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel, 2018-06-14 Thoroughly revised and updated since its initial publication in 2010, the second edition of this gold standard guide for case managers again helps readers enhance their ability to work with complex, multimorbid patients, to apply and document evidence-based assessments, and to advocate for improved quality and safe care for all patients. Much has happened since Integrated Case Management (ICM), now Value-Based Integrated Case Management (VB-ICM), was first introduced in the U.S. in 2010. The Integrated Case Management Manual: Valued-Based Assistance to Complex Medical and Behavioral Health Patients, 2nd Edition emphasizes the field has now moved from “complexity assessments” to “outcome achievement” for individuals/patients with health complexity. It also stresses that the next steps in VB-ICM must be to implement a standardized process, which documents, analyzes, and reports the impact of VB-ICM services in removing patient barriers to health improvement, enhancing quality and care coordination, and lowering the financial impact to patients, providers, and employer groups. Written by two expert case managers who have used VB-ICM in their large fully disseminated VB-ICM program and understand its practical deployment and use, the second edition also includes two authors with backgrounds as physician support personnel to case managers working with complex individuals. This edition builds on the consolidation of biopsychosocial and health system case management activities that were emphasized in the first edition. A must-have resource for anyone in the field, The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients, 2nd Edition is an essential reference for not only case managers but all clinicians and allied personnel concerned with providing state-of-the-art, value-based integrated case management.
  complex case management criteria: CMSA Core Curriculum for Case Management , 2008 This text contains the core body of knowledge for case management practice as delineated by the Case Management Society of America (CMSA), the largest professional organization of case managers. The core curriculum provides a synthesis of case management evolution, and presents essential elements, concepts, and vision for current and future case management practice. This edition is significantly expanded to reflect the dynamic changes taking place in case management. Each chapter is organized in a consistent format that includes learning objectives; introduction; important terms and concepts; key definitions; and references.
  complex case management criteria: CMSA’s Integrated Case Management Rebecca Perez, MSN, RN, CCM, FCM, 2023-09-15 Developed by the Case Management Society of America (CMSA), this manual provides case managers with the essential tools necessary to successfully support quality patient care within today's complex healthcare system. This updated and revised second edition addresses the role of the case manager and unpacks how to assess and treat patients with complex issues; including those who are challenged with medical and behavioural conditions and poor access to care services, as well as chronic illnesses and disabilities, and require multidisciplinary care to regain health and function. With a wealth of information on regulatory requirements, new models of care, integration of services, and new performance measures, chapters outline the steps needed to begin, implement, and use the interventions of the Integrated Case Management approach. Written by case managers for case managers, this practical manual presents the CMSA--tested approach toward systematically integrating physical and mental health case management principles and assessment tools. As the healthcare field continues to increase in complexity and given the constantly changing regulatory environment, healthcare workers must know how to integrate those new regulations, describe alternative payment options, and implement requirements for greater patient and family assessment, care planning, and care coordination in their practice. New to This Edition: Increased coverage and focus on Social Determinants of Health New chapters on support specialty populations including veterans, trauma survivors, maternal child health, children with special healthcare needs Simplified terminology and presentation of CMSA Assessment Grid and process Key Features Aligned with the Model Care Act, the CMSA Standards of Practice, and the CMSA Core Curriculum for Case Management Assists case managers enhance their ability to work with complex patients and learn how to apply new evidence-based assessments, as it fosters safe and high-quality care Teaches case managers to evaluate patients for medical and mental health barriers in order to coordinate appropriate integrated interventions and treatment planning Integrates biological, psychological, social and health system assessment Supports care of adult, elderly, and pediatric patient populations with complex issues
  complex case management criteria: A Case Manager’s Study Guide Skinner, Stefany H Almaden, 2018-03-20 Preceded by A case manager's study guide / Denise Fattorusso, Campion Quin. 4th ed. c2013.
  complex case management criteria: The Hospital Case Management Orientation Manual Peggy Rossi, Bsn, Mpa, CCM, Karen Zander, 2014-06-12 The Hospital Case Management Orientation Manual Guide is a comprehensive resource that supplements of initial training for new case managers. This book explains what to document, where to document it to ensure appropriate level of care and reimbursement, and how to avoid unnecessary denials. This book's focus is utilization management, discharge planning, and relevant CMS regulations. It can help new case managers learn how to perform their jobs effectively on their own time. It can also serve as a wide-ranging resource for more experienced case managers, particularly those whose training was less than adequate.
  complex case management criteria: Advanced Case Management Norma Radol Raiff, Barbara K. Shore, 1993-08-19 This overview of issues pertinent to case management in the social services illustrates the diversity of innovative approaches which have been developed. These include: new forms of outreach and assessment; alternative methods for engaging family members and natural supports; and strategies attuned to the needs of culturally diverse constituencies. The degree to which existing services are available to meet clients' needs, and variations in service philosophies and resources are among the issues discussed. Examples from many practice settings illustrate the adaptability of case management.
  complex case management criteria: A Case Manager's Study Guide Denise Fattorusso, Campion Quinn, 2013 A Case Manager's Study Guide: Preparing for Certification, Fourth Edition is the perfect study guide for new case managers preparing to take the Certified Case Manager (CCM) exam and practicing case managers who are recertifying. Based on the Commission for Case Manager Certification (CCMC) six knowledge domains and eight essential activities, it addresses new changes passed and legislative updates resulting in significant changes in healthcare and case management. New topics include patient-centered care, readiness to change, evidence-based case management, and management outcomes. Completely updated and revised, A Case Manager's Study Guide: Preparing for Certification, Fourth Edition contains nearly 700 questions and comprehensive answer rationales.Included with the book is an online Access Code for Navigate TestPrep, a dynamic and fully hosted online assessment tool designed to help nurses prepare for certification examinations by offering case-based questions, detailed rationales, and robust reporting. Navigate TestPrep: A Case Manager's Study Guide also sold separately.* Randomized questions create new exams on each attempt* Monitors results on practice examinations with score tracking and time on each task* Reporting tools evaluate progress and results on each attemptDon't forget to visit our nursing certification website: www.NursingCertificationSuccess.com.
  complex case management criteria: Life Care Planning and Case Management Handbook, Third Edition Roger O. Weed, 2004 Life Care Planning and Case Management Handbook, Second Edition brings together the many concepts, beliefs, and procedures regarding life care plans into one state-of-the-art publication. This second edition of a bestseller is focused on prioritizing and managing the spectrum of services for people with serious medical problems and their families. Keeping up with advances in the field, this is the most comprehensive reference for everyone concerned with coordinating, evaluating, assessing, and monitoring care.
  complex case management criteria: Initiating and Sustaining the Clinical Nurse Leader Role: A Practical Guide James L. Harris, Linda A. Roussel, 2009-08-03 Initiating and Sustaining the Clinical Nurse Leader Role: A Practical Approach serves as a practice guide Clinical Nurse Leaders (CNLs) using the ten assumptions for preparing the CNL, the CNL roles, and the end of program competencies. The CNL designs, implements, and evaluates client care by coordinating, delegating and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals. This text provides real world tools and processes and includes chapter objectives, summaries, articles, case studies, tools, notes from the field, interviews with CNLs, CNL students, employers of CNLs and educators.
  complex case management criteria: Social Workers' Desk Reference Albert R. Roberts, 2009 This is a new edition of the wildly successful everyday reference for social workers. Like the first edition, it has been crafted with the help of an extensive needs assessment survey of educators and front-line practitioners, ensuring that it speaks directly to the daily realities of the profession. It features 40% new material and a more explicit focus on evidence-based practice.
  complex case management criteria: The Fragmentation of U.S. Health Care Einer Elhauge, 2010 Why is the American health care system so fragmented in the care it gives patients? This title approaches this question and more with a highly interdisciplinary approach. The articles included in the work address legal and regulatory issues, including laws that mandate separate payments for each provider.
  complex case management criteria: Simple Rules Donald Norman Sull, Kathleen M. Eisenhardt, 2015 Outlines an approach to high-performance problem solving and decision making that draws on insights from survival guides, pop culture, and other sources.
  complex case management criteria: Oxford Handbook of Prescribing for Nurses and Allied Health Professionals Sue Beckwith, Penny Franklin, 2011-05-12 This new edition is fully revised to provide concise, practical, and expert advice for the non-medical prescriber. Intended for all levels, it covers basic pharmacology, legal parameters, safe and effective prescribing and common conditions. Written by experienced nurse prescribers, it contains a wealth of guidance and information.
  complex case management criteria: Concepts of Rehabilitation for the Management of Common Health Problems Gordon Waddell, A. Kim Burton, 2004 Although there is broad agreement on the importance of rehabilitation and the need to improve occupational health and vocational rehabilitation in the UK, there is considerable uncertainty about what 'rehabilitation' is, and about its cost-effectiveness, particularly for the common health problems that cause most long-term disability and incapacity. This paper seeks to develop a theoretical and conceptual basis for the rehabilitation of common health problems. Chapters include: traditional rehabilitation and the need for a different approach; illness, disability and incapacity for work; the biopsychosocial model and framework of disability; obstacles to recovery and return to work; clinical and occupational management of common health problems; personal responsibility and motivation; and rehabilitation in a social security context.
  complex case management criteria: Improving the Quality of Health Care for Mental and Substance-Use Conditions Institute of Medicine, Board on Health Care Services, Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, 2006-03-29 Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€use conditions will benefit from this guide to achieving better care.
  complex case management criteria: Case Management Mary Hubbard Linz, Patricia L. McAnally, Colleen Ann Wieck, 1989
  complex case management criteria: Pocket Book of Hospital Care for Children World Health Organization, 2013 The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.
  complex case management criteria: The Case Manager's Handbook Catherine M. Mullahy, 2013-06-20 Written by renowned author Catherine Mullahy, The Case Manager’s Handbook, Fifth Edition is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the Certified Case Manager (CCM) exam, and most importantly, advance their careers after the exam. Written for all professionals in all practice settings in case management, it uses real-life examples and an easy-to-read, conversational style to examine the case management process while presenting practical procedural information. An excellent daily reference and training guide for new case managers and seasoned professionals in various setting, The Case Manager’s Handbook, Fifth Edition is the “go-to” resource for facing the day-to-day challenges of case management, especially as the nation navigates through the many changes introduced by the landmark Patient Protection and Affordable Care Act. Significantly updated and revised, it contains eight new chapters: * Hospital Case Management: Changing Roles and Transitions of Care * Patient Centered Medical Home, ACOs, Health Exchanges * Evidence-Based Practice * Public Sector Reimbursement * Predictive Modeling * Pain Management * Health Technology, Trends, and Implications for Case Managers * The Affordable Care Act of 2010: Implications for Case Managers Included with each new print book is an Access Code for a Navigate Companion Website for students with objectives, multiple choice questions, and bonus appendices.
  complex case management criteria: Army Health Care Randall B. Williamson, 2009-12 In Feb. 2007, a series of Washington Post articles disclosed problems at Walter Reed Army Medical Center, particularly with the management of servicemembers receiving outpatient care. In response, the Army established Warrior Transition Units (WTU) for servicemembers requiring complex case management. Each servicemember in a WTU is assigned to a Triad of Care (ToC) -- a primary care manager, a nurse case manager, and a squad leader -- who provide case management services to ensure continuity of care. The Army established staff-to-servicemember ratios for each ToC position. This report examines: (1) the Army's ongoing efforts to staff WTU ToC positions; and (2) how the Army monitors the recovery process of WTU servicemembers. Illus.
  complex case management criteria: Final Report of the Civil Justice Reform Act Advisory Group for the District of South Carolina United States. District Court (South Carolina), 1993
  complex case management criteria: Civil Litigation Management Manual , 2010
  complex case management criteria: Patient Safety and Quality Ronda Hughes, 2008 Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043). - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
  complex case management criteria: Engineering a Learning Healthcare System National Academy of Engineering, Institute of Medicine, 2011-07-14 Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.
  complex case management criteria: Health Professions Education Institute of Medicine, Board on Health Care Services, Committee on the Health Professions Education Summit, 2003-07-01 The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.
  complex case management criteria: Crossing the Quality Chasm Institute of Medicine, Committee on Quality of Health Care in America, 2001-07-19 Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
  complex case management criteria: Handbook of Court Administration and Management Steven W. Hays, Cole Blease Graham Jnr., 2017-10-19 Blending both the theoretical and applied aspects of contemporary issues in court management, this reference/text offers in-depth coverage of all major topics and developments in judicial systems administration. It is suitable for use in the classroom or for self-study.;Providing the background material to clarify even the most technical management application, this book: presents the history and theory of the court management movement; examines the separation of powers doctrine, and its relationship to judicial independence; discusses the latest developments in court reform, the American Bar Association standards, alternative dispute resolution techniques and caseflow considerations; analyzes unified court budgeting and revenue generation by judicial systems; describes personnel administration, training and jury management; and elucidates court performance evaluation, planning approaches, the use of cameras in the courtroom and audio-visual applications.
  complex case management criteria: The Case Manager's Training Manual David W. Plocher, Patricia L. Metzger, 2001 Stem Cell and Bone Marrow Transplantation
  complex case management criteria: The Case Management Workbook Cherilyn G. Murer, Michael A. Murer, Lyndean L. Brick, 2011-06-27 Case management has become one of the most effective means by which a continuum of care functions effectively and efficiently. A complete examination of the application of continuum of care, The Case Management Workbook: Defining the Role of Physicians, Nurses, and Case Managers defines the roles of the case management team and provides an overview of key post acute venues of care. It supplies an overview of the process, its structure, and the responsibility of each member of the team. The book discusses how managing the care of the patient in today’s healthcare environment will take a concerted effort from the entire case management team—not just a handful of case managers. The authors demonstrate that the case management team includes many more individuals than simply those with the title of case manager. The team must consist of key clinical personnel including the nurse, the physician and the case manager, each of whom have specific roles in case management. The book also highlights the role administration plays in assuring each member of the team is on board with the hospital’s or health system’s goal in assuring the patient is at the right place at the right time in their episode of care. In the words of the authors, case managers are ... the unsung heroes of effective healthcare delivery. They push and they prod, they inform and they educate, they provide valuable information to physicians and families with a common goal—to assure the patient is provided care in the most appropriate venue correlative to the medical resources needed and provided. In their book they explore a key byproduct of an effective case management system— the realization of an effective integrated health system whereby physicians and hospitals are aligned as caretakers of future health resources.
  complex case management criteria: The Civil Justice Reform Act Expense and Delay Reduction Plans David Rauma, 1995
  complex case management criteria: Case Management Suzanne K. Powell, Hussein M. Tahan, 2018-02-26 Prepare for a new career as a case manager—or just upgrade your skills to a whole new level—with the newly updated Case Management: A Practical Guide for Education and Practice, 4th Edition. Ideal for case management certification (CCMC) exam preparation, this is a thorough review of the case manager’s many roles and skills, from acute to post-acute care. Whether you are a nurse transitioning to case management or already active in it, this is your road map to coordinating successful patient care, from hospital to home. Build a strong case management career foundation, with expert, evidence-based direction: NEW chapter on case manager orientation programs that offers orientation checklists, competency assessment, and learning profiles, with available online tools NEW topics on current practice issues and developments, including the impact of the Patient Protection and Affordable Care Act and value-based care NEW content on experiential, problem-based learning—learning practices, training programs, case management team professional development Offers in-depth, evidence-based guidance on: The case manager’s roles, functions, and tasks Key concepts—quality management and outcomes evaluation, legal and ethical considerations, case management process, utilization management, transitions of care The role of the nurse case manager versus social worker role Strategies that ensure effectiveness of case management models Coordinating care, protecting privacy and confidentiality, health insurance benefit analysis, practice standards The Case Management Code of Professional Conduct, accreditation agencies and standards, specialty board certifications Management of resources and reimbursement concepts Case management in various settings—acute care, emergency department, admissions, perioperative services, disease management, insurance case management, palliative care, end-of-life care, hospice, home health care, physician groups, public health/community-based care, rehabilitation Ideal preparation for the CCMC exam—offers a large portion of CCMC exam content—and for Continuing Education Unit (CEU) for Case Management study A must-have desk reference that offers plentiful case studies—considered to be “the bible” of case management
  complex case management criteria: Professional Nursing Concepts Anita Ward Finkelman, 2013 ... takes a patient-centered, traditional approach to the topic of nursing education and professional development. This dynamic text engages students in recognizing the critical role that nurses play in health care delivery, and focuses on the five core competencies for health professions as determined by the Institute of Medicine (IOM) ...--Back cover.
Complex Care Management Toolkit
Complex Care Management | April 2012 1 ... disease or case management. The changes suggested in this change package were gleaned from a variety of sources: ... Develop an …

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CASE MANAGEMENT Mobile Psy - mercercountybhc.org
Please keep in mind that for each type of case management, criteria must be met, and specific referral materials and docu-mentation will be required. ... and C/A Complex Case …

Complex Case Meetings Practice Guidance - teescpp.org.uk
Complex Case Meetings provide a mechanism to support services to address ... 4 Criteria for Complex Case Planning The process seeks to deliver a flexible and holistic, multi-agency …

Peoples Health Complex Case Management (CCM) Program
Complex case management is provided to Peoples Health plan members with multiple medical or behavioral health conditions and a complex social situation that affects management of the …

Complex Case guidance - norfolksafeguardingadultsboard.info
Feb 4, 2025 · Complex Case Management - Multi-agency Guidance FINAL Issue Number 4 – FINAL Document Owner Norfolk Safeguarding Adults Board ... Circumstances where there is …

Case Management Services - Government of New York
Adult and Children Case Management Health Home Care Management 2021-22 NYC 2022 Upstate/Downstate Funding Source Codes: 034J Adult Case Management ... needed …

Social Work Best Practice Healthcare Case Management …
Healthcare Case Management Standards Introduction Currently, the term Case Management has varied meanings within the context of its use by ... multiple services to meet the specific …

Proprietary & Confidential Page 1 - group-health.com
Member may be co-managed with a case manager if they meet complex case management criteria. Signature:_____ Date: 5/1/2025 REVISION HISTORY: Rev. Date Revised By/Title …

CHCCSM004 Coordinate complex case requirements
requirements for clients with complex needs within a case management framework. ... Performance criteria specify the level of performance needed to demonstrate achievement of …

Complex Case Panel Policy and Procedure April 2021
Complex Case Panel Policy and Procedures SECTION CONTENTS PAGE 1 Introduction 3 2 Objectives 3 3 Criteria 3 4 Factors to Consider 4 5 Written Information 4 6 Case Responsibility …

Case Management and Clinical Services Manual - PA.GOV
Prevention, Case Management and Clinical Services, Fiscal and Operations Manuals issued by DDAP, unless otherwise specified by DDAP or the Commonwealth, such as in Policy Bulletins …

Serving Children with Complex Needs - Minnesota …
Children’s Mental Health Targeted Case Management Eligibility criteria Minnesota State Statute 245.4871, subd. 6. For purposes of eligibility for case management and family community …

Screening Questions to Help Determine Need for Case …
Screening Questions to Help Determine Need for Case management Services and Level of Service Needed Author: AIDS Institute Subject: Screening Questions to Help Determine Need …

CERTIFICATION GUIDE
safe care transitions. Professional case managers help navigate complex systems to achieve mutual goals, advocate for those they serve, and recognize personal dignity, autonomy, and …

Complex Case Management Program
Complex Case Management Program We offer a Complex Case Management program for members who could be helped through more intensive coordination of services. This program …

CHCCSM010 Implement case management practice
ELEMENTS PERFORMANCE CRITERIA Elements describe the essential outcomes Performance criteria describe the performance needed to demonstrate achievement of the element. 1. …

2025 Quality Management and Utilization Management …
19195 500 NE Multnomah St., Ste. 100, Portland, OR 97232. ©2025 Kaiser Foundation Health Plan of the Northwest04-25 RegionalAdmin/KPB Kaiser Permanente Northwest

CHCCM404A Undertake case management for clients with …
ELEMENT PERFORMANCE CRITERIA 1. Work within a case management framework suitable for the client's needs 1.1 Identify a range of case management models that have established …

CHCCM703A Apply effective case management practice
ELEMENT PERFORMANCE CRITERIA 1. Initiate complex case management process 1.1 Confirm eligibility of persons for case management by matching client profile against service …

Revised October 2016 L Behl Page 1 - ghcscw.com
The Complex Case Management Program description is reviewed and approved annually by the Clinical and Service Quality Committee (CSQC). ... Criteria for identifying members who are …

POLICY AND PROCEDURE Medical Management : Care …
Attachment A: Complex Case Management is the former LA.CM.01 and was replaced by this policy (Case Management Program Description) on 4/10/13. 4/2013 Added “Children with …

Final Report June 30, 2003 - California Courts
Complex Case Management Before Implementation of the Pilot Program Finding 1: Use of a master calendar system was viewed as the single most ... available to all litigants who meet …

Policy: The overall goal of Complex Case Management …
Effectiveness Criteria: Inpatient and Emergency Room utilization 6months prior to CCM, during CCM and 6 months post CCM ... "MHL 12.07 Complex Case Management" History Document …

Enhanced Case Management Criteria - Virginia Department …
Enhanced Case Management Criteria Other Factors: • Case Managers will be assessing the individuals on their caseloads and documenting the results of their assessment t iti t th i dt as …

Appendix 1 Proposed Standard Changes for HPA 2022
Nov 18, 2020 · NCQA reviews initial assessments in a random sample of up to 40 complex case management files. Files are selected from active or closed member cases that were identified …

Step by Step - American Institutes for Research
approach to case management, including: • Researching and designing a model. • Supporting staff in providing case management services. • Evaluating impact. Step One: Researching …

GUIDELINES FOR THE COMPLEX LITIGATION PROGRAM - sb …
Once a case is deemed complex, the function of the Initial Case Management Conference and all subsequent Case Management Conferences is to facilitate discovery, motion practice, and trial …

Differentiated Case Management - Office of Justice Programs
Differentiated Case Management Nancy E. Gist, Director U.S. Department of Justice Office of Justice Programs ... assigned to the applicable track based on criteria developed by the local …

Care Programme Approach Practice Guidance Note Managing …
Appendix 1 Complex Case Referral Form 1 Jan 18 Jan 21 1 Introduction On occasion clinical teams and individual Lead Professionals/ Care Co- ordinators face complex problems …

Chronic Care Management Frequently Asked Questions
Aug 16, 2022 · • CPT codes 99487 – complex CCM, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month ... (such as by a …

PROVIDER MEMO - files.santaclaracounty.gov
Aug 30, 2024 · 1. Patient’s primary condition and additional information for complex case management support 2. Patient’s contact information 3. Practitioner’s contact information, …

Community Case Management - Mass.gov
Community Case Management: Onboarding Guide for New Members | February 2025 6 2. Role of CCM Community Case Management (CCM) provides coordination of MassHealth Community …

Targeted Case Management, Case Management, and Care …
Enrollment criteria is outlined in 441 IAC 77.47(249A). For the purposes of this manual, the term case management will incorporate TCM, WCM, and care coordination. If any section of the …

NCQA Corrections, Clarifications and Policy Changes to the …
Jul 26, 2021 · Note: Organizations whose case management systems automatically generate answers will be surveyed on this requirement on or after 7/1/2021. CL 11/23/20 58, 64 CM 2, …

Values Complex Case Management - swmbh.org
Complex Case Management Referral: SWMBH-CCM@swmbh.org Mission “SWMBH strives to be Michigan’s preeminent benefits manager and integrative healthcare partner, assuring regional …

Care Management: Chronic Care Management - NGS …
Care Management: Making all-inclusive care plan a ... services using criteria suggested in CPT guidance • Number of illnesses, number of medications, or repeat admissions or emergency ...

ORDER GOVERNING CIVIL CASE MANAGEMENT AND …
ORDER GOVERNING CIVIL CASE MANAGEMENT AND RESOLUTION WHEREAS, pursuant to Article V, section 2(d) of the Florida Constitution and section 43.26, ... shall be identified based …

2023 Quality Management Program - Health Alliance
3. clinical management criteria and guidelines 4. disease management 5. credentialing and recredentialing 6. inpatient care review for inpatient, surgical and behavioral health care …

Kentucky Checklist for the Identification of Co-Occurring …
The following table illustrates the criteria that shall be met for an individual to be designated as qualifying for targeted case management for co-occurring Behavioral Health (SMI, SED, SUD) …

Division of Health Benefits - NC Medicaid
Dec 15, 2023 · Management (PHM) elements, PHM 5 refers to complex case management (targeting high risk members with complex conditions) and PHM 7 refers to delegation of …

SECTION 10 CASE MANAGEMENT - Missouri Department of …
CASE MANAGEMENT ENROLLMENT CRITERIA . To provide and bill for case management services, a local health department must be approved and enrolled as a case management …

Complex Case Management Procedure - mht.vic.gov.au
Complex Case Management Procedure A GUIDE FOR PATIENTS, DMHS AND LEGAL REPRESENTATIVES ON COMPLEX CASES Purpose To establish a procedure for the timely …

CALAIM ENHANCED CARE MANAGEMENT POLICY GUIDE
3 I. INTRODUCTION This California Advancing and Innovating Medi-Cal (CalAIM) Enhanced Care Management (ECM) Policy Guide is intended to serve as a resource for Med-iCal