Complex Care Management Program

  complex care management program: Closing the Quality Gap Kaveh G. Shojania, 2004
  complex care management program: 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 care management program: Comprehensive Care Coordination for Chronically Ill Adults Cheryl Schraeder, Paul S. Shelton, 2011-07-22 Breakthroughs in medical science and technology, combined with shifts in lifestyle and demographics, have resulted in a rapid rise in the number of individuals living with one or more chronic illnesses. Comprehensive Care Coordination for Chronically Ill Adults presents thorough demographics on this growing sector, describes models for change, reviews current literature and examines various outcomes. Comprehensive Care Coordination for Chronically Ill Adults is divided into two parts. The first provides thorough discussion and background on theoretical concepts of care, including a complete profile of current demographics and chapters on current models of care, intervention components, evaluation methods, health information technology, financing, and educating an interdisciplinary team. The second part of the book uses multiple case studies from various settings to illustrate successful comprehensive care coordination in practice. Nurse, physician and social work leaders in community health, primary care, education and research, and health policy makers will find this book essential among resources to improve care for the chronically ill.
  complex care management program: 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 care management program: 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 care management program: 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 care management program: Health for Everyone Zackary Berger, 2022-06-20 A guide to progressive healthcare packed full of actionable recommendations and a road map to a more inclusive and equitable future. Health for Everyone: A Guide to Politically and Socially Progressive Healthcare brings together experts across a range of healthcare and related disciplines to explore how we can make our healthcare system more progressive for groups that have been overlooked for too long. Rather than a health policy manual adopting a 30,000-foot view, this is a practical guide to start making healthcare more responsive, more patient-centered, and more community-led—right now, starting from present realities. Zackary Berger, a well-known primary care physician, activist, and bioethicist, has brought together teachers, clinicians, advocates, and researchers, to map the steps we need to take to provide better care to African American, Latinx, chronically ill, and disabled patients while improving the system overall for everyone Health for Everyone answers questions such as how do you provide the same care to every individual, when individuals are different? How do you get ideal care when you are a member of a disadvantaged group? What if you have a chronic condition that tends to get the short end of the stick, for which treatment might not be available, or be stigmatized? Focusing on a practical, yet ethical and philosophical case for progressive health care, this book focuses on what matters most to patients and on the steps we need to take to insure better health for everyone.
  complex care management program: 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 care management program: Pending Health Legislation, Including the Heather French Henry Homeless Veterans Assistance Act United States. Congress. Senate. Committee on Veterans' Affairs, 2002
  complex care management program: 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 care management program: The 1st Annual Crossing the Quality Chasm Summit Institute of Medicine, Board on Health Care Services, Committee on the Crossing the Quality Chasm: Next Steps Toward a New Health Care System, 2004-09-13 In January 2004, the Institute of Medicine (IOM) hosted the 1st Annual Crossing the Quality Chasm Summit, convening a group of national and community health care leaders to pool their knowledge and resources with regard to strategies for improving patient care for five common chronic illnesses. This summit was a direct outgrowth and continuation of the recommendations put forth in the 2001 IOM report Crossing the Quality Chasm: A New Health System for the 21st Century. The summit's purpose was to offer specific guidance at both the community and national levels for overcoming the challenges to the provision of high-quality care articulated in the Quality Chasm report and for moving closer to achievement of the patient-centerd health care system envisioned therein.
  complex care management program: Healthcare Changes and the Affordable Care Act James S. Powers, 2014-10-20 Healthcare Changes Reach Main Street: A Call to Action for Physicians provides guidance, examples, and information on processes and time lines for physicians based on the implementation of The Affordable Care Act (ACA) that was established in 2010. This volume focuses on how geriatricians and other healthcare professionals can be engaged in responding to the roll-out of the ACA in their communities, and through this engagement assume leadership roles in local hospitals, healthcare organizations, and medical societies to advance quality improvement and new models of care for older adults. In-depth chapters provide an update on quality improvement efforts at the state level, as well as changes in Medicaid financing and the significant impact this will have for older adults, particularly dual-eligibles. Many elements of the ACA are yet to be rolled out and many healthcare decisions are yet to be made. Healthcare Changes Reach Main Street: A Call to Action for Physicians will guide healthcare decision makers and help them to play a leadership role in advancing quality care for older adults in our changing healthcare environment.​
  complex care management program: The Case Manager’s Handbook Catherine M. Mullahy, 2016-05-25 The Case Manager's Handbook, Sixth Edition is an indispensable guide for case managers. Presented in an accessible and conversational style, this practical resource helps case managers learn the fundamentals, study for the Certified Case Manager exam, and advance their careers after the exam. Completely updated and enhanced with information on the latest developments affecting case management, it reflects the rapidly changing healthcare landscape, including the significant effects of the Affordable Care Act.--Back cover.
  complex care management program: 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 care management program: Recent Advances in Digital System Diagnosis and Management of Healthcare Kamran Sartipi, Thierry Edoh, 2021-02-03 Technologically supported healthcare management is beginning to take center stage as advances occur in many aspects of healthcare, involving big data, artificial intelligence, and improved user interfaces. This volume provides a perspective on a number of such advances, ranging from homecare with remote network support and primary homecare to telemedicine application for pediatric cardiology. A special section with chapters on Clinical Decision Support Systems (CDSS) addresses topics in improved human interfaces, intelligent support for better quality home and institutional care, effective big data visualization for decision-makers, and gathering data from multiple sources to support the battle against resistant bacteria.
  complex care management program: Lubkin's Chronic Illness Larsen, 2017-12 Lubkin's Chronic Illness, Tenth Edition is an essential text for nursing students who seek to understand the various aspects of chronic Illness affecting both patients and families. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.
  complex care management program: Everyday Heroes, Family Caregivers Face Increasing Challenges in an Aging Nation United States. Congress. Senate. Special Committee on Aging, 1999
  complex care management program: Physician's Guide Roger G. Kathol, Katherine Hobbs Knutson, Peter J. Dehnel, 2016-07-27 Improving the outcomes for patients in our changing healthcare system is not straightforward. This grounding publication on case management helps physicians better meet the unique needs of patients who present with poor health and high healthcare-related costs, i.e., health complexity. It details the many challenges and optimal practices needed to work effectively with various types of case managers to improve patient outcomes. Special attention is given to integrated case management (ICM), specifically designed for those with health complexity. The book provides a systematic method for identifying and addressing the needs of patients with biological, psychological, social, and health-system related clinical and non-clinical barriers to improvement. Through ICM, case managers are trained to conduct relationship-building multidisciplinary comprehensive assessments that allow development of prioritized care plans, to systematically assist patients to achieve and document health outcomes in real time, and then graduate stabilized patients so that others can enter the case management process. Patient-centered practitioner-case manager collaboration is the goal. This reference provides a lexicon and a roadmap for physicians in working with case managers as our health system explores innovative ways to improve outcomes and reduce health costs for patients with health complexity. An invaluable, gold-standard title, it adds to the literature by capturing the authors' personal experiences as clinicians, researchers, teachers, and consultants. The Physician's Guide: Understanding and Working With Integrated Case Managers summarizes how physicians and other healthcare leadership can successfully collaborate with case managers in delivering a full package of outcome changing and cost reducing assistance to patients with chronic, treatment resistant, and multimorbid conditions.
  complex care management program: Case Management and Care Coordination Janet Treadwell, Rebecca Perez, Debbie Stubbs, Jeanne W. McAllister, Susan Stern, Ruth Buzi, 2014-07-29 New collaborative models of health care service delivery are contributing to quality and cost improvements, especially in treating children and families. At the same time, deficits in communication between systems sharing patients can not only lead to confusion and waste, but also to increased risk of harm. Case Management and Care Coordination offers an evidence-based framework, best practices, and clinical common sense to meet this ongoing challenge. Focusing on families of children with chronic health issues, it outlines the processes of case management and care coordination, clarifies the roles and responsibilities of team members, and models streamlined, patient-centered service delivery. This analysis cuts through much of the complexity of case management while emphasizing collaboration, flexibility, and advocacy in pursuing best outcomes for patients. And as an extra dimension of usefulness, the book is accessible to lay readers, empowering families to make informed decisions and have a more active role in their own care. Included in the coverage: Essential skills for integrated case management. Children and youth with special health care needs. Transitional care and case management settings for children and families. Case management and home visitation programs. Managed care and care coordination. Technology and care coordination. Effectively illustrating the possibilities and potential of health care reform, Case Management and Care Coordination is an essential resource for pediatricians and health care professionals, as well as for families of children with special health care needs.
  complex care management program: Service Design and Service Thinking in Healthcare and Hospital Management Mario A. Pfannstiel, Christoph Rasche, 2018-12-28 This book examines the nature of service design and service thinking in healthcare and hospital management. By adopting both a service-based provider perspective and a consumer-oriented perspective, the book highlights various healthcare services, methods and tools that are desirable for customers and effective for healthcare providers. In addition, readers will learn about new research directions, as well as strategies and innovations to develop service solutions that are affordable, sustainable, and consumer-oriented. Lastly, the book discusses policy options to improve the service delivery process and customer satisfaction in the healthcare and hospital sector. The contributors cover various aspects and fields of application of service design and service thinking, including service design processes, tools and methods; service blueprints and service delivery; creation and implementation of services; interaction design and user experience; design of service touchpoints and service interfaces; service excellence and service innovation. The book will appeal to all scholars and practitioners in the hospital and healthcare sector who are interested in organizational development, service business model innovation, customer involvement and perceptions, and service experience.
  complex care management program: Case Management of Long-term Conditions Janet Snoddon, 2010-01-05 The importance of appropriate and effective management of patient with long term chronic conditions cannot be underestimated. Case Management of Long-Term Conditions aims to provide all appropriate practitioners (including nurses, pharmacists, physiotherapists, and social care practitioners) who might be involved in delivery of proactive case management with a practical understanding of how their knowledge and skills can be utilised to improve outcomes for people with chronic long-term conditions. The text contains some broad reflections on care and service delivery based on reviews of evidence and views from clinicians in the use of these skills and competencies to deliver improved outcomes for clients.
  complex care management program: Creating a Value Proposition for Geriatric Care James S. Powers, 2017-07-26 This book creates a value proposition in geriatric care - a promise of value to be delivered to improve care and to provide specific benefits to healthcare systems. It describes strategies and understanding of the incentives, barriers encountered in promoting changes in the healthcare systems, and discusses numerous examples and outcomes. Drawn from many fields such as medicine and science, sociology, politics, business and economics, the book helps guide the introduction of geriatric principles into mainstream medical care with the goal of improving the care and quality of life of older persons in all healthcare systems.
  complex care management program: Health Policy and Advanced Practice Nursing Kelly A. Goudreau, Mary Smolenski, 2013-12-11 Print+CourseSmart
  complex care management program: Catholic Bioethics and Social Justice M. Therese Lysaught, Michael McCarthy, 2018-11-16 Catholic health care is one of the key places where the church lives Catholic social teaching (CST). Yet the individualistic methodology of Catholic bioethics inherited from the manualist tradition has yet to incorporate this critical component of the Catholic moral tradition. Informed by the places where Catholic health care intersects with the diverse societal injustices embodied in the patients it encounters, this book brings the lens of CST to bear on Catholic health care, illuminating a new spectrum of ethical issues and practical recommendations from social determinants of health, immigration, diversity and disparities, behavioral health, gender-questioning patients, and environmental and global health issues.
  complex care management program: Optimizing Widely Reported Hospital Quality and Safety Grades Armin Schubert, Sandra A. Kemmerly, 2022-07-26 This practical, engaging book provides concise, real life-tested guidance to healthcare teams concerned with widely reported and incentivized hospital quality and safety metrics, offering both a conceptual approach and specific advice and frameworks for reviewing quality and safety numerator events, from the perspective and experience of clinicians and administrators working within the Ochsner Health System. The text opens with the rationale for closely managing widely (including publicly) reported hospital patient quality and safety measures. Attention is given to the financial implications of quality performance, with respect to both penalties and payment incentives used by payer organizations. It then reviews the major public ratings and their relevant methodologies, including CMS, AHRQ and NSHN. In addition, it addresses ratings by proprietary organizations that have a large member clientele, such as Vizient, USNews, Leapfrog, Healthgrades, CareChex and others. Each metric - for example, the AHRQ Patient Safety Indicators (PSIs), and other metrics such as readmission rate, risk adjusted complications, hospital-acquired conditions and mortality - is addressed in a stand-alone chapter. For each, the importance, approach to review, opportunity for optimization, and engagement of healthcare staff are reviewed and discussed. Overall, this book forefronts the benefits of a collaborative approach within a health system. The concurrent review process, multidisciplinary collaboration among quality improvement, clinical documentation, coding and medical staff personnel are all emphasized. Also described in detail is the approach to and specific opportunities for medical staff education and engagement. Additional key topics include Engagement of the Medical Staff and House Staff (i.e., residents and other trainees), Futile Care, Surgical Quality Improvement (NSQIP), Nursing Provider Partnership, and Translation of Data Review to Successful Performance Improvement. Specialty chapters on pediatric, neurologic and transplant quality metrics are also included.
  complex care management program: Leadership and Nursing Care Management - E-Book M. Lindell Joseph, Diane Huber, 2021-05-18 Develop your management and nursing leadership skills! Leadership & Nursing Care Management, 7th Edition focuses on best practices to help you learn to effectively manage interdisciplinary teams, client needs, and systems of care. A research-based approach includes realistic cases studies showing how to apply management principles to nursing practice. Arranged by American Organization for Nursing Leadership (AONL) competencies, the text addresses topics such as staffing and scheduling, budgeting, team building, legal and ethical issues, and measurement of outcomes. Written by noted nursing educators Diane L. Huber and Maria Lindell Joseph, this edition includes new Next Generation NCLEX® content to prepare you for success on the NGN certification exam. - UNIQUE! Organization of chapters by AONL competencies addresses leadership and care management topics by the five competencies integral to nurse executive roles. - Evidence-based approach keeps you on the cutting edge of the nursing profession with respect to best practices. - Critical thinking exercises at the end of each chapter challenge you to reflect on chapter content, critically analyze the information, and apply it to a situation. - Case studies at the end of each chapter present real-world leadership and management vignettes and illustrate how concepts can be applied to specific situations. - Research Notes in each chapter summarize current research studies relating to nursing leadership and management. - Full-color photos and figures depict concepts and enhance learning. - NEW! Updates are included for information relating to the competencies of leadership, professionalism, communication and relationship building, knowledge of the healthcare environment, and business skills. - NEW! Five NGN-specific case studies are included in this edition to align with clinical judgment content, preparing you for the Next Generation NCLEX® (NGN) examination. - NEW contributors — leading experts in the field — update the book's content.
  complex care management program: The PPACA's High Risk Pool Regime United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations, 2011
  complex care management program: Value Driven Healthcare and Geriatric Medicine James S. Powers, 2018-05-04 Value driven healthcare is the lasting legacy of the Affordable Care Act, which had three goals: to improve access to healthcare by increasing healthcare insurance coverage, to improve the patient’s experience and quality of care, and to slow the rate of increase in healthcare costs. Regardless of changes to the financing of healthcare or changes in policy, value-based purchasing for healthcare is to remain a constant feature of the healthcare horizon. Value-based purchasing is a demand side strategy to reward quality in health care delivery. Value-based purchasing involves cost considerations and includes the actions of employers, the public sector, health plans, and individual consumers in making healthcare decisions. Effective health care services and high performing health care providers are incentivized to provide quality outcomes and to control cost. Value-based purchasing drives quality metrics which are publicly reported and serve as important levers for changes in healthcare delivery. Geriatric patients consume a disproportionate share of healthcare resources, so CMS directs Medicare and drives geriatric healthcare models. All other insurers generally model CMS/Medicare guidelines. Innovative geriatric care models which demonstrate improved outcomes and cost moderation are scaled and lessons learned used to create new healthcare models. The best data for broader value driven healthcare comes from the geriatric models, which currently have the best data available. This book traces the origins of value-based purchasing and current geriatric care models and synthesizes their implications for today's changing health system. It also discusses healthcare accountability and risk sharing. The audience includes geriatric healthcare professionals, but also a wider audience interested in broader healthcare models and value driven healthcare from a policy, economic, and ethical perspective. These include primary care physicians, specialists who work with aging patients, hospital administrators, healthcare educators, healthcare organizations, and all medical professionals working with aging patients and patients affected by healthcare reform.
  complex care management program: Description of the Prescription Drug and Medicare Improvement Act of 2003 United States. Congress. Senate. Committee on Finance, 2003
  complex care management program: 108-1 Committee Print: Description of The Prescription Drug and Medicare Improvement Act of 2003, S. Prt. 108-29, June 2003, * , 2003
  complex care management program: The Future of Nursing Institute of Medicine, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011-02-08 The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
  complex care management program: Realizing the Future of Nursing Cathy Rick, Phyllis Beck Kritek, 2015
  complex care management program: New Models for Delivering and Paying for Medicare Services United States. Congress. House. Committee on Ways and Means. Subcommittee on Health, 2011
  complex care management program: Joslin's Diabetes Mellitus Elliott Proctor Joslin, C. Ronald Kahn, 2005 The bible on diabetes mellitus is now in its Fourteenth Edition—thoroughly revised and updated by more than 80 noted experts from the Joslin Diabetes Center and other leading institutions worldwide. This edition includes a new eleven-chapter section on hormone action and the regulation of metabolism. The section on definition and pathogenesis now includes chapters on genetics, diabetes in Asia and Africa, and diabetes in U.S. minority groups. Other new chapters cover retinopathy, cardiovascular disease, wound healing, and treatment of women with diabetes. All of the Fourteenth Edition's figures have been completely updated.
  complex care management program: 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 care management program: Seemed Like a Good Idea Mark Pauly, Flaura Winston, Mary Naylor, Kevin Volpp, Lawton Robert Burns, Ralph Muller, David Asch, Rachel Werner, Bimal Desai, Krisda Chaiyachati, Benjamin Chartock, 2022-07-28 Informs stakeholders about which changes in health care provision and financing work and which don't. Provides evidence on the evidence.
  complex care management program: Public Health Nursing E-Book Marcia Stanhope, Jeanette Lancaster, 2024-03-13 **Selected for Doody's Core Titles® 2024 in Community Health** Gain a solid understanding of community and public health nursing with this industry-standard text! Public Health Nursing: Population-Centered Health Care in the Community, 11th Edition, provides up-to-date information on issues such as infectious diseases, natural and man-made disasters, and healthcare policies affecting individuals, families, and communities. This edition has been thoroughly updated to reflect current data, issues, trends, and practices presented in an easy-to-understand, accessible format. Additionally, real-life scenarios show examples of health promotion and public health interventions, and case studies for the Next-Generation NCLEX® Examination help strengthen your clinical judgment. Ideal for BSN and Advanced Practice Nursing programs, this comprehensive, bestselling text will provide you with a greater understanding of public health nursing! - Focus on Quality and Safety Education for Nurses boxes give examples of how quality and safety goals, competencies, and objectives, knowledge, skills, and attitudes can be applied in nursing practice in the community. - Evidence-Based Practice boxes illustrate the use and application of the latest research findings in public/community health nursing. - Healthy People boxes describe federal health and wellness goals and objectives. - Check Your Practice boxes feature a scenario and questions to promote active learning and encourage students to use clinical judgment skills as they contemplate how to best approach the task or problem in the scenario. - Linking Content to Practice boxes describe the nurse's role in a variety of public and community health areas, giving specific examples of the nurse's role in caring for individuals, families, and populations. - UNIQUE! Separate chapters covering promoting healthy communities, the Intervention Wheel, and nurse-led health centers teach students the initiatives and various approaches to population and community-centered nursing care. - Levels of Prevention boxes address the primary, secondary, and tertiary levels of community/public health nursing as related to chapter content. - How To boxes provide practical application to practice. - End-of-chapter Practice Application scenarios, Key Points, and Clinical Judgment Activities promote application and in-depth understanding of chapter content.
  complex care management program: What States are Doing to Keep Us Healthy United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions, 2010
  complex care management program: Leadership and Nursing Care Management Diane Huber, 2013-09-24 Research Notes in each chapter summarize relevant nursing leadership and management studies and show how research findings can be applied in practice. Leadership and Management Behavior boxes in each chapter highlight the performance and conduct expected of nurse leaders, managers, and executives. Leading and Managing Defined boxes in each chapter list key terminology related to leadership and management, and their definitions. Case Studies at the end of each chapter present real-world leadership and management situations and illustrate how key chapter concepts can be applied to actual practice. Critical Thinking Questions at the end of each chapter present clinical situations followed by critical thinking questions that allow you to reflect on chapter content, critically analyze the information, and apply it to the situation.A new Patient Acuity chapter uses evidence-based tools to discuss how patient acuity measurement can be done in ways that are specific to nursing. A reader-friendly format breaks key content into easy-to-scan bulleted lists. Chapters are divided according to the AONE competencies for nurse leaders, managers, and executives. Practical Tips boxes highlight useful strategies for applying leadership and management skills to practice.
  complex care management program: Initiating and Sustaining the Clinical Nurse Leader Role James Leonard Harris, Linda Roussel, Patricia L. Thomas, 2016-12-14 Initiating and sustaining the clinical nurse leader role, third edition is an essential resource that outlines the role and core values of the clinical nurse leader while simultaneously providing valuable content for the CNL certification exam. The third edition features expanded content around the CNL role and offers compelling examples that illustrate the CNL's influence on care coordination, health promotion, and high-performance interprofessional care teams.--Page 4 de la couverture.
MEDI-CAL TRANSFORMATION: ENHANCED CARE …
services. Enhanced Care Management makes it easier for members to get the right care at the right time in the right setting, and receive comprehensive care that goes beyond the doctor’s …

Creating a Business Case Template for Care Coordination and …
• Transition of care program focused on high emergency room utilization and readmissions for adult and pediatric diabetics and cancer surgery • In hospital visits RN providing education, …

Integra's Approach to Advance Care Planning - Centers for …
beneficiary enrolls in the complex care management program, the nurse care manager looks to the tool in the EHR to conduct the goals-of-care conversation and then documents the …

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Michigan Medicine Complex Care Management Program Washtenaw County Community Mental Health Department MDHHS Practice Improvement Steering Committee (PISC) June 7, 2018. …

Case Management Services - Government of New York
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impact of redesign on program revenue and may propose future changes to the add-on components if needed. Additionally, the PROS redesign does not impact the utilization …

Finding a Match: How Successful Complex Care Programs …
work closely with primary care teams — such pro-grams are sometimes referred to as “primary-care integrated.” The details of Mr. D’s profile illustrate the complexity of patient selection. The …

APPENDIX W SPECIAL KIDS SPECIAL CARE PROGRAM
Appendix W. Complex Care Management shall be consistent with the care delivery, care coordination, and care management requirements set forth in Section 2.5 of the MCO …

Care Management Referral Form - IEHP
Nov 8, 2022 · The IEHP Care Management Team supports Members in managing their health. IEHP accepts referrals for Care Management for Members needing Complex Care …

SMSO Policy Manual COMPLEX CARE MANAGEMENT …
Policy Name: Complex Case Management Program Approved By: CMO UMPC Approved: 12/21/2023Uncontrolled Last Revised: 08/02/2019; 04/25/2023 if Printed Page 1 of 12. SMSO …

Chronic Care Management Frequently Asked Questions
Aug 16, 2022 · Billing for Chronic Care Management Services Last updated 8/16/2022 ... • CPT codes 99487 – complex CCM, first 60 minutes of clinical staff time directed by a physician or …

Health Homes Program - iehp.org
Jun 12, 2020 · HHP is to improve the overall health outcomes of enrolled Members through the delivery of care coordination and complex care management. HHP is a complex care …

Care Management Institute Guidelines - AAMCN
Care Management Institute (CMI) in 2006 to establish guidelines for Care Management (CM). Today, a year later, the CMI team is pleased to share the guidelines with the general …

Strategic Planning White Paper for Implementation of a …
Sep 19, 2014 · The Wisconsin vision for the Complex Care Management (aka: Super-Utilizer) project is to develop a high-level strategic plan to create a fiscally sustainable Medical …

Enhanced Care Management Program - Health Net
Member is currently enrolled in one of the following programs (Medi-Cal managed care benefit): Basic Case Management Complex Case Management If a box is checked, STOP. Member …

Complex Case Management: Program Description
fragmented care, difficulty in navigating the health care system, or other challenges that threaten to compromise their well-being if not supported through an individualized care plan (ICP). Care …

ENHANCED CARE MANAGEMENT FOR CHILDREN AND …
Providers get started and current ECM Providers refine their ECM program for Medi-Cal managed care plan Members across the state. Enhanced Care Management (ECM) plan (MCP) benefit …

Enhanced Care Management (ECM) - DHCS
case/care management available in these programs. MCP must ensure non duplication of services between ECM and the other program. Basic Case Management. Complex Case …

Department of Veterans Affairs VHA DIRECTIVE 1110.04(1) …
Sep 11, 2019 · for the oversight and management of a comprehensive plan for Veterans with complex care needs. Within the VHA level of care coordination framework, case management …

Complex Case Management Program - Sanford Health Plan
Complex Case Management Program Helping you handle your health when you need it most. sanfordhealthplan.com Is there a cost for the program? ... program or to enroll, please contact …

Care Management Program Description
Page 4 of 13 behavioral, and social needs of patients and their families while promoting quality, cost-effective outcomes.4 Care Manager: An individual with two (2) years’ experience in a …

Special Needs Plans Structure & Process Measures
The goal of complex case management is to help members regain optimum health or ... determined by one specific condition or previous enrollment in condition-specific care …

Chronic Care Management and Advance Care Planning
Complex chronic care management services, with the following required elements: 1. Multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the …

Launching Enhanced Care Management (ECM) for Children …
Jun 23, 2023 · Existing programs with a care coordination/care management component serve many of the same children and youth who will be served in ECM. • ECM will provide whole …

Care Management Resource Guide 2025 - point32health.org
Complex Care Management Policies A. Population Assessment B. Member Identification – Data Sources C. Access to Care Management D. Care Management Systems ... modality of the …

Care Management Analysis Case Management l 2022 30
Treatments for events such as complex cancer cases, organ transplants and premature or complicated pregnancies often involve multiple health care providers and procedures over an …

Population Health Program Description - Kaiser Permanente
Population Health Program by providing education to contracted network providers about the Complex Case Management Program, Care Transitions Program, and Health Profile. These …

Enhanced Care Management, Community Supports, and …
Focus defined by the Department of Health C are Services and provides intensive care management to members with complex health and/or social needs. Note: Members may not …

Introduction EF ISSUE BRI - California Health Care Foundation
Complex Puzzle: How Payers Are Managing Complex and Chronic Care | 3 While most payers agreed that the NCQA definition of complex case management was consistent with their use …

QI 8: Complex Case Management - National Committee for …
Complex case management policies and procedures specify a process for determining if follow-up is appropriate or necessary (e.g., after a member is referred to a disease management …

CountyCare Update - Cook County Health
May 17, 2021 · Complex Care Management & Care Coordination Services • All members – Initial health risk screen/assessment within 60 days of enrollment – Ongoing monitoring for changes …

Chronic Care Management Toolkit - HQIN
Management Program . Patient Eligibility . Chronic Care Management (CCM) services are available to Medicare beneficiaries ... For complex CCM, the care plan must be established or …

Care management program description2022
May 1, 2022 · CountyCare Care Management Program Description 2 ... • Complex Care Management is offered to a subset of high- risk members who have complex needs, crossing …

Serious Illness Approaches by ACOs: MaineHealth …
For its complex care management program, MHACO follows components of the model of coaching from the Care Transitions Intervention™ developed by Dr. Eric Coleman. The …

Tailoring Complex-Care Management, Coordination, and …
Those complex patients account for about half the nation’s health care spending (Cohen and Yu, 2012). HNHC patients are often people who, despite receiv-ing substantial health care …

Complex Care Management Program Overviews | Technology
ComPlex Care management Program overvIew teCnolog University of Missouri TigerPlace Interv I ewee: Marilyn tz, PhD, ran rn, FAAn 4. coordinator interviews potential residents before they …

Complex Care Startup Toolkit - Camden Coalition
3 This research paper helps you to plan for complex care coordination stafing patterns, model design, and implementation. • Effective care for high-needs patients: Opportunities for …

CALAIM ENHANCED CARE MANAGEMENT POLICY GUIDE
Management (PHM) Program. as part of CalAIM. ECM is one component of that . 6 overarching program. Under the new PHM Program, MCPs and their networks and ... within the …

Complex Care at NYC H+H - America's Essential Hospitals
§A proactive “risk list” telephonic outreach program. §A reactive risk program, meeting patients when they went to acute settings. §Universal screening for social needs for all high risk …

Complex Care Management - State of Michigan
Characteristics of Successful Complex Care Management Models • Target individuals most likely to benefit from intervention ... ⁻ Care Management Program “Care management programs …

Health Homes Program
Jun 12, 2020 · HHP is to improve the overall health outcomes of enrolled Members through the delivery of care coordination and complex care management. HHP is a complex care …

Care Management and Wellness Programs - BCBSM
Care Management provides customized programs to members who have complex medical or mental health conditions. Blue Cross Coordinated Care. SM . 1-800-775-BLUE (2583) This …

Pediatric Complex Care Program
Pediatric Complex Care Program 601 Elmwood Ave, Box 777, Rochester, NY 14642 (585) 275-4242 www.golisano.urmc.edu Hours Monday through Friday 8:00 a.m to 4:30 p.m. ... To …

Care management program description 2022 - CountyCare
Feb 22, 2022 · CountyCare Care Management Program Description 5 Benefits of a Delegated Model This arrangement has multiple benefits, listed below. • CM Program staff reach …

Complex Care Assistant Services CCM Members and Families …
What are Enhanced Care Services? 1. Enteral G-tube/J-tube feedings –includes pump set up/discontinuation and/or administering bolus feeds; does not include changing or replacing of …

2025 Provider Manual - AmeriHealth Caritas DC
6 Referrals.....71

Providing and Billing Medicare for Chronic Care …
To help providers understand the rules for billing care management services, we have condensed the regulations and related agency guidance (i.e., webinar presentations, FAQs, and Medicare …

Care NavigationCapability Briefs - collectivehealth.com
Care Navigation is an interdisciplinary care management program offered by Collective Health. The team utilizes a holistic approach to identify and engage members with complex needs and …

High-risk care management - advisory.com
The high-risk care management program at Massachusetts General Hospital resulted in: •Reduced acute care costs (7% net savings) •Reduced hospitalization (35% lower than control …

NYS Office of Mental Health 14 NYCRR Part 599 Mental …
System Reform Incentive Payment (DSRIP), intensive outpatient program (IOP), School-Based Mental Health, and Utilization Threshold exempt services for court order/AOT/SIST. FQHCs …