Liberty Mutual used case management to help with this population's cost management
in the 1940's. - Workers' Compensation
Early public health case management efforts focused on these two areas. - Psychiatry
and social work.
Following this event many insurance companies employed nurses and social workers to
take care of patients with multiple and complex injuries. - World War II
Intracorp - Founded by CIGNA in 1966 for workers' compensation; included both
vocational rehab and nursing care management; aimed at cost management
Health Maintenance Organization Act of 1973 - Removed restrictions and provided
grants and loans to develop HMO alternatives to traditional health care
The Older Act of 1978 - Resulted in case management of elders throughout the US
Case management and utilization review for medical necessity were adopted into
general insurance pools in this decade - 1980's
Case Management - A cost containment tool for managing complex and catastrophically
ill and injured patients. It is considered an advanced practice of various healthcare
professions.
Case Management Society of America - Founded in 1995. Published the first Standards
of Practice for Case Management.
Standards of Practice for Case Management - 1995, 2002, and 2010 - present core
functions, roles, responsibilities and relationships integral to professional case
management practice across the health care continuum.
Health Information Technology for Economic and Clinical Health Act of 2009 - Part of
the American Recovery and Reinvestment Act of 2009, this allotted billions of dollars to
the expansion as well as the adoption of information technology to create a national
network of electronic health records.
National Transitions of Care Coalition - Formed in 2006 by Case Management Society
of America and Sanofi to bring stakeholders together to address solutions and tools to
address gaps in continuity. Became and independent organization in 2012.
, Patient Protection and Affordable Care Act of 2010 - Provisions repeatedly focus on
coordination of care and care transition initiatives as integral to demonstration projects
for community based care transitions and outcomes reporting.
Case Management Society of America's definition of case managment - A collaborative
process of assessment, planning , facilitation, care coordination, evaluation and
advocacy for options and services to meet an individual's and family's comprehensive
health needs through communication and available resources to promote quality cost-
effective outcomes.
Philosophy - A statement of belief that sets forth principles to guide a program and the
individual in their practice of that program
Case management philosophy - The belief that when an individual reaches the optimum
level of wellness and functional capability everyone benfits
Case Management framework - Serves as a means for achieving client wellness an
autonomy through advocacy, communication, education, identification of service
resources and service facilitation.
12 Principles of case management - 1. Client centric collaborative approach 2. Facilitate
self-determination and self-care through the tenets of advocacy, shared decision
making and education 3. Holistic 4. Cultural competence 5. Evidence Based 6. Promote
safety 7. Promote integration of behavioral change science 8. Link with community
resources 9. Assist with navigating the health are system 10. Pursue professional
excellence 11. Promote quality outcomes and measurements
12. Support compliance with rules and regulations.
Problem with case management coding based reimbursement - Many case managers
are not recognized as providers capable of billing for their services
7 models heavily reliant on case management - 1. Patient Centered Medical Home 2.
Integrated Health Care Delivery Systems 3. Accountable Care Organizations 4.
Population Health Management 5. Outcomes based reimbursement with shared risk 6.
Value based purchasing 7. Public/private alignment of data collection and measurement
Integrated Case Management - Assisting of patients with complex needs to receive
coordinated physical, mental, and substance use services without cross-disciplinary
handoffs. Managers focus on biological, physical, social, psychological and health
system problems concurrently.
Integrated Case Management hallmarks - 1. Requires advanced training 2. Performs
systemic complexity assessments 3. Develops/uses comprehensive/coordinated
physical and mental health care plans 4. Uses complexity based anchor points in
specially designed ICM clinical documentation software 5. Record ongoing outcomes for
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