Full Description
Written by case managers for case managers, this reference manual for nurses and other health professionals presents a Case Management Society of America (CMSA)-tested approach toward 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 (PPACA), Mental Health Parity, Transition of Care & Chronic Care Management, and the Medicare Access and CHIP Reauthorization Act (MACRA), health care 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.
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, the CMSA Standards of Practice 2016, and the CMSA Core Curriculum for Case Management, Third Edition.
Contents
Contents
Foreword by Mary McLaughlin Davis, DNP, MSN, ACNS-BC, NEA-BC, CCM
Preface
Acknowledgments
PART I: Introduction to Integrated Case Management and Its Models
1. The Evolution of Case Management and the Professional Case Manager
2. Mechanics of Integrated Case Management, Health Complexity, and Integration Between Behavioral Health and Physical Health
3. Global Models of Integrated Case Management
PART II: Assessment of Patient Populations Using Integrated Case Management
4. Assessing the Adult Patient Through Application of the Integrated Case Management Complexity Assessment Grid
5. Assessing the Pediatric Patient Using the Integrated Case Management Complexity Assessment Grid
6. Common Physical and Mental Health Conditions
PART III: Strategies for Optimal Patient Communication and Outcomes With Integrated Case Management
7. Addressing Social Determinants: Clinical Versus Nonclinical Issues
8. Motivational Interviewing and Shared Decision Making for the Medically Complex Patient and Family Caregiver
PART IV: Transitions of Care and Accreditation Care in Integrated Case Management
9. Interdisciplinary Care Teams Fostering Successful Transitions of Care
10. Professional Case Management Accreditation Care Coordination Measures and Outcomes
Appendix A. CMSA's Definition of Professional Case Management and the Standards of Professional Case Management Practice
Appendix B. Interdisciplinary Case Management Team
Appendix C. Triggers for Integrated Case Management Intervention
Appendix D. Adult Integrated Case Management Complexity Grid
Appendix E. Adult Integrated Case Management Complexity Grid Elements and Rating Scales
Appendix F. Pediatric Integrated Case Management Complexity Grid
Appendix G. Pediatric Integrated Case Management Complexity Grid Elements and Rating Scales
Appendix H. ICM-CAG Scoring Sheet
Appendix I. PIM-CAG Scoring Sheet
Appendix J. Definition of Terms
Appendix K. Abbreviations
Appendix L. Suggested Scripted Interview Questions
Index
