positively impacting and improving patient wellbeing and health care outcomes. case management...

Positively impacting and improving patient wellbeing and health care outcomes.

Case ManagementExhibitor InformationWhat Exhibitors Should Know About CMSA


Case Management Definition

CASE MANAGEMENT is a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.


Primary Work Settings


One Job – Many Duties

• Pre-certification• Benefit Determination• Risk Management• Medical Legal Consultation• Life Care Planning• Disease Management• Utilization Management• Case Management• Discharge Planning• Health & Wellness Coaching• Research• IT or Data Services

• Direct Patient Care/Education• Product Development• Disability Management• Negotiation – contracts & fee

schedules• Telephonic/On-site Case

Management• Medication Therapy

Management• Education – patient, provider,

& staff• Accreditation • Telephonic Demand

Management

Question: What Tasks Are Currently Included in Your Job Duties?

Source: CMSA 2007 State of the Industry Survey


Industry Issues

• Health Care Reform• Care Coordination• Transitions of Care• Patient Safety• Medication Reconciliation• Payment Alignment & Performance Measures• New Models of Care• Patient & Family Caregiver Engagement• Collaborative Practice


Patient

ER ICU

In-Patient

Patient

OUTPATIENT:• Home• PCP• Specialty• Pharmacy• Case Mgr.• Care Giver

SNF ALF

EDCase Mgr

HospitalCase Mgr Managed

CareCase Mgr

Continuum Case Mgrs

Transition Issues DramaticallyImpact Patient Care


We Serve Many People Along the Health Care Continuum


One Job – Many NamesMY JOB TITLE IS:– Case Manager– Care Manager– Care Coordinator– Discharge Planner – Disease Manager – Department Supervisor – Department Manager – Department Director– Utilization Manager– Other

• Social Worker• Senior Care/Rehab • Occupational Nurse

Source: CMSA 2007 State of the Industry Survey


CMSA Standards of Practice:

• Evolution of the SOP• Definition of CM• CM Practice Settings• CM Roles, Functions,

Activities• Components of the CM

Process• Standards of Practice• Glossary and Acronyms• References

Currently

under revision


Today’s Case Manager

• Today, case managers are in most elements of the payer and provider communities where the need to balance quality care and cost-effective care exists.

• The process of case management begins with identification of high-cost, complex care individuals who meet criteria for and can benefit from case management services

Source: CMSA Standards of Practice


Healthcare Reform – On The Horizon

• Baucus Call to Action – Strengthening the role of Primary Care and Chronic Care Management

• H.R. 2773 – Supports the Transitional Care Model• The Senate Health, Education, Labor and

Pensions (HELP) Committee released a “draft of a draft” of healthcare reform legislation. – Group and individual health insurers must implement

a reimbursement structure that provides incentives for:• The implementation of case management, care coordination,

and chronic disease management activities for treatment or services under the plan;


Collaborative Care, Care Coordination and Transitions of Care Models

• Dr. Eric Coleman – Transition Coaching• Dr. Mary Naylor – Transitional Care Model• Dr. Chad Boult – Guided Care Nurses• Medical Home Demonstration • National Transitions of Care Coalition (NTOCC)• American Geriatric Society• National Coalition on Care Coordination (N3C)


DevelopingCare Coordination Measures

• CMS 9th SOW supports Care Coordination– Care Pathways

• 2009 TJC Patient Safety Standard #8 enhanced Medication Reconciliation to include patient and caregiver involvement and transition– Documentation of process

• NQF developing Performance Measures for Care Coordination– Call for Best Practices December 2008– Measures Development in 2009

• URAC incorporating TOC principals in revised CM Standards

• AMA – PCPI Transitions of Care – ACP/SHM/ABIM Foundation/PCPI will develop jointly practitioner-level

performance measures for transitions of care


The Continuum of CareClinical & Administrative Transactions

Pharmacy Employer

Physician Office

Specialist

Case Manager

Hospital

Community HealthCenter

PBM

Patient

AdherenceAssessment & Support

Health Promotion

Motivational Advocacy

Prescr

iption

Assessm

ent &

Care

Plan

Motivational InterventionsAdvocate

Assessment

Medication Reconciliation

Care Plan

AdherenceAssessment & SupportCoordination

Non-Adherence

Behavior Health Change

Facilitation

Increase Productivit

y


Case Management Society of AmericaCONNECTING YOU TO CASE MANAGERS


Expanding Our Reach• Currently approaching 12,000

members– Additional 15,000 subscribers– Over 200 company members– 75 geographic chapters

• Presence across the continuum– 34% in managed care/insurance– 26% in acute care/hospital setting– 12% in work comp/occupational

health/employers– 9% in government

agencies/military


Reaching Case Managers Year-Round

• Educational opportunities and events– In-person and on-line– With or without continuing education credits

• Tools and resources

• Increasing knowledge and case management effectiveness


COURSEWORK LEVELS

• Basic• Intermediate• Advanced

• FREE CE and Non-CE Courses (CM/DM/UM)• My Coursework• Masters Level Coursework • Other Resources• Business Courses

INCLUDED IN MEMBERSHIPCMSA’s online educational

resource offers programs to care managers and allied health professionals serving the care

management industry.

Educational Research Library


Case ManagementAdherence Guidelines

• Adherence Assessment• Motivational Interviewing• Follow-up• Using:• Accessible Material• Focused Learning• Tools and Resources


Growth of CMAG• Currently in second revision• In 2006, launched first

disease specific supplement:– Diabetes– DVT– Depression – Cardio metabolic risk– COPD (in development)

• Translated into three languages


Resource Paths

• Guides used by case managers to help navigate assessment, treatment and intervention

• Designed to be mentoring and “as needed” training devices

• Can incorporate new clinical, assessment and intervention methods

• Advocate to the health care team


Corporate Partnership

• Access to attendee and membership lists

• Discounts for exhibit booths and other CMSA products

• Complimentary individual memberships and conference registrations

• Heightened visibility


2010 Annual Conference & Expo

CMSA’S 20th ANNIVERSARYJune 8 – 11, 2010

Walt Disney WorldCoronado Springs Resort

Orlando, Florida

www.cmsa.org/conference


New Outreach Opportunities

• Educational and Promotional Events– CE Symposia– Non-CE Symposia

• General Conference Sponsorships– 12 months of promotion• Website• Print material• E-communications

– Signage and recognition


Partnering With Disney• Coast-to-Coast Party

Kick-Off Event– Exclusive use of Disney’s Hollywood

Studios– Unique branding and promotion

opportunities– Exclusive and wide-spread promotion

of sponsors• Disney’s Exhibitor

Concierge Service– Theme Park Events & Tickets– Entertainers– Cutting edge AV and booth

presentations


• EXHIBIT BOOTHS: contact the Exhibit Management Team for more information

• SPONSORSHIPS:available for all budgetsand guidelines

• STRATEGIC PACKAGES

Conference Opportunities


Key Contacts

• MICHELLE KOCHDirector, Corporate [email protected]

• LINDSAY HARPAccount [email protected]

• J. MICHAEL HOEHNVice-President,Business [email protected]

• HARRY ALBACorporate [email protected]

• SYLVIA JOHNSONConference [email protected]

• SHELLY GREENWOODEvent [email protected]


Thank You for Your Supportof Case Management

positively impacting and improving patient wellbeing and health care outcomes. case management...

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