Positively impacting and improving patient wellbeing and health care outcomes.
Case ManagementExhibitor InformationWhat Exhibitors Should Know About CMSA
Positively impacting and improving patient wellbeing and health care outcomes.
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.
Positively impacting and improving patient wellbeing and health care outcomes.
Primary Work Settings
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
We Serve Many People Along the Health Care Continuum
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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;
Positively impacting and improving patient wellbeing and health care outcomes.
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)
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
Case Management Society of AmericaCONNECTING YOU TO CASE MANAGERS
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
Case ManagementAdherence Guidelines
• Adherence Assessment• Motivational Interviewing• Follow-up• Using:• Accessible Material• Focused Learning• Tools and Resources
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
Corporate Partnership
• Access to attendee and membership lists
• Discounts for exhibit booths and other CMSA products
• Complimentary individual memberships and conference registrations
• Heightened visibility
Positively impacting and improving patient wellbeing and health care outcomes.
2010 Annual Conference & Expo
CMSA’S 20th ANNIVERSARYJune 8 – 11, 2010
Walt Disney WorldCoronado Springs Resort
Orlando, Florida
www.cmsa.org/conference
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
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
Positively impacting and improving patient wellbeing and health care outcomes.
• EXHIBIT BOOTHS: contact the Exhibit Management Team for more information
• SPONSORSHIPS:available for all budgetsand guidelines
• STRATEGIC PACKAGES
Conference Opportunities
Positively impacting and improving patient wellbeing and health care outcomes.
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]
Positively impacting and improving patient wellbeing and health care outcomes.
Thank You for Your Supportof Case Management