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

Contents

SECTION I: THE ROLE OF INTEGRATED CASE MANAGEMENT IN ADDRESSING COMPLEXITY

Chapter 1: Defining Healthcare Complexity

Chapter 2: The Mechanics of an Integrated Case Management Approach

Chapter 3: The Interaction of Medical and Behavioral Conditions

SECTION II: STRATEGIES FOR PATIENT ENGAGEMENT AND RETENTION

Chapter 4: Communication Methods and Techniques

Chapter 5: Building Relationships

Chapter 6: Patient/Person-Centered Care

Chapter 7: Addressing Social Determinants

Chapter 8: Addressing Health Inequities

SECTION III: ADDRESSING COMPLEX PATIENT POPULATIONS USING AN INTEGRATED CASE MANAGEMENT APPROACH

Chapter 9: Common Physical and Mental Health Conditions

Chapter 10: Assessing the Adult Patient Through Application of the Integrated Case Management Complexity Assessment Grid

Chapter 11: Assessing the Pediatric Patient Using the Integrated Case Management Complexity Assessment Grid

Chapter 12: Targeted Care Planning and Care Transitions

SECTION IV: SPECIALTY POPULATIONS

Chapter 13: Trauma Survivors: Trauma Informed Care

Chapter 14: Children with Special Healthcare Needs

Chapter 15: Integrated Case Management for Veterans

Chapter 16: Maternal Child Health

SECTION V: INTERDISCIPLINARY TEAMS AND USING ICM TO IMPROVE OUTCOMES

Chapter 17: Composition, Roles, and Functions in Value-based Reimbursement Models

Chapter 18: The Integrated Case Management Complexity Assessment Grid as An Outcome Measure

APPENDICES

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: Integrated Case Management Complexity Assessment Grid (ICM-CAG)

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

Appendix M: VA Affairs Integrated Case Management Standards of Practice

Appendix N: Emotional Intelligence Questionnaire

Authors

Rebecca Perez, MSN, RN, CCM, FCM is an experienced Registered Nurse with a master's degree in nursing, is a Certified Case Manager, a member of the Omega Gamma Chapter of Sigma Theta Tau International Nursing Honor Society, Capella University National Society of Leadership and Success, and a member of the National Quality Forum Leadership Consortium. Her most recent works are primary author for Case Management Society of America Integrated Case Management: A manual for Case Managers by Case Managers, Second Edition, CMSA's Case Management Adherence Guide 2020, CMSA's Case Management Adherence and Transition of Care Guide for Clostridiodes difficile, and CMSA's Case Management Adherence and Transitions of Care Guide for Hepatic Encephalopathy. She is the author of numerous professional articles and resources for CMSA, and speaker on case management topics. She is the Senior Manager of Education for CMSA and Executive Director for the Case Management Society Foundation. She was recently awarded a Fellow in Case Management designation.

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