Improving the outcomes for patients in our changing healthcare system is not straightforward. This grounding publication on case management helps physicians better meet the unique needs of patients who present with poor health and high healthcare-related costs, i.e., health complexity. It details the many challenges and optimal practices needed to work effectively with various types of case managers to improve patient outcomes. Special attention is given to integrated case management (ICM), specifically designed for those with health complexity. The book provides a systematic method for identifying and addressing the needs of patients with biological, psychological, social, and health-system related clinical and non-clinical barriers to improvement. Through ICM, case managers are trained to conduct relationship-building multidisciplinary comprehensive assessments that allow development of prioritized care plans, to systematically assist patients to achieve and document health outcomes in real time, and then graduate stabilized patients so that others can enter the case management process. Patient-centered practitioner-case manager collaboration is the goal.
This reference provides a lexicon and a roadmap for physicians in working with case managers as our health system explores innovative ways to improve outcomes and reduce health costs for patients with health complexity. An invaluable, gold-standard title, it adds to the literature by capturing the authors' personal experiences as clinicians, researchers, teachers, and consultants. The Physician's Guide: Understanding and Working With Integrated Case Managers summarizes how physicians and other healthcare leadership can successfully collaborate with case managers in delivering a full package of outcome changing and cost reducing assistance to patients with chronic, treatment resistant, and multimorbid conditions.
ForewordPrefaceAcknowledgments I. Overview of Case Management, Health Complexity, and the Integrated Case Management Approach 1. Patient Health Care Assist and Support Services, Integrated Case Management, and Complexity Assessment Grids2. Health Complexity and the Interaction Between Physical and Behavioral Health Conditions in Adults 3. Health Complexity and the Interaction Between Physical and Behavioral Health Conditions in Children and Youth 4. The Organizational and Operational Setup of Adult Integrated Complex Case Management5. The Organizational and Operational Setup of Pediatric Integrated Complex Case Management6. Indirect and Direct Physician Support for Integrated Case Management in Adults7. Indirect and Direct Physician Support for Integrated Case Management in Children/Youth II. Guidelines for Physicians Working to Maximize Patient Outcomes in Collaboration with Integrated Case Managers8. Organizing and Implementing Value-Added Integrated Case Management9. Connecting Integrated Case Management with Integrated Complex Inpatient and Outpatient Care10. Physicians' Contributions to Building and Participating in a Population-Based Case Management Center of Excellence III. AppendicesAppendix 1. Integrated Case Management (ICM) Algorithmic Triage StrategiesAppendix 2. Adult Integrated Case Management-Complexity Assessment Grid (ICM-CAG) Variables and their Clinical Anchor PointsAppendix 3. Scripted Dialogue for AdultsAppendix 4. Elina's ICM-CAG Assessment StoryAppendix 5. Scripted Dialogue for Children/Youth and Parents/CaregiversAppendix 6. Care Plan Development SheetAppendix 7. Measurement of Progress: Goals, Actions, OutcomesAppendix 8. Pediatric Record for Outcome Measurement (ROM)Appendix 9. Pediatric ICM-CAG Variables and AnchorsAppendix 10. Pediatric ICM-CAG Item Anchor Point ActionsAppendix 11. Understanding "Complexity Assessments" for Youth and Families Helped by Case ManagementAppendix 12. Understanding "Complexity Assessments" for Clinicians with Youth in Case ManagementAppendix 13. Notification Letter to Patient's Clinician(s)Appendix 14. Universal Consent FormAppendix 15. Adult ICM-CAG Item Anchor Point ActionsAppendix 16. Understanding "Complexity Assessments" for Persons Entering Case Management Appendix 17. Understanding "Complexity Assessments" for Clinicians with Patients in Case ManagementAppendix 18. Barriers to AdherenceAppendix 19. Adult Record for Outcome Measurement (ROM)Appendix 20. Core ICM PrinciplesAppendix 21. Core ICM Practices Needed to Implement the full ICM ComponentsAbbreviationsGlossary of TermsIndex