1.1 CM process and Tools

Question 1

CCMC defines CM as…

Answer 1

“a collaborative process that assesses, plans, implement, coordinates, monitors, and evaluates the options and services required to meet the client’s health and human services needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes”.

Question 2

CM process according to the Body of Knowledge…

Answer 2

o	Screening
o	Stratifying risk
o	Assessing
o	Planning
o	Implementing (care coordination)
o	Following up
o	Transitioning (transitional care)
o	Communication post transition
o	Evaluation

Question 3

Many phases will take place_______ or be revisited and repeated.

Answer 3

concurrently

Question 4

Clients may be appropriate for CM based on

Answer 4

o	Diagnosis
o	High dollar diagnosis
o	High utilization
o	Poor pain control
o	Chronic catastrophic illness
o	Social issues, such as weak or nonexistent support system
o	Difficult discharge planning
o	Financial issues

Question 5

Case Managers use _____ ______ and ____ ____ ____ tools to classify clients into low, moderate, or high risk categories.

Answer 5

biometric screening; health risk assessment

Question 6

The _____ phase is similar to screening but provides a more in-depth look into the client’s healthcare situation

Answer 6

assessment

Question 7

The assessment phase may include

Answer 7

• Medical history
• Current medical conditions
• Functional status
• Cognitive status
• Health insurance status
• Spiritual life
• Psychosocial concerns
• Environmental
• Vocational/educational status
• Financial status
• Support system
• Culture and language
• Self care capability
• Health literacy
• Health goals
• Readiness to change
• Past and current service utilization
• Current medications
• Safety

Question 8

The ______ are the treatments, resources and services needed to meet the client’s needs and goals and should apply evidence-based standards and care guidelines

Answer 8

interventions

Question 9

SMART stands for….

Answer 9

Specific
Measurable
Achievable
Realistic
Timely

Question 10

The case management plan is carried out during the _______ phase, also called care coordination

Answer 10

Implementation

Question 11

The CM acts as a liaison between the…

Answer 11

Client
caregivers
providers
payer

Question 12

The interventions arranged in the planning phase are..

Answer 12

executed
coordinated
secured

Question 13

What is it called when modifications are made to the plan as needed?

Answer 13

Following up/ Monitoring

Question 14

____ ____ ____ across the health and human services continuum or to differing levels of care, put the client at ___ ____ for ____ _____

Answer 14

Transitions of care; increased risk; adverse events

Question 15

Evaluation may focus on multiple aspects of care:

Answer 15

• A financial evaluation with a cost-benefit analysis and return on investment
• Clinical outcomes
• Quality of life
• Client satisfaction
• Self-care management ability
• Knowledge of health conditions