Case Management Chapter 1: Overview of Case Management

Question 1

CMSA definition of case management

Answer 1

Collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet as individual health needs through communication and available resources to promote quality and cost-effective outcomes.

Question 2

CCMC definition of case management

Answer 2

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

Question 3

Managed Care vs. Case Management

Answer 3

Managed care systems oriented and focuses on health insurance plans and management of member benefits. Case management is people oriented and negotiates the managed care systems in a way that ideally benefits everyone, particularly patient.

Question 4

Milestones in evolution of Case Management

Answer 4

1990s- public health sector
1920s- behavioral health 
1930s- community based
1940s- workers comp
1970s- return to work/work comp focus
1978- CM services for elders
1980s- CM for catastrophically ill or injured
1990s- Hospital based, practiced across health care continuum.

Question 5

Strategies in ensuring effective case management model

Answer 5

Collect and analyze data, assess gaps in education and training, set organizational goals, consider standards of regulatory agencies, redesign implementation process, determine system of measurement of effectiveness

Question 6

CCM

Answer 6

Refers to designation board-certified case manager

Question 7

CCMC

Answer 7

Commission for Case Manager Certification

Question 8

Case Management Process

Answer 8

Assessment, Planning, Implementation, Coordination, Monitoring, Evaluation, Outcomes

Question 9

Assessment

Answer 9

process of collecting in-depth information about client’s situation and functioning to identify individual needs in order to develop a comprehensive case management plan that will address those needs. In addition to client, information should also be gathered form other relevant sources (professional and non-professional caregivers, employers, health records, educational/military records, etc.)

Question 10

Planning

Answer 10

Process of determining and documenting specific objectives, goals, and actions designed to meet client’s needs as identified through the assessment process. Plan should be action-oriented and time specific.

Question 11

Implementation

Answer 11

Process of executing and documentating specific case management activities and/or interventions that will lead to accomplishing goals set forth in case management plan.

Question 12

Coordination

Answer 12

Process of organizing, securing, integrating, modifying, and documenting the resources necessary to accomplish the goals set forthe in the case management plan.

Question 13

Monitoring

Answer 13

Ongoing process of gathering sufficient information from all relevant sources and its documentation regarding the case management plan and its activities and/or services to enable the case manager to determine the plan’s effectiveness.

Question 14

Evaluation

Answer 14

The process, repeated at appropriate intervals, of determining and documenting the case management plan’s effectiveness in reaching desired outcomes and goals. Might lead to modification or change in the case management plan in its entirety or in any of its component parts.

Question 15

Outocomes

Answer 15

Process of measuring the interventions to determine the outcomes of case management involvement.