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The case manager's handbook / Catherine M. Mullahy, BS, RN, CRRN, CCM, President, Mullahy & Associates, LLC, Huntingdon, New York

Author:
Mullahy, Catherine M.
Published:
Burlington, MA : Jones & Bartlett Learning, [2017]
Copyright Date:
©2017
Edition:
Sixth edition.
Physical Description:
xxi, 746 pages : illustrations ; 24 cm

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Contents:
Machine generated contents note: ch. 1 Case Manager as Catalyst, Problem Solver, Educator -- Case Manager's Role -- Case Management Is Not Equivalent to Managed Care -- Medical Credentials and Expertise -- Definition of Case Management -- Case Management Role and Functions -- Certification, Accreditation, and Standards of Practice -- Proliferation of New Titles Encroaching on the Case Manager's Role -- ch. 2 Case Manager's Universe -- Healthcare Providers -- Managed Care: HMOs, PPOs, MCOs, IPAs, PHOs, PSOs, and EPOs-and Now ACOs and PCMHs! -- Standards of Care -- ch. 3 Case Management Work Format and Process -- Case Management Defined -- CCM Domains of Knowledge -- Screening -- Stratifying Risk -- Planning -- Implementing Care Coordination -- Following Up -- Transitioning -- Evaluating -- Screening and Stratifying Risk Discussion -- Referral Sources -- Assessing Discussion -- Talking with the Patient -- Talking with the Family -- Talking with the Treating Physician -- Telephonic Case Management -- Talking with Other Professionals -- Planning Discussion -- Obtaining Approval -- Implementing Care Coordination: Putting the Plan into Action -- Follow-Up (Ongoing) Discussion -- Transitioning (Transitional Care) Discussion -- Communicating Posttransition Discussion -- Evaluating the Plan Discussion -- Repeating the Process -- Communication in Various Settings -- Stay on Point -- ch. 4 Communications and Patient Engagement -- Back to the Basics -- What Is Patient Engagement? -- Patient Engagement and Shared Decision Making -- Motivational Interviewing -- Changes in How We Communicate -- Communications within New Models of Care -- Engaging Patients and Their Families in New Ways -- Communicating with Physicians: Challenges and Strategies -- Practical Steps to a Win-Win Relationship between Case Managers and Physicians -- Communication with Patients and Families -- Communication with Payer Sources -- Communication with Legal Professionals -- Communication Subtleties -- Right Mind-Set -- Communication and Caring Overload: Burnout Red Flags for Case Managers -- ch. 5 Hospital Case Management: Changing Roles and Transitions of Care -- ch. 6 ACOs, PCMHs, and State Health Exchanges -- Accountable Care Organizations -- Patient-Centered Medical Homes -- Case Managers Serving in the PCMH -- Case Study of Case Management in the PCMH -- State Health Exchanges -- ch. 7 Independent Case Management -- Independent, Disciplined, Proactive -- Case Manager as Change Agent -- Opportunities Are Waiting, Are You Ready? -- Becoming an Independent Case Manager -- For Your Business or Department -- Developing a Business Plan -- Pricing the Market -- Looking at the Competition -- Networking and the Professional Community -- Business Community -- Generating New Business -- Hiring Additional Staff -- Defining Success -- Business Websites -- ch. 8 Home Care Case Management, Long-Term Care, and Healthcare Reform -- Consumer Demand-and Ambivalence -- Case Manager as a Pivotal Link -- Cases in Profile -- Ongoing Support at Home -- Importance of Feedback and Communication -- Payment Concerns -- Tools to Help You Assess the Quality of Care You Are Receiving -- Informing the Client -- Level of Involvement -- Importance of Ongoing Involvement -- Changes in Long-Term Cases -- Negotiating for Long-Term Care -- Employing all Possible Resources -- Long-Term Care of the Elderly -- Implications of Long-Term Care for the Family -- Implications of a Long-Term Case for the Case Manager -- From Acute Care to Home Care: A Case History -- ch. 9 Pediatric Case Management -- Challenges Facing Pediatric Case Managers -- Achieving Quality Improvements in Pediatric Case Management -- Medicaid and the Pediatric Patient -- Levels of Pediatric Case Management -- Children's Hospitals -- Immunizations -- Caring for Children with Mental Health Problems -- Benefits of Case Management -- ch. 10 Workers' Compensation Case Management Overview -- Benefits -- Costs and Occurrence -- Workers' Compensation Case Management and Rehabilitation Management -- Impact of the Affordable Care Act -- Veterans' Return to the Workforce -- Mediating Workers' Compensation Claims -- Other Issues in Workers' Compensation Case Management -- Workers' Compensation and Implications for Case Managers -- Value-Based Health Care: Workers' Compensation and Case Management -- ch. 11 Legal Responsibilities of the Case Management Professional -- Malpractice -- Other Legal Issues: Patient's Bill of Rights and Patient Confidentiality -- Medical Records, Electronic Health Records, and HITECH -- Right to Know versus the Need to Know -- Disclosure Issues -- Adequate Information -- Contracts and Letters of Agreement -- Legal Issues in Case Management -- U.S. Legislation Relevant to Case Management -- ch. 12 Ethical Responsibilities of the Case Management Professional -- Patient Rights and Case Manager Responsibilities -- Ethics and Medical Errors -- Codes of Ethical Conduct -- Objectivity and Common Sense -- Look to Your Resources -- ch. 13 Evidence-Based Practice for Case Managers: Data-Driven Decision Making -- What Exactly Is Evidence-Based Practice? -- Evidence-Based Practice for Case Managers -- Evidence -- Case Management: Specific Evidence-Based Resources -- Applying Evidence-Based Case Management -- Conclusion -- ch. 14 Case Manager Credentialing and Organizational Accreditation -- Certified Case Manager (CCM) -- CCM Exam -- Before CCM, to the Wide Array of Credentials Now Available -- Certified Professional in Healthcare Quality (CPHQ) -- Concerns and Questions -- ch. 15 Reimbursement Resources and Challenges -- Insurance Providers and Administrators -- Basic Insurance and Administrative Company Players -- Administrative and Customized Services -- Employers and Case Managers Respond to Costs -- ch. 16 Healthcare Reimbursement: Private Sector or Employer Sector -- Auto Insurance -- Health Benefit Insurance: Employer-Sponsored or Private Indemnity Plans -- Group Medical Plans: HMOs, PPOs, and POS Plans -- Disability Insurance Plans: Short Term and Long Term -- Consumer-Driven Healthcare Plans -- Diagnosis-Specific Benefits -- Traditional Insurance versus Self-Funded Plans -- Stop-Loss Insurance Plans -- Viatical Settlements -- Nontraditional Policies -- Riders to Life Insurance Policies -- Coordination of Benefits -- ch. 17 Healthcare Reimbursement: Public Sector -- New Directions in Public Sector Case Management -- Funding Sources for Public Sector Health Benefits -- Economic Impact and Government Response -- Case Manager in the Public Sector -- CMS Population Groups Challenge Managed Care Industry and Providers -- Challenges for Case Managers -- Remaining Complications -- Nonmedical Challenges Influence Outcomes -- Military (Active and Veteran) Case Management -- Conclusion -- ch. 18 Working Effectively with Claims Departments: Case Managers in Consulting Roles -- Claims Department Structure and Operations -- Computerization -- Claims Issues -- Indicators for Case Management -- Case Manager as Consultant -- Tracking Claims by Group -- Tracking Claims by Individual Claims Histories -- Moving into the Consultant Role -- ch. 19 Outcomes Management with Analysis of Financial and Quality Assurance Reporting -- Financial and Quality Assurance Reporting -- Dollars and Health Care -- Negotiating Skills -- Nuances between Negotiating with Providers and Payers -- Negotiating in a Managed Care Environment -- Documenting Negotiated Arrangements -- Cost-Benefit Analysis Reports -- Cost-Benefit Analysis Summaries -- Quality Assurance Programs -- Explaining Difficult Situations -- Feedback from Patients -- Sharing Questionnaire Results -- Communicating Success -- ch. 20 New Strategies for Leading a Case Management Department: Today and into the Future -- What Is the Difference between Leadership and Management, and Does It Matter? -- Redefining Case Management -- Evaluating a Case Management Department -- Business Considerations for Your Case Management Department -- Recruiting and Hiring Additional Staff -- Search for Case Managers, and the Retention of Valued Ones -- Training and Continuing Education -- Staffing -- Outcomes -- Positioned for Success -- ch. 21 Predictive Modeling and Case Stratification -- What Is Predictive Modeling? -- Implications for Case Management Practice -- Conclusion -- ch. 22 New Characteristics of Today's Healthcare Systems -- Continuation of Hospital Consolidations -- Continued Development of New Care Models -- Growing Shortage of Physicians -- ch. 23 Case Manager's Role in the Era of Value-Based Health Care -- Measuring Clinical Outcomes to Demonstrate a Provider's Efficient Care -- Hospitals Entering New Risk Arrangements with Payers -- Role of Case Managers in Value-Based Models -- Healthcare Price Transparency -- ch. 24 New Case Management and Healthcare Provider Approaches for Managing the High-Risk, High-Cost Patient -- Identifying the Superutilizer Patient -- Predictive Modeling -- Population Health Management -- Healthcare Informatics -- Informatics and Transitions of Care for Complex, Chronically Ill Patients -- Complex Care Management Models of Care -- Medicaid Health Homes -- ch. 25 Aging Population, Medical Advancements, and New Case Management Considerations -- Our Graying Population -- New Challenges -- New Opportunities -- Care Management -- Additional Resources -- ch. 26 Dying in America -- Personal Story -- Death Is Not an Option.
Note continued: Examining Your Own Feelings -- Addressing the Issue of Death -- DNR Orders -- Pain Management -- Hospice Care -- Palliative Care -- CMS/VS 2002 Dying in America Survey -- Cultural Diversity and End-of-Life Issues -- Call for Improvements in End-of-Life Care -- Right-to-Die Legislation -- Overprescribing of Opioids -- Medical Marijuana -- Conclusion -- Endnote -- Resources -- ch. 27 Medication Management: A Case Management Call for Action -- Medication Use among the Elderly -- Problems Associated with Multiple Medication Use -- In the News -- Tips on Managing Polypharmacy -- Medication Reconciliation -- Medication Nonadherence: The Opposite Problem -- Adherence Fact -- 10 Most-Prescribed Drugs -- 10 Drugs on Which We Are Spending the Most Money -- Comprehensive Medication Management: Beyond Adherence and Reconciliation -- What Is Comprehensive Medication Management, and Why Does It Matter? -- Pharmaceutical Industry Update -- When Drugs Become Deadly -- Marketing Drugs Directly to Consumers -- Staying Abreast of Pharmaceuticals -- Conclusion -- ch. 28 Pain Management -- Types of Pain -- Assessment of Pain -- Pain Treatment Management Spectrum -- Evidence-Based Practice Implications -- Implications for Case Managers -- Case Management Resources -- ch. 29 Our Nation's Multiculturalism and Challenges to Case Managers -- Changing Demographics -- Acculturation and Assimilation -- Implications and Opportunities for Case Managers -- Language and Communication Barriers Are Problematic -- Differences Matter -- Family Values -- Communication Considerations -- Where You Are From Does Matter -- Guidance and Standards -- Cultural Competency: Defining It, Achieving It -- Role of Culture in Health Care -- Case Managers Make a Difference -- Developing Cultural Competency -- 12-Step Program -- Conclusion -- ch. 30 Health Literacy and Adherence Issues -- Increased Need for Health Literacy -- Economic Impact of Health Literacy -- Literacy and Health Literacy -- Day-to-Day Considerations -- Health Literacy Manifestations -- Case Manager's Vital Role -- Conclusion -- Resources -- ch. 31 Obesity: The New Epidemic -- Obesity: A Simple Definition, a Complex Problem -- Metrics to Determine Obesity -- Etiology -- Treatment Overview -- Going Forward -- ch. 32 Behavioral Health with Primary Care: An Integrated Model of Care -- Prevalence, Cost, and Impact -- Treatment Alternatives: Established and Innovative -- Chronic Disease and Depression -- Chronic Mental Illness and Serious Mental Illness -- Partnering Successfully with Behavioral Health Professionals -- Behavioral Health Disease Management Programs -- Opportunities for Case Managers -- Resources -- ch. 33 Healthcare Technology and Trends: Implications for Case Managers -- Text Messaging -- Mobile Health -- Medical Advances and High-Cost Services -- Remote Patient Monitoring -- Telemedicine and Telehealth -- Clinical and Business Analytics -- Macro View -- And for Case Managers ... -- New Considerations Regarding EHRs -- Data Breaches and Potential Ramifications for Case Managers -- Ethical and Legal Issues Challenging Telehealth and Telemedicine -- Open-Access Scheduling -- ch. 34 Transformative Healthcare Approaches for the Millennial Generation -- Digital Natives -- Health Behaviors of Millennials -- Millennials' Expectations of Healthcare Providers -- Ramifications for Case Managers -- Concierge Medicine -- ch. 35 Affordable Care Act of 2010: Implications for Case Managers -- Individual Mandate and Increased Coverage -- Implications for Behavioral Health -- Implications for Health Literacy -- Implications for Patients with Disabilities -- New Developments -- Implications for Case Management Practice.
Summary:
"The Case Manager's Handbook, Sixth Edition is an indispensable guide for case managers. Presented in an accessible and conversational style, this practical resource helps case managers learn the fundamentals, study for the Certified Case Manager exam, and advance their careers after the exam. Completely updated and enhanced with information on the latest developments affecting case management, it reflects the rapidly changing healthcare landscape, including the significant effects of the Affordable Care Act."--Back cover.
Subject(s):
Genre(s):
ISBN:
9781284102406 (hardcover)
1284102408 (hardcover)
Bibliography Note:
Includes bibliographical references and index.
View MARC record | catkey: 22087585