Introdution to case management

INTRODUCTION TO CASE MANAGMENT ASSIST PROF. KARUNRAT TEWTHANOM, PHD FACULTY OF PHARMACY, SILPAKORN UNIVERSITY

SCOPE Definition of case management Case management process Success factors of case management Role of Pharmacist in case management Conclusion/Question and Answer This Photo by Unknown author is licensed under CC BY-SA-NC.

Objectives • Explain the definition of case management • Explain case management process • Expalin the role of pharmacist in case management process

Definition of case management • \" Case management is a professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs. It uses communication and available resources to promote health, quality, and cost-effective outcomes in support of the ‘Triple Aim,’ of improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Source: CCMC’s Case Management Body of Knowledge (CMBOK) [Internet]. Cmbodyofknowledge.com. 2020 [cited 27 June 2020]. Available from: https://cmbodyofknowledge.com

Case management process • Source: https://bettercarenetwork.org/s ites/default/files/Case-Management- Concepts-and-Principles.pdf

Case manager • Evaluate and understand the care options available to them • Agree on their care goals and priorities • Determine what is best to meet their needs • Institute action to achieve their goals and meet their interests/expectations

Case manager can apply • Relevant state and federal laws • Ethical principles and standards such as the CCMC’s Code of Professional Conduct for Case Managers with Standards, Rules, Procedures, and Penalties (CCMC, 2015), which applies to persons holding the CCM® credential • Accreditation and regulatory standards • Standards of care and practice such as the CMSA Standards of Practice for Case Management (CMSA, 2016) • Evidence-based care or practice guidelines • Health insurance plan requirements and obligations as appropriate

Sources: https://cmbodyofknowledge.com/ Case management process

Screening Source: https://cmbodyofknowledge.com/

Assessing Click to add text Source: https://cmbodyofknowledge.com/

Stratifying risk Source: https://cmbodyofknowledge.com/

Planning Source: https://cmbodyofknowledge.com/

Implementing Source: https://cmbodyofknowledge.com/

Review/Follow up Source: https://cmbodyofknowledge.com/

Transitioning Source: https://cmbodyofknowledge.com/

Post transitioning Source: https://cmbodyofknowledge.com/

Evaluating Source: https://cmbodyofknowledge.com/

Domain Subdomains Essential Care Delivery and Reimbursement Methods domain in •Case Management Administration and Leadership CM •Case Management and Processes of Care •Case Management Programs and Models •Care Coordination •Communication Skills of the Case Manager •Transitions of Care •Utilization Management •Wholistic Case Management Psychosocial Concepts and Support Systems •Motivational Interviewing •Social Determinants of Health

Essential domain in CM Domain Subdomains Rehabilitation Concepts and Strategies •Disability Case Management, Catastrophic Case Management, and Life Care Planning •Essentials of Workers’ Compensation •Vocational Rehabilitation Ethical, Legal, and Practice Standards •Ethical Standards for Case Management Practice – Part I: Review of the CCMC Code of Professional Conduct for Case Managers •Ethical Standards for Case Management Practice – Part II: Practice Considerations for the CCMC Standards for Professional Conduct •Legal Issues related to Case Management Practice

Essentail domain in CM Domain Subdomains Quality and Outcomes Evaluation and Measurement •Quality Management •Value of Case Management Professional Development and Advancement •Value and Return on Investment Outcomes •Health and Public Policy •Scholarship Activities Source: https://cmbodyofknowledge.com

Care Delivery and Reimbursement Methods

Psychosocial Concepts and Support Systems knowledge associated with the role clients’ cultures, values, beliefs, social networks, and support systems play in clients’ health and well-being, including health behavior and lifestyle. focuses on the impact of socioeconomic classes on clients’ health conditions, ability for self- care management, health engagement, health literacy and numeracy, and adherence to treatment regimen. This Photo by Unknown author is licensed under CC BY-NC-ND.

Rehabilitation Concepts and Strategies • knowledge associated with clients’ physical and occupational health and functioning, including catastrophic case management, workers’ compensation, vocational and disability concepts, strategies, and resources. • knowledge of life care planning, roles and skills of various healthcare providers in rehabilitation care settings, return-to-work concepts and strategies, types of rehabilitation settings/facilities, and use of assistive devices or durable medical equipment for rehabilitation and vocational purposes. In addition, this domain includes regulations pertaining to rehabilitation.

• Codes of ethics and professional conduct for Ethical, Legal, and Practice case managers Standards • Risk management • Regulatory and legal requirements • Ethical practices and principles • Privacy and confidentiality • Overall standards of case management practice • Use of standards and guidelines in the management of clients’ care • Strategies for ethical and legal practice

Quality and Outcomes Evaluation and Measurement • knowledge associated with quality management, accreditation standards, care quality and safety, demonstrating return on investment, and cost-effectiveness • demonstrating the value of case management, case load calculation, tools such as case management plans of care, and regulations related to case management. This Photo by Unknown author is licensed under CC BY.

Professional Development and Advancement • knowledge associated with the roles and responsibilities of This Photo by Unknown author is licensed under CC BY-NC-ND. case managers in articulating, advancing, and demonstrating the value of case management practice. • case managers’ involvement in scholarship activities (e.g., writing for publication, public speaking, research and utilization of evidence, training and education, and curriculum development), health or public policy work, accountability for ongoing education or learning, maintaining necessary skills and competencies for effective performance, engagement in practice innovation, and mentoring other case managers.

This Photo by Unknown author is licensed under CC BY. Factors effect on sucessful case management • Initiation phase • Patients' needs assessment • Care plan • Evaluation

Role of Pharmacist in case management Who involve ? This Photo by Unknown author is licensed under CC BY-SA-NC. • professionals and paraprofessionals • governmental and NGO employees • members of community-based coordination mechanisms such as child protection committees

Pharmacist as a case manager • Identification client comes to the attention of provider • Initial screening • No action required • Assess/reassess, including eligibility for services and identity needs and strengths • Case plan

Pharmacist as a case manager • Implementing • Review/Follow up • Case close This Photo by Unknown author is licensed under CC BY-NC-ND.

Thank you for your attention This Photo by Unknown author is licensed under CC BY-NC.