CCM Exam Study Guide with Questions and Answers

Case Management A collaborative process, which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. Key elements to Case Management (9) (a p cs ds l a me er po) Assessment • Planning • Coordinate Services • Deliver Services • Linkage • Advocate • Monitoring & Evaluating • Efficient use of Resources • promote Positive Outcome Assessment Getting the background info Planning Looking ahead Coordinate Service Holistic view of the client, many services must be coordinated Deliver Service CMs often deliver services themselves Linkage Relates to service coordination. Makes sure the client is connected to resources out there Advocacy CM have the responsibility for being the voice of the client Monitoring and evaluating • If providing management, you must assess and assure the delivery of the services are on target • What's the impact of the services - Evaluating (more formal) Efficient use of resources Try to do more with less Positive outcome Trying to bring about a benefit for the client Managed care: • a system of health care (HMO, PPO) that controls costs by placing limits on physicians' fees and by restricting the patient's choice of physicians. • Strong motive for the insurance co. to make profits, managed care optimizing access • Iron Triangle - We want to (optimizing access, minimizing cost, and maximize outcome)