Integrated Care Management
Adult Integrated Care Management (ICM) Training Curriculum
The ICM training curriculum, performed in conjunction with the Case Management Society of America (CMSA), is associated with 40 or more hours of continuing
education in nursing, case management, or social work. Successful completion
of the curriculum, i.e., demonstrating proficiency during face-to-face training and passing the mandatory final examination, occurs with greater frequency when trainees study The
Integrated Case Management Manual: Assisting Complex Patients Regain Physical and Mental Health and personally participate in each of the webinars described below.
For those unable to personally login to a webinar, taped recordings
of webinars can be accessed from the CMSA website prior to the face-to-face
training. Continuing education credits will be granted based
on the number of educational hours completed.
At the conclusion of the face-to-face training, trainees who have demonstrated proficiency in assessment and care plan development procedures and who achieve a final
examination score of greater than 70% will be given a certificate
of completion and receive a username and password, which will allow them access
to CMSA’s ICM software. ICM software, accessed through CMSA's national server, can be
used to document complexity in patients using INTERMED Case Management-Complexity Assessment Grid (ICM-CAG) methodology. ICM-CAG software code is also available for purchase
through CMSA. It can be installed into local servers at health plans or electronic health records (EHRs) at hospitals and clinics.
Webinar I (2 hours): Background; Program Organization
Part 1: Principles of Integrated Case Management
& The Physical and Mental Condition Interaction (1 hour)
Goals for Participants: To appreciate the advances introduced by integrated case management to traditional
management procedures; to understand the background of and research on complexity
as a base for case management; to comprehend the impact that chronic comorbid
medical or mental illnesses have on life, health
outcomes, and medical service use; to understand the impact of separate medical and mental
care delivery and payment systems on patient/client outcomes
Preparation: Introduction, Chapter 1, and Chapter 2 in The Integrated Case
Management Manual (Test Questions: Chapters 1 & 2)
Content:
- From traditional to integrated case management--the next generation
- Complexity vs. disease orientation in case/care management
- Core ICM components
- Effects of chronic illness on clinical outcomes and health service use
- Role of mental conditions in medical illness persistence and health care
costs
- Case management’s success and role in altering outcomes for patients/clients
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
As a service to enrollees in the ICM course, all may have one colleague,
supervisor, or member of their executive staff participate in the introductory
webinar. In this way, the ICM training program will inform others connected with
the case management program about core principles, its
research base, and the case/care manager techniques and skills that will be developed
during training.
Part 2: Administrative Organization of Integrated Case Management Intervention
Worksites (1 hour)
Goals for Participants: To recognize the importance of and efficient
methods to stratify and prioritize those in greatest need of case management;
to be able to use complexity-based care plan roadmaps to improve care
and outcomes; to be able to customize ICM concepts and procedures to
the enrollee’s practice situations while retaining core outcome-changing components
Preparation: Chapter 3 and Appendix 1A through
1G, Appendix 2, and Appendix 3 in The Integrated Case Management Manual (Test Questions: Chapter 3)
Content:
- Case manager training, cross-disciplinary pods, supervisor and
medical director support
- Triggering for ICM, ICM assessments, care plan
development, iterative assistance procedures, discharge
- ICM-CAG basics
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
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Webinar II (2 hours): Motivational Interviewing; Cross-Disciplinary Training
Part 1: Use of Motivational Interviewing in Integrated Case Management (.75 hour)
Goals for Participants: To understand how to use a motivational interviewing
approach in patients/clients with interdisciplinary health issues and multi-domain barriers to improvement
Preparation: Chapter 4 in The Integrated Case Management Manual (Test Questions: Chapter 4)
Content:
- Motivational interviewing concepts and application in integrated case management
Faculty: Becky Perez, RN, CCM or Deborah Gutteridge, MS, CCM
Part 2: Cross-Disciplinary Training in Common Medical and Mental Conditions (1.25 hours)
Goals for Participants: To accept that accountability for patient/client outcomes in all
complexity domains are within the responsibilities of a single integrated
case manager; to know standard medical and mental health protocols and be
able to apply them; to be capable of acquiring core medical and mental condition
information and use it to assist and support patients/clients with health complexity
Preparation: Chapters 5 and 6 in The Integrated Case Management Manual (Test
Questions: Chapters 5 and 6)
Content:
- Core components of common physical and mental conditions in moving
patients/clients to health improvement
- Financial and logistical patient/client challenges in getting mental health care for those with medical disorders
and medical care for those with mental health conditions in a payment segregated
system
- Standard emergency medical and mental health procedures and when
to implement them
- Providing cross-disciplinary support to colleagues
Faculty: Roger Kathol, MD
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Webinar III (2 hours): Complexity Assessments & Documentation
Part 1: Triage, Using Open-Ended Questions, and Complexity Assessments (1.25 hours)
Goals for Participants: To know how to efficiently stratify and
prioritize a population for entry into case management; to understand the
basics of complexity assessments using ICM-CAG methodology; to connect answers to
open-ended questions in the assessment “dialogue” with complexity items in the IM-CAG;
to enhance the relationship with the patient/client during the assessment process
Preparation: Chapters 3 (review), 7, & 10; Appendices 4, 6, & 8 in The Integrated
Case Management Manual (Test Questions: Chapters 7 & 10)
Content:
- Stratification and prioritization techniques in different populations
- Complexity
domains, item anchor points, and connected actions in the performance
of systematic complexity assessments
- Use of content areas and open-ended
questions during patient/client assessments
- Developing a relationship
with the patient/client as assessments are
performed
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
Part 2: How to Use ICM Complexity Assessment Software (.75 hour)
Goals for Participants: To be able to enter patient/client information into
the CMSA complexity assessment system for scoring and clinical note documentation;
to recognize how to establish goals and actions for identified and connected
barriers to improvement; to be able to print the complexity grid and associated
notes for communication to the patient/client and their clinicians
Preparation: Entering a mock patient into the software training module using
provided username and password
Content:
- Opening a case, entering complexity scores, making clinical notes
- Establishing
clinical and functional goals (patient’s and case manager’s)
with actions linked to complexity items or combinations of complexity
items
- Entering follow-up ICM-CAGs; completing goals and actions
- Documenting outcomes
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
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Webinar IV (3 hours): Basics in Using Integrated Case Management
Part 1: Interpreting ICM-CAG Anchor Points, Creating Care Plan Goals and Actions, Managing Patients/Clients, Documenting Outcomes (1.5 hour)
Goals for Participants: To develop skill in applying consistent anchor
points related to each complexity item using individual patient examples;
to be able
to develop goals and action plans based on scored anchor points
Preparation: Chapters 9 & 11; Appendices 4, 6, & 8 in The Integrated
Case Management Manual (Test Questions: Chapters 9 & 11; closed book scoring of
Robert in ICM-CAG software—case provided prior to Webinar)
Content:
- Item by item anchoring of ICM scores (barriers to improvement)
- Creating care plan goals and actions based on item scores
- Use of ICM management procedures
- How to use the CD, MP3, and ROM to document outcomes and move to "graduation"
- Use of scored color-coded CAG to communicate with patient/client and clinicians initially and during management
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
Part 2: Managing a Patient: Care Plan Development, the Intervention Alliance,
and Outcome Documentation (1.5 hours)
Goals for Participants: To be able to convert ICM-CAG item scores into a consolidated
and systematic care plan (CD); to use the ICM-CAG to communicate with the patient/client
and their clinicians in jointly deciding action-oriented priorities; to document
individual patient/client outcomes (MP3; ROM); to return patients to standard
care
Preparation: Chapters 12; Appendices 10, 11, & 12 in The Integrated
Case Management Manual (Test Questions: Chapter 12)
Content:
- Pre-webinar item by item scoring of patient example (Lucinda) at
baseline and 3 months before reading Chapter 12; comparison of baseline individual and composite
scores
- Application
of care plan development (CD), measurement of progress (MP3), and record
of outcome measurement (ROM) templates
- Comparison of 3 month individual and
composite scores
- Preparation for graduation; graduation
Faculty: Becky Perez, RN, CCM; Deborah Gutteridge, MS, CCM; or Roger Kathol,
MD
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Face-to-Face Implementation Training (12 hours)
Preparation: In addition to completing the Webinars and tests related
to the Webinars, all trainees should perform ICM open-ended interviews with
at least
one patient/client or "mock" patient/client prior to attending the face-to-face training.
Trainees will turn in a scored ICM-CAG of this preliminary interview at the opening of the implementation training.
Goals for Participants: To develop initial relationship-building interviewing
and ICM-CAG anchor point scoring skills while performing mock interviews; to
learn how to translate complexity assessments into care plans with goals and
actions
using ICM software; to understand how to document clinical, functional, satisfaction,
quality of life, and fiscal outcomes while working with patients/clients
toward ICM graduation
Faculty: Roger Kathol, MD, Becky Perez, RN CCM, and/or Deborah Gutteridge,
MS, CCM
Agenda:
Day 1
7:00 am to 8:00 am |
- |
Registration |
8:00 am to 8:30 am |
- |
Introductions |
8:30 am to 9:00 am |
- |
Brief Manual Overview; Q & A |
9:00 am to 9:20 am |
- |
Observation videotaped interview--Chesterfield |
9:20 am to 10:00 am |
- |
Role Play/Mock interview #1--Robert; individual ICM-CAG scoring |
10:00 am to 10:15 am |
- |
Break |
10:15 am to 12:00 pm |
- |
Small group ICM-CAG score; large group ICM-CAG score reconciliation |
12:00 am to 1:00 pm |
- |
Lunch |
1:00 pm to 1:15 pm |
- |
Q & A from morning |
1:15 pm to 2:00 pm |
- |
Care plan development for mock case #1 (goals, actions, outcomes [CD, MP3, ROM]) |
2:00 pm to 2:45 pm |
- |
Role Play/Mock Interview #2 |
2:45 pm to 3:00 pm |
- |
Break |
3:00 pm to 5:00 pm |
- |
Small group ICM-CAG score; large group ICM-CAG score reconciliation; care plan development for mock case #1 (goals, actions, outcomes [CD, MP3, ROM]) |
5:00 pm |
- |
Adjourn |
Day 2
8:00 am to 8:15 am |
- |
Q & A from day #1 |
8:15 am to 9:00 am |
- |
Completion of case #2 |
9:00 am to 9:45 am |
- |
Role Play/Mock Interview #3 |
9:45 am to 11:30 am |
- |
Small group ICM-CAG score; large group ICM-CAG score reconciliation; care plan development for mock case #1 (goals, actions, outcomes [CD, MP3, ROM]) |
11:30 am to 12:00 pm |
- |
Patient/client graduation |
12:00 pm to 12:30 pm |
- |
Course evaluation; adjourn |
A comprehensive internet-based final test will be taken by trainees within 2 weeks of course completion. A score of 70% or greater allows receipt of certificate of
completion and username and password for CMSA’s ICM software
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Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
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