Integrated Care Management

Overview of Adult Integrated Case Management Courses

Rationale

Today’s health care is fragmented. Thus, one of the greatest challenges for patients with chronic medical conditions and concurrent mental health needs, often those with the highest health service use, is to receive coordinated care and assistance that will stabilize medical and mental health symptoms while also addressing social and health system factors that contribute to poor outcomes. This is aggravated by the fact that case managers with medical backgrounds do not feel competent to assist with mental condition needs and those with mental condition backgrounds do not feel competent to assist with medical needs. The core curriculum of the ICM training program was developed to allow case managers, usually nurses or social workers, coming from either medical or mental health backgrounds to transition to a holistic assessment and assistance approach that allows them to help patients overcome barriers to improvement in any complexity domain from case management initiation to graduation.

Integrated case management (ICM) training has four independent programs for personnel contributing to improved outcomes for patients/clients/members: 1) ICM orientation training for care/case manager enrollment and support personnel ; 2) full care/case manager ICM assessment, implementation, and management training; 3) physician/medical director training about ICM care manager activities and how to effectively work with them to achieve maximum clinical and cost outcomes; and 4) customized ICM training for organizations or companies that are not able or do not wish to utilize integrated case management-complexity assessment grid (ICM-CAG) technology and its associated Case Management Society of America (CMSA) software. Programs one through three are offered through CMSA in collaboration with Cartesian Solutions, Inc.™ The fourth program is offered exclusively through Cartesian Solutions, Inc.™

CMSA and Cartesian Solutions, Inc.™ Programs

Program 1: ICM orientation training for case manager enrollment and support personnel is designed to acquaint ICM enrollment and support personnel with:

The basic differences between traditional and integrated case management
The complexity versus disease approach to case management
The role of multi-domain barriers to improvement in poor clinical and fiscal outcomes for medical and mental conditions
How to maximize the efficiency and effectiveness of the integrated care/case managers that they support

Program 2: ICM care/case management professional training is the core curriculum, an advanced educational program designed to:

Provide care/case managers coming from either medical or mental health backgrounds with the content and skills needed to perform systematic interdisciplinary ICM-CAG assessments and care management;
Collaborate with patients and their clinicians in developing and carrying out comprehensive and coordinated physical and mental condition care plans
Apply consistent complexity-based anchor points into specially designed ICM clinical documentation software
Record ongoing clinical, functional, quality of life, satisfaction, and fiscal outcomes during the management process to document improvement and value

Program 3: Physician/medical director training in ICM

Compares the value of complexity and disease models for physician-supported care/case management
Reviews the negative effects of ineffectively treated mental conditions in medical patients on physical health and total cost outcomes
Acquaints them with the value enhancing role that ICM care/case managers bring to their complex, high cost patients
Educates them on how to most effectively work with ICM case/care managers to maximize outcomes for complex patients through case review, treating to target, and intervention escalation in those showing limited health improvement

Core curriculum ICM training (Program 2) provides care/case managers with complexity-based techniques used to form alliances with patients/clients and their treating clinicians as they work together in disentangling and reversing biological, psychological, social, and health system barriers to improvement. It requires 40 hours of manual study, participation in three two-hour and one three-hour webinar, and one and one-half days of face-to-face training. Training for care/case manager enrollment and support personnel (Program 1) is composed of four two-hour webinars. While it does not prepare trained personnel to use ICM to manage patients/clients, it allows them to expand the reach and capabilities of fully trained care/case managers by reducing the need for them to personally perform important non-patient/client encounter-based activities related to barrier reversal, e.g. setting up appointments, finding providers, assisting with community resources, identifying housing, etc.

Physician/medical director training is an important addition to CMSA's ICM offerings. Most physicians are not familiar with the relatively new field of care/case management. Thus, they are often unaware of the type of patients that benefit most and should be referred, care/case manager's role in augmenting the efforts of doctors, and their own contributions to supporting the care/case management process, i.e. through case review, understanding treatment to target concepts, and care escalation of patients who are not improving as expected.

Training in ICM (Program 2) has been in development since 2008 by Cartesian Solutions, Inc.™ and the Case Management Society of America. It is, in part, based on the application of 15 years of complexity research largely performed in Europe and, in part, on the systematic application of the 2010 Case Management Standards of Practice using ICM methodology. To date, over two-fifty hundred case managers have participated in training experiences. Programs 1 and 3 have recently been added in response to consumer demand. Both build on the strengths of Program 2.

Program 2 is associated with 48 60-minute clock hours of continuing education in case management, 57.6 50-minute clock hours of continuing education in nursing, and 48 60-minute clock hours of continuing education in social work. Program 1 is associated with over 40 hours of continuing education in case management. Both use The Integrated Case Management Manual: Assisting Complex Patients Regain Physical and Mental Health written by Roger Kathol, Rebecca Perez, and Janice Cohen (Springer, 2010) for its text. Those considering the use of ICM for the population that they serve are encourage to purchase and review content of the Manual.

Customized Cartesian Solutions, Inc.™ Program

Program 4: Customized Cross-Disciplinary Training for Those Not Using CMSA-Based ICM Software or Workflows

Informs care/case managers about the negative clinical and cost effect of medical and mental condition interaction and how this is better approached using integrated management techniques
Provides "medical" care/case managers with basics in addressing mental health issues and "behavioral health" managers with basics in addressing medical issues in their patients/clients
Expands care/case manager outcome producing capabilities through education in complexity-based as opposed to disease-based methodology
Shares methods to systematically document and measure clinical, functional, satisfaction, quality of life, and cost outcomes of the care/case management process

The customized integrated case management program recognizes that many organizations and companies will not be in a position to incorporate all of the integrated care techniques available through the full care/case manager implementation program. To meet the needs of programs that wish their care/case managers, coming from medical backgrounds, mental health backgrounds, or both to perform cross-disciplinary care/case management, Program 4 customizes training to meet the requirements of an organization or company interested in integrated care/case management assistance delivery. As with Program 1, it is built around basic principles found in The Integrated Case Management Manual: Assisting Complex Patients Regain Physical and Mental Health, which it uses as its text, and expects care/case managers to participate in four 2-hour webinars that provide basics about interdisciplinary care/case management. Program 4 does not include training in anchoring items using the ICM-CAG or CMSA's associated software. Case managers receiving customized management training who wish to upgrade to full CMSA-based ICM skills will be required to take webinar and face-to-face training described above in Program 2.

For companies wishing to implement integrated care/case management practices into their unique system, customized onsite onsite training can be arranged.