Integrated Care Management

INTERMED-Complexity Assessment Grid (ICM-CAG)

Cartesian Solutions, Inc.™ adapted the INTERMED, a complexity assessment and intervention tool resulting from 15 years of research performed in countries throughout Europe, to the health environment of the United States with assistance from members of the original multinational INTERMED research team. It is called the INTERMED Case Management-Complexity Assessment Grid (ICM-CAG--see example of a scored patient with health complexity below). The ICM-CAG, and its pediatric equivalent, the Pediatric Case Management-Complexity Assessment Grid (PCM-CAG), use complexity-based barriers to improvement to create action oriented care plans used in integrated case management. Color-coded "anchored" item scores (red--needs immediate action; orange--problem that needs correction soon; yellow--potential problem; green--no problem) derived from an open-ended relationship-building dialogue with the patient allow the development of mutually agreed upon goals, actions designed to achieve the goals, the documentation of outcomes, and patient graduation.  While the European and U.S. grids are very similar, thus obviating the need to restandardize the instrument in the U.S. population, the U.S. version of the ICM-CAG recognizes that barriers to care and improvement can also originate from fragmented service access and delivery, which is related to inconsistent, non-existant, or unnecessarily complicated insurance and practitioner payment procedures. These are impediments to health largely unique to the United States.

The Instrument: ICM-CAG and PCM-CAG

The ICM-CAG and PCM-CAG can be used with equal effectiveness in those with health complexity for whom there are only physical conditions, only mental conditions, or a combination of the two. Its use, however, requires that managers coming from medical or mental condition backgrounds be trained in cross-disciplinary integrated case management techniques either through the Case Management Society of America copyrighted training program or the customized ICM training program offered through Cartesian Solutions, Inc.™. The customized Cartesian Solutions, Inc.™ program does not require inclusion of ICM-CAG or PCM-CAG use, however, draws from multi-domain assessment principles within the grids as medical and mental health case managers are trained in cross-disciplinary work processes using client procedures.

The ICM-CAG is composed of twenty-cells, which identify areas of risk for poor clinical, functional, and cost outcomes in four domains: biological, psychological, social, and health system.  In adults, two cells comprise each domain in the historical and current columns and one in the vulnerabilities column. In the pediatric version, five cells are added and several adult complexity cells are adapted to document complexity issues related to childhood/youth.  Each cell is scored from "0" (green) to "3" (red), based on the level and immediacy of need related to the area of complexity. Anchored foils for scoring consistency define each cell within each temporal period.  Absolute scores for the ICM-CAG can be from zero to sixty (PCM-CAG--zero to seventy-five). Level and duration of care manager involvement will be determined by a combination of individually scored items and the composite grid score for the patient.

The ICM-CAG and PCM-CAG are explained at great length in the integrated case management training textbook, The Integrated Case Management Manual: Assisting Complex Patients Regain Physical and Mental Health.