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Case Management · CCM

Case Management: Care Coordination Fundamentals

Core care coordination models and the case manager's role across the care continuum tested on the CCM certification exam.

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What professional organization publishes the Standards of Practice for Case Management?
Case Management Society of America (CMSA)
Which body administers the CCM (Certified Case Manager) credential?
Commission for Case Manager Certification (CCMC)
What is the core goal of care coordination?
To organize patient care activities and share information among everyone involved to achieve safer, more effective care
According to CMSA, case management is a collaborative process of ____, planning, facilitation, care coordination, evaluation, and advocacy to meet an individual's health needs.
assessment
What is a caseload in case management?
The number of clients a case manager is actively managing at one time
In the case management process, what does the planning phase involve?
Developing goals and an action plan for the client's care
In the case management process, what does implementing involve?
Putting the care plan into action
In the case management process, what does coordinating involve?
Organizing and sequencing services among multiple providers
In the case management process, what does monitoring involve?
Ongoing tracking of the client's progress and response to the care plan
In the case management process, what does evaluating involve?
Assessing whether the care plan's goals and outcomes were achieved
What is transitional care?
Actions that ensure coordination and continuity of care as a patient moves between different care settings
Who developed the Care Transitions Intervention model, which uses a trained transition coach?
Dr. Eric Coleman
What is the name of the transitional care model developed by Mary Naylor for high-risk older adults?
The Transitional Care Model (TCM)
What is the Chronic Care Model, developed by Edward Wagner?
A framework for improving chronic disease care through productive interactions between an informed patient and a prepared care team
Patient-Centered Medical Home
PCMH

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