Case Management

Front 1

What are the features of today's health care system?

Back 1

-Complexity
-Diversity
-Fragmentation
-Heavily dominated by Managed care
-Capitation
-Risk agreements

Front 2

What is managed care?

Back 2

A system of cost-containment strategies designed to enhance cost-effectiveness by eliminating inappropriate services.

Front 3

What are the 3 major managed care stakeholders?

Back 3

health care consumers, providers, and payers (so-called three parties)

Front 4

What is capitation?

Back 4

A fixed per capita payment made periodically to a medical service provider (such as a physician) by a managed care group (such as an HMO) in return for medical care provided to enrolled individuals
A method of reimbursing the health care provider an all-inclusive set fee for health care services for each individual in the plan, rather than paying a fee for each service encounter (the traditional fee-for-service method)

Hint 4

a payment to a doctor by a HMO in return by a enrolled patient, not a fee for service method/////

Front 5

What do HMO and PPO stand for?

Back 5

HMO stands for health maintenance organization///Preferred provider organization or PPO

Front 6

What is integrated health care delivery system?

Back 6

A health care provider or group of health care providers, which offers a broad range of services that include acute care, a selection of intermediate care (between acute and long term, e.g. adult day care), home care, and long term care
The integrated system may offer its services on a contracted basis, especially in a capitated environment

Hint 6

services combined that reach into different health arenas

Front 7

What are the results of fragmented and uncoordinated care?

Back 7

Fragmented and uncoordinated care in both public and private sectors contribute to the overall limited access, increased cost, and poor quality of health care

Front 8

What are the major issues and challenges of the health care system?

Back 8

The health care system is struggling with how to handle an older, sicker, and more technology-dependent population with a variety of co-morbid diagnoses

Hint 8

more than one serious illness

Front 9

What are the chronic co-morbid conditions?

Back 9

Diabetes and/or heart diseases combined with
High blood pressure
Obesity
Congestive heart failure
Renal insufficiency
COPD
Arthritis
Anxiety or depression
Cancer

Front 10

How may case management be the catalyst to re-engineer health care?

Back 10

Case management may be the catalyst to re-engineer health care, and serve to facilitate coordinated care, reduce fragmentation, and increase effective use of resources

Front 11

What is case management?

Back 11

Defined by the Case Management Society of America (CMSA)
A collaborative process that
Assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs
Using communication and available resources to promote quality, cost-effective outcomes

Front 12

What are the general/special goals of case management?

Back 12

Manage cost and quality
Achieve positive patient outcomes////

Optimize the client’s self-care capability and increase self-care capabilities, Enhance the client’s quality of life, sense of autonomy, and self-determination,Assist the client to adjust to and manage his or her altered health state and manage his or her own symptoms,
Enable the client and family to implement a complex health care plan through the development of an interactive relationship with a case manager (usually a nurse) who serves in an educative and supportive role
Prevent inappropriate hospitalizations and contain health care costs
Provide quality health care along a continuum with decreased fragmentation of services across many settings

Front 13

What is a typical case management process?

Back 13

organizatin of details and planning,///
coordinating, counseling and educating/// negotiating and referrals, implementation///reassesments and updates

Front 14

What are the key indicators for case management outcomes?

Back 14

Developed by the Council for Case Management Accountability (CCMA), which was established by CMSA
Patient adherence to treatment
Patient knowledge, empowerment, and involvement in the care process
Coordination of care

Front 15

Why do you refer your patients to other health care professionals?

Back 15

because of the scope of practise

Front 16

How do you develop a strong referral base and make a solid referral connection?

Back 16

presentations, outreach during lunch, etc...

Front 17

Within how many days of the date of the referral from a chiropractor is acupuncture by a license holder?

Back 17

2 months

Front 18

For what conditions can a licensed acupuncturist perform treatment without an evaluation or a referral from a physician, dentist, or chiropractor?

Back 18

smoking addiction, weight loss, alcoholism, chronic pain, or substance abuse.

Front 19

For what conditions after performing acupuncture 20 times or for 2 months, should a liscensed acupuncturist recommend an evaluation by a licensed Texas physician or dentist, if there is no substantial improvemnt of the patient's condition?

Back 19

chronic pain , alcoholism, or substance abuse.

Front 20

What is the key to successful referral building?

Back 20

using cash, insurance, case manager

Front 21

SOAP?

Back 21

subjective- pertinent positives and negatives from a focused Hx (Patient) in a narrative form
objective- relevant positive and negative physical findings and test results...what the practitioner sees or observes,
assessment- list of differential Dx in priority of most likely or important as determined from S and O
Plan - list of further diagnostic W/U(work up), advice, Rx, and F/U(follow up) based on A (assessment)

Front 22

Why are SOAP notes used in clinical practise?

Back 22

The written record organizes the information from the Hx & PE
It should facilitate clinical reasoning & clearly communicate the patient’s clinical issues to all members of the health care team
Utilizing the 7 key attributes of a symptom or complaint
Writing as soon as possible before fading from your memory (may have to take notes at first until you gain experience)

Front 23

What does each component of the SOAP notes describe?

Back 23

(Hx: History; Sx: Symptom; PE: Physical examination; Dx: Diagnosis; Rx: Treatment; S/P: Status post; W/U: Work-up; F/U: Follow-up)

Front 24

Difference between S and O
Defference between A and P

Back 24

subjective is the patient describing from their own perspective their problems

Objective is the practitioner after examination writing down their findings and observations with their scope of practise

Assessment is the actual diagnosis in priority or important determined from S and O

Plan is the treatment to solve the A

Front 25

What is the main topic of the article?

Back 25

case management is different in each healthcare system

Front 26

What type of case management is discussed in the article?

Back 26

hospital