Product Detail

1. Analyze why specific case management strategies are most effective for complex or targeted populations.
2. Discover what case management interventions are crucial to the success of Accountable care organizations and Patient-centered Medical Homes.
3. Interpret the current legal and ethical responsibilities of case managers using case studies to highlight key concepts.
4. Differentiate case management benchmarks for various care settings/patient populations.
5. Explain why reimbursement is central to increasing the value of case management’s role.
6. Evaluate available methods to support case management workloads when limited resources are available.

Complex Populations

• Medical homes for the uninsured
• What is “hotspotting” - and why is it effective?
• Behavioral Health Transitional care
• Community collaboration for the complex populations
• Managing differences - including LGBT
• Advanced illness management
• Non-adherence strategies
• Shared medical appointments

ACOs and PCMH

• Care coordination: Foundational principles
• Remote patient monitoring: Why technology is essential
• Predictive modeling/risk screening for targeting patients
• The benefits of embedded case managers
• Patient engagement and the key to over-utilization
• How team-based care enhances cost savings

Reimbursement

• CMS goals for case management reimbursement
• Transitions of Care reimbursement
• Cost-Benefit-Analysis in case management
• Pay-for-performance
• Value-based purchasing

Case Management Benchmarks & Specialty Populations

• Operationalizing clinical goals within the case management plan
• Workman’s compensation - When to return to work?
• Community-based vs. hospital-based case standardization
• Integrated care models specific to behavioral health
• Geriatric care management
• Pediatric specialty care management - coordination essentials
• Commercial insurance outcomes

Legal and Ethical Responsibilities

• Patient rights/Transitional care rights
• Shared decision-making
• Case management ethical conflicts
• HIPPA privacy concerns
• Person-centered care essentials

Patient Protection and Affordable Care Act

• Readmission: A case management opportunity
• CMS penalties
• Patient satisfaction measures
• Transitions of Care implementation
• Priority patient populations: CHF, Duals, Diabetics, COPD, Cardiovascular disease

Case Load Management

• Case management caseloads: Standards across settings
• Utilization review is not case management
• Discharge planning: The “golden rules”
• Community resource development

Tamara Burdon is a Registered Nurse and Certified Case Manager (CCM), with twenty-eight years of health care experience. Her work in the acute care settings spans across intensive care to medical-surgical settings. She also holds a board certification in Adult-Mental Health nursing. Currently, she works as a Program Manager within a care coordination department. In this role, she has oversight of the care management processes within an embedded care coordination project which is focused on providing primary case management in a medical home model, no matter the payer.

Tamara's experience in the world of care coordination has allowed her to develop, implement and provide oversight for transitional care programs for patients with multiple co-morbid conditions. She understands the importance of collaboration across the care continuum when various disciplines are involved. As such, Tamara remains a Senior Advisor in the coordination and development of innovative group models of care for those patients with complex, co-morbid conditions who over-utilize the emergency department.

A reflection of her expertise on the topic of transitions of care is demonstrated through her work with the IHI Impact Transitions Project Grant that focused on improving transitions from the hospital to office practice, in order to prevent re-hospitalizations. Tamara remains committed to her specialty, as a member of the Case Management Society of America.

Speaker Disclosures:

Financial: Tamara Burdon has an employment relationship with Community Care Partners of Greater Mecklenburg. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.

Non-financial: Tamara Burdon has no relevant non-financial relationship to disclose.

For U.S. and Canadian customers, a CE test is available for $9.99 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion may be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 4/29/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Social Workers
PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this self-study course. ACE provider approval period: January 27, 2017 - January 27, 2020. Social Workers completing this course receive 6.25 Clinical Practice continuing education credits. Course Level: Intermediate. Full attendance is required; no partial credits will be offered for partial attendance. A certificate of attendance will be awarded at the end of the program to social workers who complete the program evaluation.

Canadian Social Workers: PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this self-study course. ACE provider approval period: January 27, 2017 - January 27, 2020. Social Workers completing this course receive 6.25 Clinical continuing education credits. Course Level: Intermediate. Full attendance is required; no partial credits will be offered for partial attendance. A certificate of attendance will be awarded at the end of the program to social workers who complete the program evaluation. Canadian provinces may accept activities approved by the ASWB for ongoing professional development.

Illinois Social Workers: PESI, Inc. is an approved provider with the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 159-000154. Successful completion of this self-study activity qualifies for 6.0 contact hours.

Minnesota Social Workers: PESI, Inc. is an approved provider with the State of Minnesota, Board of Social Work. Provider #: CEP-140. This self-study course has been approved for 6.0 continuing education hours. A certificate will be issued upon successful completion of a post-test.

California Social Workers/ Counselors/Marriage & Family Therapists/Licensed Educational Psychologists: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This intermediate level activity consists of 6.0 clock hours of continuing education instruction.

Florida Social Workers, Marriage & Family Therapists, and Mental Health Counselors: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 6.25 continuing education credits.

Ohio Social Workers, Counselors, and Marriage & Family Therapists: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #: RCST071001. Successful completion of this self-study course meets the qualifications for 6.25 clock hours of continuing education credit.

Pennsylvania Social Workers/Counselors/Marriage & Family Therapists: This intermediate activity consists of 6.25 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please contact your licensing board to determine if they accept programs or providers approved by other national or state licensing boards. A certificate of attendance will be awarded at the end of the program to participants who are in full attendance and who complete the program evaluation. Full attendance is required, variable credits may not be awarded per the Pennsylvania State Board.

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Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Case Managers, Nurses, Social Workers, and other Healthcare Professionals