Understanding Case Management: Key Insights for Exhibitors at CMSA

1. Case ManagementExhibitor Information What Exhibitors Should Know About CMSA

2. Case Management Definition CASE MANAGEMENT is a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.

3. Primary Work Settings

4. One Job – Many Duties Question: What Tasks Are Currently Included in Your Job Duties? • Pre-certification • Benefit Determination • Risk Management • Medical Legal Consultation • Life Care Planning • Disease Management • Utilization Management • Case Management • Discharge Planning • Health & Wellness Coaching • Research • IT or Data Services • Direct Patient Care/Education • Product Development • Disability Management • Negotiation – contracts & fee schedules • Telephonic/On-site Case Management • Medication Therapy Management • Education – patient, provider, & staff • Accreditation • Telephonic Demand Management Source: CMSA 2007 State of the Industry Survey

5. Industry Issues • Health Care Reform • Care Coordination • Transitions of Care • Patient Safety • Medication Reconciliation • Payment Alignment & Performance Measures • New Models of Care • Patient & Family Caregiver Engagement • Collaborative Practice

6. Transition Issues DramaticallyImpact Patient Care Continuum Case Mgrs ED Case Mgr • OUTPATIENT: • Home • PCP • Specialty • Pharmacy • Case Mgr. • Care Giver Patient ER ICU In-Patient SNF ALF Patient Hospital Case Mgr Managed Care Case Mgr

7. We Serve Many People Along the Health Care Continuum

8. One Job – Many Names MY JOB TITLE IS: • Case Manager • Care Manager • Care Coordinator • Discharge Planner • Disease Manager • Department Supervisor • Department Manager • Department Director • Utilization Manager • Other • Social Worker • Senior Care/Rehab • Occupational Nurse Source: CMSA 2007 State of the Industry Survey

9. CMSA Standards of Practice: • Evolution of the SOP • Definition of CM • CM Practice Settings • CM Roles, Functions, Activities • Components of the CM Process • Standards of Practice • Glossary and Acronyms • References Currently under revision

10. Today’s Case Manager • Today, case managers are in most elements of the payer and provider communities where the need to balance quality care and cost-effective care exists. • The process of case management begins with identification of high-cost, complex care individuals who meet criteria for and can benefit from case management services Source: CMSA Standards of Practice

11. Healthcare Reform – On The Horizon • Baucus Call to Action – Strengthening the role of Primary Care and Chronic Care Management • H.R. 2773 – Supports the Transitional Care Model • The Senate Health, Education, Labor and Pensions (HELP) Committee released a “draft of a draft” of healthcare reform legislation. • Group and individual health insurers must implement a reimbursement structure that provides incentives for: • The implementation of case management, care coordination, and chronic disease management activities for treatment or services under the plan;

12. Collaborative Care, Care Coordination and Transitions of Care Models • Dr. Eric Coleman – Transition Coaching • Dr. Mary Naylor – Transitional Care Model • Dr. Chad Boult – Guided Care Nurses • Medical Home Demonstration • National Transitions of Care Coalition (NTOCC) • American Geriatric Society • National Coalition on Care Coordination (N3C)

13. DevelopingCare Coordination Measures • CMS 9th SOW supports Care Coordination • Care Pathways • 2009 TJC Patient Safety Standard #8 enhanced Medication Reconciliation to include patient and caregiver involvement and transition • Documentation of process • NQF developing Performance Measures for Care Coordination • Call for Best Practices December 2008 • Measures Development in 2009 • URAC incorporating TOC principals in revised CM Standards • AMA – PCPI Transitions of Care • ACP/SHM/ABIM Foundation/PCPI will develop jointly practitioner-level performance measures for transitions of care

14. The Continuum of Care Clinical & Administrative Transactions Physician Office Patient Motivational Interventions Advocate Adherence Non-Adherence Assessment & Support Community Health Center Behavior Health Change Coordination Medication Reconciliation Assessment Care Plan Facilitation Hospital Motivational Advocacy Case Manager Adherence Health Promotion Prescription PBM Assessment & Support Specialist Increase Productivity Assessment & Care Plan Pharmacy Employer

15. Case Management Society of America CONNECTING YOU TO CASE MANAGERS

16. Expanding Our Reach • Currently approaching 12,000 members • Additional 15,000 subscribers • Over 200 company members • 75 geographic chapters • Presence across the continuum • 34% in managed care/insurance • 26% in acute care/hospital setting • 12% in work comp/occupational health/employers • 9% in government agencies/military

17. Reaching Case Managers Year-Round • Educational opportunities and events • In-person and on-line • With or without continuing education credits • Tools and resources • Increasing knowledge and case management effectiveness

18. Educational Research Library INCLUDED IN MEMBERSHIPCMSA’s online educational resource offers programs to care managers and allied health professionals serving the care management industry. • COURSEWORK LEVELS • Basic • Intermediate • Advanced • FREE CE and Non-CE Courses (CM/DM/UM) • My Coursework • Masters Level Coursework • Other Resources • Business Courses

19. Case ManagementAdherence Guidelines • Adherence Assessment • Motivational Interviewing • Follow-up • Using: • Accessible Material • Focused Learning • Tools and Resources

20. Growth of CMAG • Currently in second revision • In 2006, launched first disease specific supplement: • Diabetes • DVT • Depression • Cardio metabolic risk • COPD (in development) • Translated into three languages

21. Resource Paths • Guides used by case managers to help navigate assessment, treatment and intervention • Designed to be mentoring and “as needed” training devices • Can incorporate new clinical, assessment and intervention methods • Advocate to the health care team

22. Corporate Partnership • Access to attendee and membership lists • Discounts for exhibit booths and other CMSA products • Complimentary individual memberships and conference registrations • Heightened visibility

23. 2010 Annual Conference & Expo CMSA’S 20th ANNIVERSARY June 8 – 11, 2010 Walt Disney WorldCoronado Springs ResortOrlando, Floridawww.cmsa.org/conference

24. New Outreach Opportunities • Educational and Promotional Events • CE Symposia • Non-CE Symposia • General Conference Sponsorships • 12 months of promotion • Website • Print material • E-communications • Signage and recognition

25. Partnering With Disney • Coast-to-Coast Party Kick-Off Event • Exclusive use of Disney’s Hollywood Studios • Unique branding and promotion opportunities • Exclusive and wide-spread promotion of sponsors • Disney’s Exhibitor Concierge Service • Theme Park Events & Tickets • Entertainers • Cutting edge AV and booth presentations

26. Conference Opportunities • EXHIBIT BOOTHS:contact the Exhibit Management Team for more information • SPONSORSHIPS:available for all budgetsand guidelines • STRATEGIC PACKAGES

27. Key Contacts HARRY ALBACorporate Accountshalba@comcast.net SYLVIA JOHNSONConference Coordinatorsjohnson@acminet.com SHELLY GREENWOODEvent Plannersgreenwood@acminet.com • MICHELLE KOCHDirector, Corporate Accountsmkoch@acminet.com • LINDSAY HARPAccount Representativelharp@acminet.com • J. MICHAEL HOEHNVice-President,Business Developmentmhoehn@acminet.com

28. Thank You for Your Supportof Case Management