The Case Manager's Handbook / Edition 6

by Catherine M. Mullahy

Overview

Written by renowned author Catherine M. Mullahy, The Case Manager’s Handbook, Sixth Edition is an indispensable guide for case managers. Presented in an accessible and conversational style, this practical resource helps case managers learn the fundamentals, study for the Certified Case Manager (CCM) exam, and advance their careers after the exam. Completely updated and enhanced with information on the latest developments affecting case management, it reflects the rapidly changing healthcare landscape, including the significant effects of the Affordable Care Act (ACA).

The Sixth Edition includes new chapters on pediatric case management, workers’ compensation case management, key factors driving today’s healthcare system, the case manager’s role in the era of value-based health care, case management and healthcare provider strategies for managing the high-risk or high-cost patient, and transformative healthcare approaches for the millennial generation.

Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, midterm and final exam, instructor’s manual, and learning analytics reporting tools.

Product Details

ISBN-13:	9781284102406
Publisher:	Jones & Bartlett Learning
Publication date:	06/06/2016
Edition description:	New Edition
Pages:	746
Product dimensions:	6.10(w) x 9.10(h) x 1.70(d)

About the Author

With over four decades of experience managing health care and a prominent role in shaping the case management industry, Catherine M. Mullahy, RN, BS, CRRN, CCM, is recognized as one of the industry’s most significant and passionate leaders. In her multiple positions as an officer, board member, task force member, and executive committee member for leading professional associations (e.g., CMSA, CCMC, URAC), she has played a vital role in raising the standards of the case management profession. A former editor of The Case Manager, she continues to be a prominent contributor to other leading professional publications (Professional Case Management, Advance for Nurses, Care Management, etc.) and numerous professional books. Currently, she is a highly sought after educator and training consultant to case management firms, managed care organizations, hospitals, healthcare providers, and government agencies, as well as a popular speaker on the conference and professional association circuit. The educational programs she provides through her firm, Mullahy & Associates, LLC, are widely-valued for their content with two of them having been honored with prestigious Case in Point Platinum Awards. Her firm is a Continuing Education Provider for the Commission for Case Manager Certification®’s (CCMC) CMLearning Network®. Evidence of her distinguished career can be seen in her many awards, including: the 2010 “Lifetime Achievement Award” from the Case Management Society of America (CMSA) and “CMSA Distinguished Case Manager of the Year” in 1999. Today, through her spirited writing and sharing of the ideas and principles put forth in this latest edition of The Case Manager’s Handbook, she continues to capture the critical role of case managers, empowering them with timely, need-to-know information and insights so that they can be vital catalysts and strong patient advocates in the rapidly changing healthcare continuum.

Table of Contents

Part Part I Introduction: Biography of a Case Manager
Chapter 1 The Case Manager as Catalyst, Problem Solver, Educator
Chapter 2 The Case Manager’s Universe
Part II Part II: Case Management Process: The Microsystem Level
Chapter 3 The Case Management Work Format and Process
Appendix APPENDIX 3-A VIII. Standards of Case Management Practice
Chapter 4 Communications And Patient Engagement
Part Part III Practice Settings And Models of Care
Chapter 5 Hospital Case Management: Changing Roles and Transitions of Care
Chapter 6 ACOs, PCMHs, And State Health Exchanges
Chapter 7 Independent Case Management
Chapter 8 Home Care Case Management, Long-Term Care and Health Care Reform
Chapter 9 Pediatric Case Management
Chapter 10 Workers’ Compensation Case Management
Part Part IV The Case Management Professional
Chapter 11 Legal Responsibilities Of The Case Management Professional
Appendix APPENDIX 11-A Written Agreement: Some Typical Provisions
Appendix APPENDIX 11-B Legal Issue s in Case Management Checklist
Appendix APPENDIX 11-C AMA Evidence-Based Principles of Discharge and Discharge Criteria
Appendix APPENDIX 11-D U.S. Legislation Review Relevant to Healthcare Case Management
Chapter 12 Ethical Responsibilities Of The Case Management Professional
Appendix APPENDIX 12-A CCMC Rules of Conduct
Appendix APPENDIX 12-B Excerpts from the CCMC Code of Professional Conduct for Case Managers
Chapter 13 Evidence-Based Practice For Case Managers: Data-Driven Decision Making
Chapter 14 Case Manager Credentialing and Organizational Accreditation
Part Part V Reimbursement
Chapter 15 Reimbursement Resources And Challenges
Chapter 16 Healthcare Reimbursement: Private-Sector or Employer-Sector Funding
Chapter 17 Healthcare Reimbursement: Public Sector
Chapter 18 Working Effectively With Claims Departments: Case Managers In Consulting Roles
Part Part VI Leadership And Management: Macrosystems
Chapter 19 Outcomes Management With Analysis Of Financial And Quality Assurance Reporting
Appendix APPENDIX 19-A Program Questionnaire and Facility Review for Case Managers
Appendix APPENDIX 19-B Provider Service Agreements
Appendix APPENDIX 19-C Expanded Cost–Benefit Analysis Summary
Appendix APPENDIX 19-D Expanded Cost–Benefit Analysis Summary for -Self-Funded Plan
Chapter 20 New Strategies for Leading A Case Management Department: Today and Into the Future
Appendix APPENDIX 20-A Sample Nurse Reviewer for Prenotification Department Position Description
Appendix APPENDIX 20-B Sample Medical Case Manager Position Description
Appendix APPENDIX 20-C Sample Director of Case Management Services Position Description
Appendix APPENDIX 20-D UNIT-BASED NURSE CASE MANAGER CHART
Chapter 21 Predictive Modeling And Case Stratification
Part Part VII Focus On Current Challenges And Emerging Trends
Chapter 22 New Characteristics of Today’s Healthcare Systems
Chapter 23 The Case Manager’s Role in the Era of Value-Based Healthcare
Chapter 24 New Case Management and Healthcare Provider Approaches for Managing the High Risk, High Cost Patient
Chapter 25 The Aging Population, Medical Advancements, And New Case Management Considerations
Chapter 26 Dying In America
Appendix APPENDIX 26-A: End-of-Life Care: The Latino Culture
Appendix APPENDIX 26-B: End-of-Life Care: The Russian Culture
Appendix APPENDIX 26-C: End-of-Life Care: The Vietnamese Culture
Chapter 27 Medication Management: A Case Management Call to Action
Chapter 28 Pain Management
Chapter 29 Our Nation’s Multiculturalism And Challenges To Case Managers
Appendix APPENDIX 29-A: Communicating with Your Chinese Patient
Appendix APPENDIX 29-B: Communicating with Your American Indian/Alaska Native Patient
Appendix APPENDIX 29-C: Communicating with Your Latino Patient
Appendix APPENDIX 29-D: Communicating with Your Russian Patient
Chapter 30 Health Literacy And Adherence Issue s
Chapter 31 Obesity: The New Epidemic
Chapter 32 Behavioral Health with Primary Care: An Integrated Model of Care
Chapter 33 Healthcare Technology And Trends: Implications For Case Managers
Chapter 34 Transformative Healthcare Approaches for the Millennial Generation
Chapter 35 The Affordable Care Act Of 2010: Implications For Case Managers

Editorial Reviews

4 Stars! from Doody

This new book is written to provide an integrated overview of the various roles, work formats, and processes a case manager encounters while coordinating the delivery of health care to patients. The purpose is to provide prospective and new case managers with more knowledge related to the case management profession, procedures, and future trends and opportunities. A second purpose is to increase communication and continuity of patient care between case managers, physicians, patients, families, and insurance parties. This book is written as a how-to guide for nurses, social workers, and rehabilitation specialists who may be training as case managers. The book is also written as a teaching tool for physicians and health care providers who are prescribing the care for patients a case manager oversees. This handbook is concise, easy to read, and informative. There are many examples of worksheets, summaries, contracts, and letters used by case managers to coordinate patient care services. The references are current, and the glossary offers useful medical, legal, and insurance terminology. This is an informative handbook for practitioners who desire to have a better understanding of case management in the health care delivery system. The book offers a look at the roles and responsibilities of a case manager as well as examples of practical issues to be used when coordinating patient care services. With guidelines to follow, the new case manager can receive assistance with problem solving so more time can be devoted to overseeing continuity of patient care.

Eileen G. Hill

This is a comprehensive look at the components involved in case management. The purpose is to provide a foundation of knowledge of those components. It is written for all who are involved in case management or for those who need a general overview of the functions of a case manager. Before I began the book, I thought about the critical components I look for in reviewing the case management process. They include integration of clinical, financial, and data systems analysis, and the ability to work with a multidisciplinary team (including the patient). I found this book to be a very comprehensive look at all of these components. It also has a balance of theory and practical examples. As a case manager on the front line, I found Appendix 10-A (Program Questionnaire and Facility Review for Case Managers) and Appendix 5-B (Legal Issues in Case Management Checklist) tools I could incorporate into my day-to-day case management process. One area that most case management programs struggle with is how to calculate case management cost savings and case manager productivity. The author touched on these concepts in theory, but it would have been helpful to see more concrete examples. Overall, I feel this book can be used as a foundation for developing a case management program/process.

Lynn Riippi

Reviewer: Lynn Riippi, RN, BSN, CCM (University of Colorado Health Sciences Center)
Description: This is a comprehensive look at the components involved in case management.
Purpose: The purpose is to provide a foundation of knowledge of those components.
Audience: It is written for all who are involved in case management or for those who need a general overview of the functions of a case manager.
Features: Before I began the book, I thought about the critical components I look for in reviewing the case management process. They include integration of clinical, financial, and data systems analysis, and the ability to work with a multidisciplinary team (including the patient). I found this book to be a very comprehensive look at all of these components. It also has a balance of theory and practical examples. As a case manager on the front line, I found Appendix 10-A (Program Questionnaire and Facility Review for Case Managers) and Appendix 5-B (Legal Issues in Case Management Checklist) tools I could incorporate into my day-to-day case management process. One area that most case management programs struggle with is how to calculate case management cost savings and case manager productivity. The author touched on these concepts in theory, but it would have been helpful to see more concrete examples.
Assessment: Overall, I feel this book can be used as a foundation for developing a case management program/process.

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