Showing papers by "Roger G. Kathol published in 2016"

Comprar Physician's Guide. Understanding And Working With Integrated Case Managers | Roger G. Kathol | 9783319289571 | Springer

Abstract: Tienda online donde Comprar Physician's Guide. Understanding And Working With Integrated Case Managers al precio 79,79 € de Roger G. Kathol | Katherine Hobbs Knutson | Peter J. Dehnel, tienda de Libros de Medicina, Libros de Medicina Interna - Medicina interna

Health Complexity and the Interaction Between Physical and Behavioral Health Conditions in Children and Youth

Abstract: There are multiple domains that act independently and in concert to influence the health of children/youth. Children/youth with multiple factors in each domain and/or in multiple domains are likely to present with increased health complexity resulting in poor health outcomes and increased cost. Addressing these issues in a holistic manner, with a focus on relationship and continued joint effort, may reverse these potential negative outcomes. By simultaneously addressing the clinical, social, and health-system barriers to health improvement for vulnerable populations, there is a significant potential to reduce reliance on high-cost treatments. Interestingly, lower-cost and community-based care may result in better health outcomes for children/youth compared to treatment in high-cost environments, such as inpatient units and the Emergency Department. Treatment for chronic medical and BH conditions in children/youth necessarily requires long-term continuous relationships with providers. This type of care is best delivered in an outpatient community setting as opposed to the fragmentation that often occurs when children/youth transition between levels of care. PICM managers have the expertise and ability to help maintain children/youth in these lower cost and higher quality treatment settings.

Indirect and Direct Physician Support for Integrated Case Management in Adults

Abstract: ICM is intended to augment clinical treatment from a physician by assisting in health and life circumstances that interfere with patients’ ability to improve and stabilize their health. Treating physicians maintain a focus on clinical evaluation and treatment. Physicians working with patients having an ICM manager, however, have the advantage of quick access to information not typically included in standard medical assessments as well as intervention capabilities for circumstances that impede treatment outcomes. To the extent that the physician and ICM manager see themselves as a team for the patient, the physician will incorporate into their treatment plans an improved understanding of non-clinical factors affecting their patients’ health outcomes that have been uncovered through the ICM assessment process. For instance, knowing that a patient is not taking full doses of needed medications due to financial challenges allows a physician to consider cheaper generic alternatives or to seek medication cost support programs rather than simply increasing the dose of an expensive medication on the presumption that the current dose is insufficient to effect change. It is through enhanced information sharing that improved outcomes can be achieved.

Health Complexity and the Interaction Between Physical and Behavioral Health Conditions in Adults

Abstract: The first chapter of the Physician’s Guide goes into great detail about patient health care assistance and support programs and its case management subcategory, which requires the skills of licensed professionals with case manager competencies that match increasing levels of assist and support program intensity. Since assistance and support programs and the published literature are generally indiscriminant in their use of terminology to describe assistance and support interventions regardless of program intensity or the personnel competencies of those providing services, we will rely on the concepts of program intensity and assist and support personnel competency used in Chap. 1 throughout this book. “Case management” will remain the term that demarcates programs with higher intensity and “case managers” the professionals needed to meet program and patient needs.

Patient Health Care Assist and Support Services, Integrated Case Management, and Complexity Assessment Grids

Abstract: The practice of medicine is much more complicated than in the day of the “old fashioned” house call. Providing respectful patient-centered care remains at the heart of clinician assessments and treatments. However, with the introduction of the Patient Protection and Affordable Care Act (ACA), there is now also an expectation that physicians and other treating clinicians, e.g., clinical nurse specialists, physician assistants, non-physician behavioral health (BH) professionals, will optimize clinical outcomes and reduce costs in the populations of patients for whom they and their group are responsible. Thus, the face-to-face encounter is only one of several components of an increasingly complicated care delivery process. In addition to completing a patient evaluation and providing appropriate treatment, physicians are being asked to improve their communication and collaboration with others involved in the patient’s care, to use health resources efficiently, and to do so in a way that maximizes and documents long-term clinical and functional improvement for the population as a whole, not just the individual patient (McClellan et al., Health Aff., 29(5):982–90, 2009; Epstein et al., Health Aff., 33(1):95–102, 2014). In the USA, often these goals are carried out through integrated clinician and health administrative networks, called Accountable Care Organizations (ACOs).

Physicians’ Contributions to Building and Participating in a Population-Based Case Management Centers of Excellence

Abstract: Value-added case management has a bright future as a contributor to population health management. It utilizes trained health professionals to assist and support individual patients, identified using aggregate service use data related to an accountable population, with various levels of health complexity. In successful population health management programs, population-based work processes, including case management, are designed to achieve improved clinical, functional, and economic outcomes (Struijs JN et al. (Health Policy 119(4):522–529, 2015)) in a healthcare environment that often retards, rather than promotes, health.

Connecting Integrated Case Management with Integrated Complex Inpatient and Outpatient Care

Abstract: ICM and PICM are specialty programs that will increasingly contribute to health improvement and cost reduction for patients with health complexity in the future. They, however, do not provide service in isolation. Rather, theirs is a synergy between (1) the clinical and non-clinical assistance and support function they perform and (2) the clinical services that are directed at evaluation and treatment of medical and BH conditions. Unless these two complementary components of care work effectively together, the value that either one can produce will be limited. This chapter suggests interim and long-term steps to which physicians working with ICM and PCIM managers can be substantial contributors.

The Organizational and Operational Setup of Adult Integrated Complex Case Management

Abstract: PICM shares many of the essential features of adult ICM. There are sufficient differences when working with a pediatric population and their families, however, that a parallel but separate approach is needed with characteristics specifically designed for children/youth. To date, we are aware of no other case management programs, especially created for children/youth, that has assessment and intervention components particularly focused on the integration of physical and behavioral health and the incorporation of social and health system factors impacting health, as are found in PICM. It is our hope that with appropriate training, competent ICM managers with or without pediatric backgrounds will be able to improve outcomes for families with children/youth having early life health complexity. Ultimately improved health during early life development may lead to better health and productivity in adulthood, thus continuing the return on the health system’s investment throughout the lifespan.

Organizing and Implementing Value-Added Integrated Case Management

Abstract: Physicians should now have a grasp of the types of assist and support services, a conceptual framework for the value that ICM can bring to populations of patients with health complexity, how ICM can complement clinical practice, the effects of the interactions between medical and BH conditions on clinical and financial outcomes, and the foundational components of ICM and PICM used in patients. It is now time to discuss when and how an ICM program should be considered in an organizational setting and the high-level decision-making associated with its deployment. For purposes of this chapter, “ICM” will be used to refer to both the adult and pediatric components.

Indirect and Direct Physician Support for Integrated Case Management in Children/Youth

Abstract: Pediatric physicians have a very direct and important role in supporting integrated case management activities. The first task is to define very explicitly what level of case management is being considered by their healthcare organization. Care coordination carried out by a non-clinical (non-RN) support staff may be effective for patients with low to moderate case complexity in terms of health outcomes, patient costs, and patient and family satisfaction. However, the most complex patients, often with a combination of physical health, behavioral health, social situation, and health system challenges, benefit most from case managers trained to practice PICM. These patients and their families require support from case managers who are facile in addressing their clinical and health system challenges in an integrated way, without hand-offs or other interruptions in care. Physicians working with case managers in this process also need to be familiar with the PICM approach to best support the PICM managers and their patients.