The Value-Based Integrated Case Management Workplace

Kathol, Roger G.; Andrew, Rachel; Squire, Michelle; Dehnel, Peter J.

doi:10.1007/978-3-319-74742-2_4

The Integrated Case Management Manual 2018

DOI: 10.1007/978-3-319-74742-2_4

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The Value-Based Integrated Case Management Workplace

Roger G. Kathol

Rachel Andrew

Michelle Squire

et al.

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2023

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“…One example of an integrated model is ICM. ICM is a high-intensity, cross-disciplinary, longitudinal “assistance and support” model for those with comorbid medical and behavioral health conditions and increased service use (Kathol et al, 2016,2018). A licensed nurse, behavioral health provider (e.g., social worker, psychologist, and professional counselor), or registered dietitian provides ICM by addressing clinical and nonclinical barriers to health improvement, with the goal of eventually returning patients (called “members” by health plans) to standard outpatient care.…”

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confidence: 99%

Value-Based Integrated Case Management at Payor Level

Martin

Suri

Doebbeling

et al. 2023

Professional Case Management

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Purpose of Study: Case management is an ideal service for patients with health complexity. However, most case management models do not integrate medical and behavioral health training and interventions, and there are little data evaluating these models in privately insured populations. The purpose of this study was to evaluate impact of an integrated case management (ICM) service at the payor level. Primary Practice Setting: Health care insurance company. Methodology and Sample: A multimethod observational study was conducted at a health care insurance company in the Pacific Northwest of the United States. We conducted focus groups of case managers, leaders, and administrators and statistical analyses of outcomes data. Measures included care quality data (discharge follow-up appointment, cost per case, depression and anxiety measures, customer experience and satisfaction, and audit scores) of members receiving ICM services and employee focus group data (acceptability, adoption, feasibility, appropriateness, fidelity, and sustainability) related to the practice of ICM. Results: Care quality data suggest ICM reduces mental health symptoms and increases discharge follow-up appointments for members. Implementation challenges include new employee orientation to ICM model, traditional views of case management, performance evaluation, documentation, and information technology. Facilitators of implementation include training, autonomy, and leadership support. Implications for Case Management Practice: Organizations should be aware both of the benefits and challenges related to implementing ICM. Open communication between case managers and leadership and an improvement-focused culture appear to be important elements of implementation success. Future research should examine the perspective of members receiving ICM services and the implementation of ICM into health care delivery systems.

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confidence: 99%

Value-Based Integrated Case Management at Payor Level

Martin

Suri

Doebbeling

et al. 2023

Professional Case Management

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The Value-Based Integrated Case Management Workplace

Cited by 1 publication

References 6 publications

Value-Based Integrated Case Management at Payor Level

Value-Based Integrated Case Management at Payor Level

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