Module A: Care Management for a Population

CE Credits: 1.5

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This module lays out the foundations for an overall understanding of Population Health Management—an approach that emphasizes value for patients over volume. It begins by defining the concept, in part by showing its goals: improved patient health and experiences, but also lower costs. Then, it explores the roles played by both people and organizations in promoting population health, including Case Managers, Accountable Care Organizations (ACO), and Chief Population Health Officers (CPHO). The module also looks at the effects of uncompensated healthcare and under-insured individuals on population health—namely, that the two scenarios result in higher costs, less preventative care and an over-reliance on emergency room visits.

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Learning objectives: After completing this module case managers will be able to:
» Describe the changing landscape of healthcare delivery
» Discuss the compelling need for a re-engineered healthcare system
» Define population health and the Institute for Healthcare Improvement’s (IHI) Triple Aim
» Review the pivotal role of case management in population health
» Describe the shift in healthcare delivery and reimbursement management
» Discuss the economic and societal effects of uncompensated healthcare and underinsured individuals on population health
» Identify organizational changes and effective leadership

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Advance your professional practice: As a leader, liaison and “hub” of care for many patients, case managers play a pivotal role in helping to promote population health—not only by helping to connect patients with the entire continuum of care, but also by engaging with the transdisciplinary team. When we CMs understand the basic concept of population health, we are better equipped to implement its best practices.

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Improving organizational performance: Population health management promotes preventative and evidence-based care, which is ideal for patients—but that kind of care is also indicative of healthy hospitals and healthcare organizations. When the transdisciplinary team understands and embraces population health management, our healthcare organization benefits, too.