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Population Health: Supporting the Complex Population

** This session earns RN and CCM Ethics **

National health care expenditures continue to rise in the United States. A significant portion of national health spending can be attributed to programs administered by the Centers for Medicare & Medicaid Services (CMS) which includes Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). According to the CMS, national health expenditures across all public and privately funded programs are projected to reach $5.7 trillion by 2026. Medicare and Medicaid are subject to legislative and administrative changes led by Congress “to make improvements in the provision of health care services to our nations aged, disabled, and disadvantaged and to reduce the overall cost of care for these programs.” A call to action to control national health care expenditures is a shared responsibility among federal and state governments, businesses, stakeholder organizations, and health care consumers. With a shift in the healthcare landscape toward value-based payment models finding a way to better manage and support individuals with complex health and social needs has gained much attention. Most notably, individuals with complex health care needs comprise only one percent of the population but account for nearly one-fifth of health care costs. As a result, several leading foundations are working together to improve health care delivery and outcomes for individuals with complex medical and social needs. Professional case managers working in value-based payment models support patients with complex health and social needs through care transitions across the full continuum of healthcare. CMSA’s Standards of Practice for Case Management and CCMC’s Code of Professional Conduct for Case Managers serve as a foundation for professional case management practice to ensure high quality services. Professional case managers have the ability to impact health policy in support of the complex population. This session invites case managers to share successes, challenges, and opportunities in working with the complex population.

  1. Describe the characteristics of the complex care and social needs population.
  2. Identify how the Standards of Practice for Case Management and the Code of Professional Conduct for Case Managers serve as a foundation for a quality care management program to support the complex population.
  3. Define how professional case managers can support the complex population through public policy advocacy.