** 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. OBJECTIVES:
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