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The exam consists of two components. The first section contains core case management questions that test the knowledge of Case Managers working in a hospital/health system. The second component consists of clinical simulations, which test the application of case management knowledge to simulated practice scenarios.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes. [2] Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community. [3]
If attempts are made to purchase or commission health services using outcomes data, bias may be introduced that will negate the benefits, especially in the service provider produces the outcomes measurement. See Goodhart's Law; Inadequate attention may be paid to the analysis of context data, such as case mix, leading to dubious conclusions. [27]
The case manager becomes an effective facilitator or enabler by use of self, understanding the social systems, the etiology of needs, and functioning of the clients. Moore in 1990s said that a case manager should possess the clinical skills of a psychotherapist and the advocacy skills of a community organizer. [10]
There are efforts to define core sets of patient-relevant outcome variables to be measured in clinical trials in general [28] and for multi-modal pain therapy. [29] Meanwhile, a core outcome measure set based on PROMS was developed with routine data and validated for operationalizing success in multimodal pain therapy. [30]
Healthcare quality and safety require that the right information be available at the right time to support patient care and health system management decisions. Gaining consensus on essential data content and documentation standards is a necessary prerequisite for high-quality data in the interconnected healthcare system of the future.
The case management restrictions must not "substantially impair access" to primary care services of "adequate quality where medically necessary"; and; The case management restrictions must be "cost effective". [2] In their earliest forms, PCCM programs closely resembled traditional fee-for-service Medicaid than managed care.