CMSA Today - Issue 4, 2017 - 30

or accessible to them. This is an important
distinction between engagement models/
systems because not all patients have access
to the newest and best technology.
That patient self-reported information
appears on a care manager's dashboard that
updates daily, in real time. The dashboard
displays charts and graphs of historical daily
surveys, offering insight into patient behavior, change and trends. This 360-degree
holistic view into a patient's clinical status,
self-care habits, and social determinants of
health empowers care teams to focus on
interventions and make the necessary referrals to other entities.
This "whole picture" of the patient's
status provides insight to a care manager
regarding which patients may be struggling
on a given day. The system triggers alerts for
patients who are at risk for a health event,
allowing care managers to intervene only
with those patients who most need it. With
this kind of trending insight, 70 percent of
all alerts can be resolved by care managers
by simply better educating patients on their
self-care behavior.
Daily engagement provides an immediate
feedback loop; care managers can provide
positive reinforcement or correction at the
time of the event before it escalates into a
larger health issue. This immediate feedback
also helps patients understand which behaviors affect their health and well-being, and
reinforces better options.
Due to their daily check-ins and immediate
feedback, patients develop better habits and
become more self-aware about what to look
out for and how to better care for themselves. By integrating this daily connection

INDEX OF ADVERTISERS
AIR AMBULANCE
Aviation West Charters Inc dba Angel Med Flight ������3
www�angelmedflight�com/case-managers
ASSOCIATIONS
American Association of Nurse Life Care Planners����14
www�aanlcp�org
BRAIN INJURY REHABILITATION
Hope Network Neuro Rehabilitation �������������������������23
www�hopenetwork�org
Learning Services, Inc� ���������������������������������������������24
www�learningservices�com
CARE PLANNING SERVICE
Home Instead Senior Care��������������� Inside Back Cover
www�HomeInstead�com
CASE MANAGEMENT
GENEX Services, LLC �����������������������������������������������22
www�genexservices�com
30

CMSA TODAY

Issue 4 * 2017

into their lives, over the course of time
patients become better educated and about
their own health and far more involved in
their self-care, which builds in accountability
and responsibility for their own health.
A WIN-WIN FOR EVERYONE
Not only does this kind of patient
engagement model help keep patients
healthier, it also allows care managers to
manage caseloads far more efficiently.
Thanks to a prioritized worklist generated by the system, the number of patient
panels per care manager significantly
increases, without any additional work.
In fact, care managers can typically handle
three to five times more patients (per care
manager) with technology-enabled care
management workflow tools.
We have found that if patients participate
in an engagement program for 30 days, it
becomes a part of their lives. Participating
in the program increases accountability for
their own health and becomes a healthy
habit. The outcomes speak for themselves:
* Better compliance with keeping doctor's appointments
o 85 percent of physician appointments kept
* Better medication adherence because
patients are asked about it
o 98-percent prescription fill rates
* Better compliance among patients about
managing their chronic conditions, e.g.,
daily weighing, checking blood glucoses
daily, and monitoring their medications.
* A 60-percent reduction in all-cause
admissions
In healthcare, we make care plans for our
patients, but we often leave out the most
CERTIFICATION
CCMC (Comm� For CM Cert�) �������������������������������������7
www�ccmcertification�org
EDUCATION & TRAINING
National Comprehensive Cancer Network ���������������19
www�education�nccn�org/case-manager
HANDICAP ACCESSIBLE EQUIPMENT
Amramp���������������������������������������� Outside Back Cover
www�amramp�com/CMSA
HOME HEALTH CARE
ComForCare Health Care Holdings, LLC ������������������11
www�comforcare�com
Right at Home, Inc� ���������������������������������������������������15
www�rightathome�net
REHABILITATION SERVICES
Florida Institute for Neurologic
Rehabilitation, Inc� ������������������������Inside Front Cover
www�finr�net
Rainbow Rehabilitation Centers �������������������������������18
www�rainbowrehab�com

important person-the patient. Patients
have a lot to say about their care and interactions with the healthcare system; all we
need to do is get them engaged. ■
Sue Brown, BSN, RN, is Vice President, Clinical Operations & Quality for Pharos Innovations. Prior to Pharos Innovations, she served
as Vice President of Clinical Operations for
Health Contact Partners, a subsidiary of the
Trustmark Company. Ms. Brown has a Bachelor of Science in Nursing from Barat College
in Lake Forest, Illinois.

REFERENCES
1. Carman KL, Dardess P, Maurer M, Sofaer S, Adams
K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and
developing interventions and policies. Health Affairs.
2013 Feb;32(2):223-31. doi: 10.1377/hlthaff.2012.1133.
2. HIMSS Patient Engagement Framework. HIMSS
Web site. http://www.himss.org/ResourceLibrary/
genResourceDetailPDF.aspx?ItemNumber=28305
Published Feb. 10, 2014. Accessed March 2016.
3. Patients & Families. HealthIT.gov Web site. http://
www.healthit.gov/patients-families/video/healthit-you-giving-you-access-your-medical-records
Published Dec. 6, 2012. Accessed March 2016.
4. Engagement Behavior Framework. Center for
Advancing Health Web site. http://www.cfah.org/
engagement/ Revised 2014. Accessed March 2016.
5. Korda, H. Patient Satisfaction: The New Rules of
Engagement. The Health Care Blog Web site. http://
thehealthcareblog.com/blog/2012/10/26/patientsatisfaction-the-new-rules-of-engagement/
Published October 26, 2012. Accessed March 2016.
6. HCUP Statistic Brief #146, Jan. 2013.
7. Thorpe K., Howard D. The Rise in Spending Among
Medicare Beneficiaries: The Role of Chronic Disease
Prevalence and Changes in Treatment Intensity Health
Affairs 2006;25(5): w378-w388.
8. Pharos Innovations analysis of CMS Physician
Group Practice Demo cohort data

TREE OF LIFE������������������������������������������������������������26
www�tree-of-life�com
SUBACUTE
Florida Institute for Neurologic
Rehabilitation, Inc� ������������������������Inside Front Cover
www�finr�net
VENTILATORS
Florida Institute for Neurologic
Rehabilitation, Inc� ������������������������Inside Front Cover
www�finr�net
WORKERS COMPENSATION
Florida Institute for Neurologic
Rehabilitation, Inc� ������������������������Inside Front Cover
www�finr�net
WOUND MANAGEMENT
Florida Institute for Neurologic
Rehabilitation, Inc� ������������������������Inside Front Cover
www�finr�net


http://www.tree-of-life.com http://www.ccmcertification.org http://www.angelmedflight.com/case-managers/ http://www.education.nccn.org/case-manager http://www.finr.net http://www.aanlcp.org http://www.amramp.com/CMSA http://www.finr.net https://hopenetwork.org http://www.comforcare.com http://www.learningservices.com http://www.rightathome.net/cmsa http://www.finr.net http://www.HomeInstead.com http://www.finr.net http://www.finr.net http://www.rainbowrehab.com http://www.genexservices.com

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2017

President’s Letter
Association News
CMSA Conference Supporters
CMSA Corporate Partners
Case Management at the Helm of Diverse America
Community Health Workers: A Key Role on the Collaborative Care Team
Ticket to Work: Strategies for Case Managers Who Face Work-Disrupting Disabilities
For Case Managers, Success Requires Mastering Today’s Challenges
Using a Patient Engagement Strategy to Help Care Managers Educate Patients at the Right Time—Before It’s Too Late
Index of Advertisers
CMSA Today - Issue 4, 2017 - Intro
CMSA Today - Issue 4, 2017 - cover1
CMSA Today - Issue 4, 2017 - cover2
CMSA Today - Issue 4, 2017 - 3
CMSA Today - Issue 4, 2017 - 4
CMSA Today - Issue 4, 2017 - 5
CMSA Today - Issue 4, 2017 - President’s Letter
CMSA Today - Issue 4, 2017 - 7
CMSA Today - Issue 4, 2017 - Association News
CMSA Today - Issue 4, 2017 - 9
CMSA Today - Issue 4, 2017 - CMSA Conference Supporters
CMSA Today - Issue 4, 2017 - CMSA Corporate Partners
CMSA Today - Issue 4, 2017 - Case Management at the Helm of Diverse America
CMSA Today - Issue 4, 2017 - 13
CMSA Today - Issue 4, 2017 - 14
CMSA Today - Issue 4, 2017 - 15
CMSA Today - Issue 4, 2017 - Community Health Workers: A Key Role on the Collaborative Care Team
CMSA Today - Issue 4, 2017 - 17
CMSA Today - Issue 4, 2017 - 18
CMSA Today - Issue 4, 2017 - 19
CMSA Today - Issue 4, 2017 - Ticket to Work: Strategies for Case Managers Who Face Work-Disrupting Disabilities
CMSA Today - Issue 4, 2017 - 21
CMSA Today - Issue 4, 2017 - 22
CMSA Today - Issue 4, 2017 - 23
CMSA Today - Issue 4, 2017 - 24
CMSA Today - Issue 4, 2017 - For Case Managers, Success Requires Mastering Today’s Challenges
CMSA Today - Issue 4, 2017 - 26
CMSA Today - Issue 4, 2017 - 27
CMSA Today - Issue 4, 2017 - Using a Patient Engagement Strategy to Help Care Managers Educate Patients at the Right Time—Before It’s Too Late
CMSA Today - Issue 4, 2017 - 29
CMSA Today - Issue 4, 2017 - Index of Advertisers
CMSA Today - Issue 4, 2017 - cover3
CMSA Today - Issue 4, 2017 - cover4
http://www.nxtbook.com/naylor/CMSQ/CMSQ1118
http://www.nxtbook.com/naylor/CMSQ/CMSQ0417
http://www.nxtbook.com/naylor/CMSQ/CMSQ1417
http://www.nxtbook.com/naylor/CMSQ/CMSQ0317
http://www.nxtbook.com/naylor/CMSQ/CMSQ1317
http://www.nxtbook.com/naylor/CMSQ/CMSQ0217
http://www.nxtbook.com/naylor/CMSQ/CMSQ1217
http://www.nxtbook.com/naylor/CMSQ/CMSQ0117
http://www.nxtbook.com/naylor/CMSQ/CMSQ1117
http://www.nxtbook.com/naylor/CMSQ/CMSQ0416
http://www.nxtbook.com/naylor/CMSQ/CMSQ1416
http://www.nxtbook.com/naylor/CMSQ/CMSQ0316
http://www.nxtbook.com/naylor/CMSQ/CMSQ1316
http://www.nxtbook.com/naylor/CMSQ/CMSQ0216
http://www.nxtbook.com/naylor/CMSQ/CMSQ1216
http://www.nxtbook.com/naylor/CMSQ/CMSQ0116
http://www.nxtbook.com/naylor/CMSQ/CMSQ1116
http://www.nxtbook.com/naylor/CMSQ/CMSQ0415
http://www.nxtbook.com/naylor/CMSQ/CMSQ1415
http://www.nxtbook.com/naylor/CMSQ/CMSQ0315
http://www.nxtbook.com/naylor/CMSQ/CMSQ1315
http://www.nxtbook.com/naylor/CMSQ/CMSQ0215
http://www.nxtbook.com/naylor/CMSQ/CMSQ1215
http://www.nxtbook.com/naylor/CMSQ/CMSQ0115
http://www.nxtbook.com/naylor/CMSQ/CMSQ1115
http://www.nxtbook.com/naylor/CMSQ/CMSQ0414
http://www.nxtbook.com/naylor/CMSQ/CMSQ1414
http://www.nxtbook.com/naylor/CMSQ/CMSQ0314
http://www.nxtbook.com/naylor/CMSQ/CMSQ1314
http://www.nxtbook.com/naylor/CMSQ/CMSQ0214
http://www.nxtbook.com/naylor/CMSQ/CMSQ1214
http://www.nxtbook.com/naylor/CMSQ/CMSQ0114
http://www.nxtbook.com/naylor/CMSQ/CMSQ1114
http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com