About this Learning Activity

NCQA Essentials for Case Management (Self-Paced)

Through this course, participants will learn the fundamentals of case management from systematic evidence reviews through care transitions. Our experts dive deep into practical cases for working with interdisciplinary teams and ensuring patients receive timely and appropriate care. The NCQA publication related to this learning activity may be accessed, here: Case Management: https://store.ncqa.org/health-plans-other-organizations/case-management-cm.html

Duration: ~3.5 hours

What You Will Learn

Content Topics

• Case Management Program Essentials
• Patient Identification and Assessment
• Care Planning, Monitoring, and Transitions
• Measurement and Quality Improvement
• Staffing, Training, and Verification
• Member Rights and Responsibilities
• Delegation of Case Management

Learning Objectives

Throughout this learning activity, guidance is provided on how to:

• Use evidence-based information to develop and refine a case management program.
• Define activities for systematically identifying patients for the case management program.
• Recognize attributes of adequate individualized care plans.
• Recognize practices for effectively monitoring individualized care plans.
• Explore tactics for reducing unplanned transitions and identifying care transition issues.
• Define practices for measuring program effectiveness and improving patient experience.
• Discuss opportunities for preparing staff with clinical practice guidelines.
• Recognize practices for effectively communicating expectations to members enrolled within a case management program.
• Define structures for and mechanisms to oversee delegated case management activities.

Learning Outcomes

After completing this learning activity, learners will be able to:

• Identity opportunities for enhancing their current case manegemnt program.
• Evaluate the effectiveness of their current case management program.
• Recognize the changes necessary to improve a case management program.
• Optimize coordination for delegation arrangements.                                                                                                                                                                

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates, and vendors who are employed or contracted by health plans with responsibilities related to case management operations, including:

• Directors of Accreditation or Compliance
• Directors of Case Management
• Case Managers
• Population Health Managers
• Clinical Social Workers
• Care Coordination Managers
• Discharge Planners

Learning Materials and Resources

• Live Q&A with a case management expert
• Recording of live presentations
• Three (3) case studies
• Knowledge check quizzes
• Presentation Slides

BONUS Content

Navigating NCQA Delegation (Self-paced)

Want to know what Delegation means to NCQA and familiarize yourself with the nuances? This virtual course can provide you with those answers and more. Experienced faculty will take a deep dive of each NCQA delegation standard, to improve your understanding, from oversight to automatic credit. You will learn how to navigate through examining key elements that should be in place prior to an organization's decision to give an entity the authority to act on their behalf. A demo of NCQA’s Interactive Review Tool (IRT) will also be provided.

Duration: ~3.5 hours

What You Will Learn

At the conclusion of this event, learners will be able to:

• Explain NCQA’s Delegation Standards—including oversight requirements and criteria for automatic credit and file review
• Identify appropriate documentation and operational procedures required to comply with NCQA’s delegation requirements
• Describe potential areas of concern in the delegation process
• Apply NCQA’s Delegations Standards to assist healthcare organizations in the delegation process

Faculty

Candice Costello, BS

Candice Costello is Assistant Director of Accreditation Operations at NCQA. Accreditation Operations provides direct customer support for organizations pursuing NCQA Accreditation and Certification programs. In her role, Candice provides team support, leads new and updated product implementation efforts and is responsible for the maintenance and enhancement of survey systems. She is focused on continuous improvement of the NCQA survey process and customer experience.

Candice completed her undergraduate education in Health Services Administration at James Madison University, and has been supporting the NCQA mission since 2010. Candice currently lives in Atlanta, GA with her husband and two children.

Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking. Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Clint Koenig, MD, MSPH, MA

Clint Koenig, MD, MA, MSPH is the Senior Medical Director at OhioHealthy, a new system-based health plan in Columbus, Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse, New York, as well as, the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems. He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.

Dr. Koenig received his MD from Albany Medical College in Albany, New York. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received a master’s degree in Public Health and Journalism.

Veronica Locke, MHSA

Veronica Locke, MHSA is a process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. Prior to joining HCSC, Veronica was a consultant for The Mihalik Group, providing healthcare-related consulting services.  Her areas of expertise include quality assessment and improvement; credentialing; delegation; disease management accreditation/certification; population health management; multicultural health care. Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA’s Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally. 
She received her Bachelor of Science Degree in Public Health from the University of Maryland, College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.

Continuing Education

Essentials for Case Management:

In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team. 

This educational activity is approved for: 4.0 AMA PRA Category 1 Credit^TM , 4.0 ANA CNE contact hours and 4.0 ASWB contact hours.

This live webinar grants 4 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

• Please note – You must attend the entire program to be eligible for total number of contact hours.

Navigating Delegation: This is a non-accredited activity.

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:

Candice Costello: None

Clint Koenig: None

Irv Koehler: None

Veronica Locke: None

Additional Planning Committee Members:
Vince Pereira: None