A. The Core Curriculum is written in the format and style of a “detailed topical outline.” It highlights current and salient practices and knowledge areas of case management that are useful for all case managers or health care professionals, including those who:

B. Similar to the CMSA’s Standards of Practice, some adjustments to the content of the Core Curriculum may be necessary before application or incorporation into individual practices or care settings. This may mean using practice setting- or specialty-specific terms instead of the generic ones. For example, in skilled care facilities or nursing homes, the term “resident” may be used instead of “client” or “patient.” However, in this Core Curriculum, “client” and “patient” are used as generic reference to the individual receiving health care or case-managed services.

C. Since the terms “client” and/or “patient” do not apply in every setting across the continuum of health and human services, changing the term to another more appropriate is warranted. One may choose to replace the term client and/or patient with:

D. The Core Curriculum is intended for voluntary use. It does not replace one’s judgment; the relevant legal, ethical, or professional practice requirements; or the policies, procedures, and standards of the organizations where case managers practice.

E. Although it is a helpful resource for preparing for case management certification examinations, the Core Curriculum is not intended as a certification review textbook. Case management professionals are advised to use additional review materials when preparing for certification.

F. The Core Curriculum describes case management programs and models and roles and responsibilities of case managers in the diverse care/practice settings across the continuum of health and human services and the various professional disciplines of those who assume these roles.

G. The Core Curriculum consists of materials that are both directly and indirectly related to the practice of case management.

H. Each chapter includes descriptions of some key terms cited in the chapter. These descriptions reflect the way the terms are used in the chapter. They are not necessarily standardized or nationally recognized in the industry;
however, they may be used to establish wide agreement. The descriptions do not necessarily form a glossary of terms. Readers are advised to use their judgment when applying these terms into own practice.

I. Two features are shared at the end of the Core Curriculum. These are as follows:

J. The Core Curriculum applies certain terms in a generic manner and to refer to other similar terms sometimes used interchangeably in the literature and by health care professionals. For example:

A. Care Coordination—The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care (AHRQ, 2007).

B. Care Setting—(Also referred to as practice site, practice setting, or work setting.) The organization or agency at which case managers are employed and execute their roles and responsibilities. The practice of case management extends across all settings of the health and human service continuum. These may include but are not limited to payer, provider, government, employer, community, independent/private, workers’ compensation, or a client’s home environment.

C. Case Management—“A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and
services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes” (CMSA, 2010, p. 24).

D. Case Manager—(Also referred to as care manager or care coordinator.) The health and human service professional responsible for coordinating and managing the overall care delivered to an individual client or a group of clients. Case manager ensures that care provided is based on the client’s health or human service needs, issues, preferences, and interests.

E. Case Management Process—The process through which case management services are offered and case/care managers provide health and human services to clients/support systems. This consists of several phases that are iterative, cyclical, and recursive rather than linear. The phases are applied until clients’ needs and interests are met. They may include assessment, problem identification, outcomes identification, planning, implementation (facilitation, advocacy, and coordination), monitoring, evaluation, and follow-up.

F. Client—The recipient of case management and health and human services. “This individual can be a patient, beneficiary, injured worker, claimant, enrollee, member, college student, resident, or health care consumer of any age group.” Client can also mean something very different than the end user of case management services. It may “imply the business relationship with a company who contracts, [or pays], for case management services” (CMSA, 2010, p. 24).

G. Client’s Support System—Recipients of case management interventions, other than the client. The person or persons identified by each individual client to be directly or indirectly involved in the client’s care. This “may include biological relatives [family members], spouses, partners, friends, neighbors, colleagues, or any individual who supports the client [caregivers, volunteers, and clergy or spiritual advisors]” (CMSA, 2010, p. 24).

H. Core Curriculum—An organized package of courses, topics, materials, or areas of content reflective of a particular subject, specialty, or professional practice. These make the essential subject matter and knowledge a professional (e.g., case manager) must possess, or maintain familiarity with, to effectively perform in an area of specialty (e.g., case management).

I. Guiding Principles—Are important concepts or characteristics used to clarify practice and communicate its primary focus and boundaries. They promote a better understanding of the purpose, core values, and objectives of a practice.

J. Level of Care—The intensity and effort of health and human services and care activities required to diagnose, treat, preserve, or maintain a client’s health. Level of care may vary from least to most complex, least to most intense, or prevention and wellness to acute care and services.

K. Payer—The person, agency, entity, or organization that assumes responsibility for funding the health and human services and resources consumed by a client while cared for because of an existing health condition or routine checkups and prevention. The payer may be the client himself/herself, a member of the client’s support system, an employer, a government benefit program (e.g., Medicare, Medicaid, Tricare), a commercial insurance agency, or a charitable organization.

L. Philosophy—Is a statement of belief that sets forth principles to guide a program and/or an individual in his/her practice of that program.

M. Philosophy of Case Management—Is a statement or belief that sets forth an organization’s or individual’s practice with special focus on case-managed health care delivery to clients and their support systems or other customers such as employers, payers, regulators, and/or accreditation agencies.

N. Standards of Practice—Authoritative statements agreed upon and recognized by health care professionals and professional organizations and associations as best or ideal practices. Usually based on evidence and assure quality and safe care.

O. Transitions of Care—Is the movement of a client from one health care provider or setting to another as the client’s health condition and care needs change. During transitions, case managers facilitate and coordinate care activities and assure that transitioning clients receive the required services to enhance continuity of care and promote safety. Sometimes referred to as care transitions or transitional care (CMSA, 2010).

A. The Case Management Society of America (CMSA) developed the Standards of Practice for Case Management to describe the important and current aspects of case management practice. CMSA states that case management today extends across all health care settings (e.g., payer/health insurance plans, providers, government, employers, community, home) and professional disciplines (e.g., nursing, social work, vocational rehabilitation counseling, workers’ compensation, disability management, pharmacy).

B. The Core Curriculum for Case Management uses the CMSA Standards of Practice for Case Management as a guide for the essential topics and areas it addresses. It also explains these topics in a way that reflects CMSA’s philosophy and guiding principles of case management practice, available knowledge based on published literature, and the opinions of the editors, contributors, and other experts in the field.

C. In the chapters where appropriate, specific content from the CMSA Standards of Practice for Case Management is presented to provide the reader with better understanding of the Core Curriculum and its relevance to case management practice while promoting the standards.

D. The Core Curriculum for Case Management reflects the general and common practice of case management.

A. The Case Management Society of America (CMSA) first introduced its nationally recognized Standards of Practice for Case Management in 1995. It then revised them in 2002 and most recently in 2010. The revisions were necessary to ensure the standards continue to be current, relevant, and substantiated by the latest changes in the knowledge and practices of case management. The 2010 standards:

B. The Standards of Practice are intended for voluntary use. They do not replace relevant legal, ethical, or professional practice requirements. CMSA explains that the Standards of Practice for Case Management:

C. A team of case management experts developed the CMSA Standards of Practice. The team included:

D. Founded in 1990, CMSA is the leading international, nonprofit, interdisciplinary health care association dedicated to the support and development of the profession of case management through educational forums, networking opportunities, and legislative involvement (CMSA, 2015).

E. In its mission, CMSA explains that:

F. In its strategic vision, CMSA describes “case managers as recognized experts and vital participants in the care coordination team. They empower people to understand and access quality and efficient health care” (CMSA, 2015). Safety is subsumed under quality.

G. To complement the vision, case management practitioners, educators, and leaders have come together to reach consensus regarding the guiding principles and fundamental spirit of the practice of case management (CMSA, 2010).

H. Since the first version, which was published in 1995, the Standards of Practice for Case Management:

I. The 1995 Standards of Practice for Case Management were recognized as a tool that case management would use within every case management practice arena. They were seen as a guide to move case management practice to excellence.