Care Coordination & Resource Management Flashcards

Which federal program provides comprehensive care coordination specifically designed for low-income elderly individuals who qualify for both Medicare and Medicaid?

Answer: PACE (Program of All-inclusive Care for the Elderly)

PACE provides integrated Medicare and Medicaid services to dual-eligible elderly clients, with interdisciplinary teams coordinating all aspects of care.

A care manager conducting a care needs assessment discovers a client is a caregiver for an ill spouse while managing their own chronic illness. The BEST response is to:

Answer: Assess caregiver burden and include caregiver support resources in the care plan

Caregiver burden directly impacts the client's own health outcomes, so addressing both roles with appropriate supports is essential.

In care coordination, 'care compacts' between primary care providers and specialists are designed to:

Answer: Define mutual responsibilities and communication expectations between providers

Care compacts clarify roles, responsibilities, and communication protocols between PCPs and specialists to reduce care fragmentation.

A care manager identifies that a high-risk client has not filled a critical prescription for two months. The PRIORITY intervention is to:

Answer: Conduct an immediate outreach call to identify and address the barrier

Immediate outreach to identify the barrier—cost, access, understanding, or side effects—allows the care manager to intervene before a health crisis.

Which type of community resource assessment tool helps identify local service availability, eligibility criteria, and contact information for referrals?

Answer: Community resource directory (e.g., 211 database)

Community resource directories like the 211 database catalog local services including eligibility and contact details to facilitate referrals.

A care manager is preparing for an interdisciplinary team meeting. To maximize effectiveness, the care manager should FIRST:

Answer: Review the client's current care plan and gather updated clinical data

Reviewing current care plan status and gathering updated data ensures the care manager contributes accurate, actionable information to the team discussion.

When a care manager documents a client interaction, which principle should guide the content of the documentation?

Answer: Record objective facts, interventions, responses, and follow-up plans

Professional documentation must be objective, factual, and include interventions, client responses, and planned follow-up to support continuity of care.