CCM Case Analysis & Practical Application 2 — Questions and Answers
Question 1: A 78-year-old patient with COPD is repeatedly readmitted within 30 days due to medication non-adherence. Which case management intervention is MOST likely to reduce readmissions?
- Arrange inpatient admission for closer monitoring
- Coordinate a home health aide to perform daily medication reconciliation (Correct answer)
- Refer the patient to a pulmonologist for a medication review only
- Discharge with a pamphlet on medication adherence
Correct answer: Coordinate a home health aide to perform daily medication reconciliation
Home health support with daily medication reconciliation directly addresses the non-adherence barrier in the patient's own environment.
Question 2: During a case conference, a social worker reports that a client with schizophrenia refuses to take antipsychotics. The case manager's FIRST step should be to:
- Notify the prescribing physician and document refusal
- Explore the client's reasons for refusing medication (Correct answer)
- Initiate an involuntary treatment petition
- Discharge the client from the program
Correct answer: Explore the client's reasons for refusing medication
Understanding the client's reasons for refusal is essential before escalating interventions, as barriers may be addressable.
Question 3: A case manager identifies that a diabetic patient's HbA1c has worsened despite attending diabetes education classes. The MOST appropriate next action is to:
- Refer the patient to an endocrinologist immediately
- Assess barriers to self-management such as food insecurity or health literacy (Correct answer)
- Increase the frequency of education classes
- Document the finding and continue monitoring
Correct answer: Assess barriers to self-management such as food insecurity or health literacy
Worsening outcomes despite education signal that unaddressed social or literacy barriers may be undermining self-management.
Question 4: A case manager is developing a care plan for a patient with multiple chronic conditions. Which framework BEST guides prioritization of goals?
- Prioritize the physician's clinical priorities first
- Use the patient's self-identified goals as the primary driver (Correct answer)
- Address the most expensive conditions to reduce costs
- Follow payer guidelines exclusively
Correct answer: Use the patient's self-identified goals as the primary driver
Person-centered care planning centers on the patient's own goals to maximize engagement and adherence.
Question 5: A case manager working with a frail elderly client notes that the family caregiver is showing signs of burnout. The MOST appropriate intervention is to:
- Advise the family to manage stress better
- Assess caregiver needs and connect them to respite care resources (Correct answer)
- Transfer the client to a nursing facility immediately
- Increase the client's visit frequency only
Correct answer: Assess caregiver needs and connect them to respite care resources
Caregiver burnout threatens care quality; assessing needs and offering respite maintains the caregiving relationship.
Question 6: A patient is discharged to home following a hip replacement but lacks transportation to follow-up appointments. The case manager's PRIORITY action is to:
- Reschedule appointments until the patient arranges transport
- Identify community transportation resources or telehealth alternatives (Correct answer)
- Recommend the patient purchase a vehicle
- Document the barrier and close the case
Correct answer: Identify community transportation resources or telehealth alternatives
Connecting the patient to transportation or telehealth removes a social determinant barrier to follow-up care.
Question 7: When conducting a post-discharge follow-up call, a case manager discovers the patient has not filled a prescription because of cost. The BEST response is to:
- Advise the patient to ration the medication
- Explore patient assistance programs, generics, or pharmacy discount cards (Correct answer)
- Contact the physician to discontinue the medication
- Document and schedule a call in one month
Correct answer: Explore patient assistance programs, generics, or pharmacy discount cards
Identifying cost-reduction strategies ensures the patient can access prescribed therapy and prevents adverse outcomes.
CCM Case Analysis & Practical Application 2
A 78-year-old patient with COPD is repeatedly readmitted within 30 days due to medication non-adherence.
Which case management intervention is MOST likely to reduce readmissions?