CCM Case Analysis & Practical Application 3 — Questions and Answers
Question 1: A case manager receives a referral for a 55-year-old with newly diagnosed heart failure. Which initial assessment is MOST critical for developing a safe care plan?
- The patient's employment history
- Functional status, living situation, and support system (Correct answer)
- The patient's recreational activities
- Previous hospitalizations from five years ago
Correct answer: Functional status, living situation, and support system
Functional status and social supports determine the patient's capacity to self-manage and identify gaps requiring intervention.
Question 2: A case manager is coordinating care for a patient whose primary care physician and specialist have conflicting treatment recommendations. The BEST action is to:
- Follow the specialist's recommendation automatically
- Facilitate a collaborative conversation between both providers and the patient (Correct answer)
- Ask the patient to choose between the two plans
- Refer the case to risk management
Correct answer: Facilitate a collaborative conversation between both providers and the patient
Facilitating provider communication resolves conflicts and produces an integrated plan that serves the patient's best interest.
Question 3: A case manager notes that a patient from a non-English-speaking background consistently misses appointments. The MOST likely contributing factor to investigate first is:
- The patient's preference to self-manage
- Language and cultural barriers to navigating the health system (Correct answer)
- The patient's disinterest in healthcare
- The physician's scheduling practices
Correct answer: Language and cultural barriers to navigating the health system
Language and cultural barriers are documented drivers of appointment non-adherence and must be assessed before other assumptions are made.
Question 4: A utilization review flags a patient for a longer-than-expected inpatient stay. The case manager's FIRST step is to:
- Arrange immediate discharge
- Review the clinical record to identify clinical and social barriers to discharge (Correct answer)
- Notify the payer that the stay is inappropriate
- Transfer the patient to a lower level of care without assessment
Correct answer: Review the clinical record to identify clinical and social barriers to discharge
A thorough review of clinical and social barriers ensures discharge planning is safe and individualized.
Question 5: During care planning, a patient with chronic pain states their goal is to return to work. The case manager should:
- Advise the patient that returning to work is unrealistic
- Incorporate the return-to-work goal and coordinate vocational rehabilitation resources (Correct answer)
- Focus only on pain management without addressing employment
- Defer the goal to the physician to evaluate
Correct answer: Incorporate the return-to-work goal and coordinate vocational rehabilitation resources
Supporting patient-identified goals like return to work and linking vocational resources reflects person-centered practice.
Question 6: A case manager learns that a patient has been visiting the ED repeatedly for issues that could be managed in a primary care setting. The BEST strategy is to:
- Contact the ED to restrict the patient's access
- Establish a primary care relationship and provide ED diversion education (Correct answer)
- Report the patient to the insurer as a frequent flyer
- Advise the patient to call 911 less often
Correct answer: Establish a primary care relationship and provide ED diversion education
Connecting patients to a primary care home and educating them on appropriate care settings reduces inappropriate ED utilization.
Question 7: A case manager identifies that an older adult client is at risk for falls. Which intervention reflects best practice?
- Advise the client to stay in bed
- Coordinate a home safety assessment and fall prevention program (Correct answer)
- Recommend the client move to assisted living immediately
- Limit the intervention to documenting the risk
Correct answer: Coordinate a home safety assessment and fall prevention program
A home safety assessment and fall prevention program are evidence-based interventions proven to reduce fall risk.
CCM Case Analysis & Practical Application 3
A case manager receives a referral for a 55-year-old with newly diagnosed heart failure.
Which initial assessment is MOST critical for developing a safe care plan?