Sample Care Management Training Curriculum

Training Programs are custom designed to align content with a payer’s organizational goals.

Care Managers will be provided with information regarding the most commonly presenting medical conditions, psychiatric comorbidities, and assessment and treatment. Similarly, care managers will learn about the most commonly presenting psychiatric issues, common medical comorbidities, and resources to best address these concerns.

Care managers will learn best treatment practices for the top five psychiatric conditions that are major drivers of utilization demand, by primary care diagnosis. These include:

1) Mood disorders;

2) Adjustment disorders and V codes;

3) Anxiety Disorders;

4) Substance Abuse Dependency Disorders; and

5) Child and Adolescent Disorders.

  • Care Managers will also learn best practices for behavioral and medical health integration, with an emphasis on the most commonly presenting medical conditions to the specialty care BC/BS Massachusetts provides, including:

1) Cardiovascular/Circulatory Disease (e.g., Myocardial infarction);

- Up to 40% status-post MI have depression

2) Cerebrovascular Disease (e.g., Stroke);

- Up to 60% experience depression (Kurlowicz, 1994).

3) Disorders of the Nervous System (e.g., Alzheimer’s Disease);

- Up to 50% develop psychiatric comorbidities

4) Neoplastic Disease (e.g., Breast, Uterine, colorectal, and stomach cancers, leukemia, lymphoma);

- Depression is common in patients with cancer and is related to longer hospital stays (Hosaka et al., 1999).

5) Traumatic Brain Injury.

- Anxiety, depression, and PTSD are common comorbidities (Moldover et al., 2004).

  • In the service of facilitating behavioral and medical health integration and the effective treatment of the above mentioned conditions, we will provide training on best practices for:

1)Motivational interviewing and treatment engagement;

2)Treatment adherence.

Training in these areas will enhance the care managers existing repertoires and increase the effectiveness of these interventions.

  • Cardiovascular disease was selected to provide BC/BS Massachusetts with a better sense of the scope of a proposed training curriculum. A brief outline of a proposed cardiovascular disease training module is provided below.

A. Baseline Assessment of Knowledge, Beliefs, and Behavior

a.Assess Perceived Importance of Addressing Psychiatric and Behavioral Comorbidities of Cardiovascular Disease;

b.Assess Confidence in Providing Integrated Behavioral and Medical Health Interventions when Treating Cardiovascular Disease;

c.Assess Frequency of Interventions Addressing Psychiatric and Behavioral Comorbidities of Cardiac Disease;

d.Assess Knowledge of Prevalence of Cardiovascular Conditions;

e.Assess Knowledge of Prevalence of Related Psychiatric Comorbidities;

f.Assess Knowledge of Appropriate Patient and Care Manager Support Resources.

  1. Motivation Enhancement and Engagement
  2. Provide education regarding type and prevalence of cardiovascular conditions;
  3. Provide education regarding the prevalence of related psychiatric and behavioral health comorbidities, emphasizing the role of depression, anxiety, and lifestyle behavior;
  4. Heart disease, not suicide, is the major cause of death among people with a psychiatric illness (Kisley, 2007).
  5. 72% of deaths occur in patients who had only seen their family physician (Kisley, 2007).
  6. Highlight discrepancies between importance, confidence, knowledge, and behavior;
  7. Provide data regarding the lack of integrated interventions currently available to providers;
  8. Highlight data supporting improved outcomes with integrated behavioral healthcare and importance of training in integration.
  9. Psychoeducation
  10. Prevalence
  11. Leading cause of death in U.S. for the past 80 years and is a major cause of disability (CDC, 2005)
  12. Results in substantial healthcare expenditures ($151.6 billion in 2007 according to CDC, 2005)
  13. CDC BRFSS survey found that up to 10.4% of adults have been diagnosed with a cardiovascular condition.
  14. Comorbidities
  15. Anxiety
  16. Depression
  17. Psychiatric comorbidities are associated with greater inpatient utilization, including risk of additional hospitalizations, days of stay, and hospitalization charges.
  18. Additional hospitalization costs associated with psychiatric comorbidity ranged up to $7,763, and additional days length of stay ranged up to 1.4 days (Sayers et al., 2007).
  19. Lifestyle Behavior
  20. Assessment
  21. Patient Health Questionnaire (PHQ-9)
  22. Telephone administration of the PHQ-9 is a reliable and valid procedure for assessing depression in primary care (Pinto-Meza et al., 2005).
  23. Treatment
  24. Regular healthcare visits
  25. Prevent and Control Medical Risk Factors:
  26. High Blood Pressure
  27. High Blood Cholesterol
  28. Diabetes
  29. Obesity
  30. Reduce Behavioral risk factors:

1. Adherence to any existing behavioral treatment plan, including adherence to prescribed medications

  1. Reduce tobacco exposure;
  2. Promote a healthy diet;
  3. Increase physical activity.
  1. Resources
  2. Handouts
  3. Books
  4. Websites (e.g., America Heart Association)
  1. Vignettes – Challenging Cases

Patient identified due to recent myocardial infarction. Patient presents with fatigue and subjective feelings of depression. Patient unsure if anti-depressant medications are warranted.

  1. Direct groups to advise and offer treatment recommendations
  2. Assessment – Rule-out Depression
  3. Administration of Standardized Measure
  4. Clinical Interviewing
  5. Diagnostic Rule-Outs
  6. Treatment
  7. Psychoeducation regarding cycle of depression (Lewinson)
  8. Prescribe Exercise
  9. Prescribe Pleasant Events
  10. Treatment Resources (Links to handouts and web-based support for depression) Including links to enrollment in existing BC/BS of Massachusetts resources
  11. Psychoeducation regarding Anti-depressant medications
  12. Options
  13. Costs and benefits
  14. Promoting Treatment Engagement and Adherence
  15. Collaborative formation of treatment plan
  16. Discuss patient willingness to follow through with treatment plan
  17. Assess and discuss possible barriers to treatment adherence
  18. Engage in collaborative problem-solving
  19. Soliciting social support
  20. Structured support
  21. Schedule follow up visits
  22. Stepped-Care Treatments and Resources
  23. Self-help resources
  24. Books
  25. Websites
  26. Groups
  1. Post-Test
  2. Assess Care Manager Knowledge Acquisition
  3. Assess Care Manager Satisfaction