Collaborative Care
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A Community Partnership to Develop a Recuperative Care Facility

BY CHRISTOPHER WELLINS, MD, MS, FACP, RENEE FAY-LEBLANC, MD, FACP, AND COURTNEY PLADSEN, DNP
Maine Medical Center (MMC) is a 700-bed tertiary care facility located in Portland, Maine, and is the anchor hospital of the nine-hospital MaineHealth System. In 2012 we developed the Long Stay Intervention Workgroup (LSIW) as a way of getting all the right stakeholders together who were empowered to make decisions regarding achieving discharges for our most challenging patients.

Collaborative Care
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Leveraging Community Health Workers within an Interdisciplinary Care Team to Care For Older Adults

BY LAUREN O’CONNELL, LICSW, AND ROBERTA CAPP, MD, MHS
Community health workers (CHWs) are non-clinical members of the community who usually share ethnicity, language and life experiences with the community members they serve (NIHLBI, 2023). Traditionally, CHWs are social and change agents; they reduce disparities and inequities by expanding knowledge and access to benefits and community services.

Social Determinants of Health
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CalAIM — A Lesson in Transition

BY SUSANE HAO, RN, MSN, CLCP, AND THERESA HERNANDEZ, CCM
Healthcare providers and case managers encounter patients who experience a combination of barriers related to social determinants of health (SDoH) that make it difficult for patients to manage their chronic medical conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes mellitus, hyperlipidemia, hypertension and depression.

Behavioral Health
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Viewing Mental Health Parity from a Population Health Perspective

BY GARRY CARNEAL, JD, MA, JACK SHOEMAKER, MS, AND TOM WILSON, PhD
Treating diseases of the brain is as important as treating any physical condition. Yet, U.S. health insurers have earned the dubious reputation of not covering behavioral health conditions (“BH,” aka mental health and substance use disorders) adequately when compared to physical health conditions (“PH,” aka medical/surgical care). From a population health perspective, disease states such as depression, anxiety, addiction and other mental health conditions often have been undertreated, subsequently leading to poor clinical outcomes.

Care Coordination
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Case Management Leads the Team in Transitions with Patients with Substance Abuse Disorder and Infective Endocarditis

BY BETSY STOVSKY, RN, MSN, AND MARY McLAUGHLIN DAVIS, DNP, NEA-BC, ACNS-BC, CCM
Patients with infective endocarditis (IE) due to opioid substance use disorder (SUD) and injection drug use (IDU) present to the acute care setting with a myriad of surgical, medical, psychiatric and social problems. The complexity of this patient population requires an experienced team of healthcare professionals to provide the care they need from admission to discharge. Case managers, as leaders in population health, patient advocacy and continuity of care, are important members of the multidisciplinary team to care for this patient population.

Association News
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Case Managers Come Together for #CMSA2023

Thank you to everyone who joined us in person and digitally for the CMSA Annual Conference, June 27-30 in Las Vegas! It was an incredible week of learning, networking and fun. CMSA would like to recognize our incredible volunteers including our CMSA Board, committee members, chapter leadership, speakers, session volunteers and the Las Vegas Chapter for your hard work to make #CMSA2023 a success.

President's Message
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Population Health

BY DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
Several years ago, while in my DNP population health class, I had a “discussion” with my instructor regarding the intersection of population health and the practice of professional case management.

Behavioral Health
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Reflecting on COVID Spawned Mental Health Impact on Healthcare Professionals

BY ROGER ORSINI, MD, MBA, FACS, AND DENNIS ROBBINS, PhD, MPH
How many doctors and nurses are walking around with bright smiles on the outside while suffering darkness on the inside? How many of us continue with life without acknowledging the need for or seeking treatment, respite or some other form of help? How many of us are willing to die rather than confront what is overwhelmingly happening inside our heads?

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