ACM key terms

A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs, using communication and available resources to promote quality and cost-effective outcomes.

An approach that treats the individual's values, preferences, culture, and life goals as central to every care decision, rather than fitting the person into a standard service pathway.

A measure of how complex, urgent, or resource-intensive a patient's needs are, used to set priorities and allocate case management time and attention.

The number and mix of patients assigned to a case manager at a given time, ideally weighted by acuity and care complexity rather than counted as a simple total.

An organized framework describing how case management services are structured and delivered, such as brokerage, collaborative, or primary-care-based models, each with different roles and accountabilities.

The boundaries of what a professional may legally and competently do, defined by licensure, regulation, employer policy, and training, and used to decide when to refer or delegate.

A brief, systematic process to identify individuals who may need case management or further evaluation, using defined criteria so that limited resources go to those with the greatest need.

A structured, ongoing collection of information about a person's clinical status, functioning, social supports, environment, finances, and goals, forming the foundation of an individualized care plan.

A written, individualized plan that states prioritized problems, measurable goals, planned interventions, responsible parties, and target timeframes, and is reviewed and revised as the person's situation changes.

The outcomes a patient values and wants to achieve, documented through discussion with the patient and family, which guide treatment choices and set the direction for the care plan.

The deliberate organization of patient care activities among participants so that needs and preferences are met, information is shared, and gaps, duplication, and conflicting plans are avoided.

Sorting a population into groups by likelihood of poor outcomes or high resource use, so that interventions can be targeted to those most likely to benefit.

A set of time-limited actions designed to ensure continuity and coordination when a patient moves between settings or providers, reducing avoidable complications and readmissions.

A process that begins at or near admission and prepares the patient and family for leaving a facility, arranging follow-up, services, equipment, and education needed for a safe next setting.

A return to a hospital within a defined period after discharge, often used as a marker of transition quality and sometimes carrying financial penalties for the discharging facility.

A formal process of comparing a patient's full medication list across settings and obtaining an accurate list, to prevent omissions, duplications, dosing errors, and harmful interactions.

Services delivered after an acute hospital stay, such as home health, skilled nursing, inpatient rehabilitation, or long-term acute care, chosen according to the patient's needs and coverage.

A classification of the intensity and type of services a patient requires, used to determine the appropriate setting, staffing, and whether a payer will cover the admission.

A process that evaluates whether the care being delivered is medically necessary, appropriate, and consistent with the authorized level of service, often performed concurrently with the hospital stay.

The organization that pays for health care services, such as a commercial insurer, Medicare, Medicaid, or a self-funded employer plan, each with its own rules and covered benefits.

A system that combines financing and delivery of care with mechanisms such as networks, authorizations, and care coordination to control cost while maintaining quality.

The process of confirming a patient's insurance eligibility, covered services, cost-sharing, and any requirements such as authorizations before services are delivered or scheduled.

A payer requirement that approval be obtained in advance before certain services, drugs, or settings are used, otherwise payment may be denied.

The systematic review and appeal of payer refusals to pay, including root-cause analysis of why the denial occurred and steps to prevent similar denials.

The way available staff, services, equipment, and funding are used to meet patient needs, balanced against cost, access, and quality considerations.

The conditions of daily life, such as income, housing, food security, transportation, education, and social connection, that shape health and can be addressed through community resources.

The degree to which a person can obtain, understand, and act on health information, which affects education approach, consent, and self-management ability.

Acting on behalf of a patient to protect rights, preferences, and access to needed services, including raising concerns when care or coverage is inadequate.

Care and services addressing mental health conditions, substance use, and related functional problems, ideally integrated with medical care rather than treated separately.

Short-term, immediate support for a person in acute psychological or social distress, aimed at safety, stabilization, and linkage to ongoing services.

A patient's voluntary agreement to a treatment after receiving understandable information about its purpose, risks, benefits, and alternatives, and about the right to refuse.

The ethical and legal duty to protect a patient's private health information from unauthorized disclosure, subject to limited exceptions such as required reporting or imminent harm.

A legal document, such as a living will or durable power of attorney for health care, that states a person's treatment wishes or names a decision maker for when the person cannot speak.

A situation in which competing values or obligations make it unclear which action is right, and where a structured process, consultation, or ethics committee may be needed.

Working with professionals from different disciplines, and with the patient and family, in a coordinated way that shares responsibility, information, and decision-making to reach common goals.

A structured transfer of patient information and responsibility between caregivers or settings, using a consistent format so that critical details are not lost.

An ongoing practice of self-reflection and openness about one's own culture and biases, combined with respect for each patient's identity, beliefs, and preferences.

A defined, quantifiable indicator of the structure, process, or outcome of care, used to compare performance, identify gaps, and guide improvement.

A measurable result of care, such as symptom change, function, satisfaction, readmission, or mortality, that shows whether interventions achieved the intended effect.

Comparing an organization's performance on a measure against an external standard, peer group, or best practice, to set targets and identify improvement opportunities.