Case Management Regulations Overview

BY GARRY CARNEAL, JD, MA The U.S. medical system is dynamic and always evolving. Understanding the regulatory landscape is essential for case managers to optimize their patient-centered mission. Simply put, a basic knowledge of the laws and regulations applicable to the jurisdiction that case managers work in and the programs they support is important to […]

The Importance of Quality Measures: Making Care Matter

BY REBECCA PEREZ, MSN, RN, CCM Everyone aspires to provide quality healthcare. The definition of healthcare quality would seem straightforward; however, establishing metrics is not necessarily so straightforward, a point recognized by Avedis Donabedian, a Lebanese physician and founder of the study of healthcare quality over half a century ago. In 1966, Dr. Donabedian recommended […]

The Power of the Medical-Legal Partnership in Population Health

BY MELANIE A. PRINCE, RN, BSN, MSN, NE-BC, CCM, FCM, FAAN This issue of CMSA Today is a compilation of articles, editorials and resources about legal considerations in healthcare. I recently attended a Health Equity Summit with leaders from a variety of sectors, including law, government, healthcare, academia, public health and community advocacy. These professionals […]


Registration Now Open for the 2023 CMSA Annual Conference: DISCOVERING SOLUTIONS, DRIVING CHANGE CMSA’s conferences are unparalleled with top-notch education, inspiring content, industry vendors and experts, professional connections and lasting friendships made. The list could go on and on! Register today to join us for the CMSA Annual Conference June 27-30, 2023, at the Mandalay […]

Gene Therapy: The Next Big Thing

BY MARY PAQUETTE, RN, BSN, CCM, AND MELINDA BAXTER, RN, MSN, CCM Gene therapy is the latest high-cost challenge facing health plans and reinsurers alike. The need to understand issues associated with treatments, medical management, network management and contracting will evolve and persist. Take, for example, when organ transplantation networks first came on the scene. […]

There’s an App for That

BY DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM Digital technologies are electronic tools, systems, devices and resources that generate, store or process data. Social media, online games, multimedia, patient portals and “apps” are just a few examples on how healthcare has leveraged digital technologies. Digital technology links to digital learning, which is any […]