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    Integrated Care Management (ICM) Training and Certification

    Integrated Care Management (ICM) is a person-centered, evidence-based care delivery model that provides care coordination and support across providers, settings and time. Course content focuses on practices that can be implemented immediately to ensure patient value, needs and preferences are identified, care options are presented, shared decision making occurs, self-management and self-care techniques are taught, and active collaboration and partnership with the patient is fostered.

    Through a combination of classroom instruction, activities and self-paced web based learning, ICM Model training prepares providers to achieve the healthcare reform goals of improved quality, improved outcomes and lower cost through the development of competencies around:

    • Partnering with individuals, families and caregivers to promote informed, health literate, activated, and engaged self-management.
    • Developing healthcare provider competencies and practices to support functioning as a prepared, proactive, health literate care team.
    • Demonstrating innovative leadership in transformational change, hardwiring excellence, and creating a learning environment that values multi-disciplinary teams.
    Classroom Content
    • In-depth overview of chronic care and patient engagement best practices, including Wagner’s Care Model, healthcare policy research findings, and our Integrated Care Model (ICM)
    • Motivational interviewing and health coaching
    • Improving health literacy assessment and interventions for patients with low health literacy
    • An overview of the Transitions of Care (TOC) Program based on current best practices
    • Role of technology and remote patient monitoring in chronic care management and reducing avoidable re-hospitalizations
    • Pivotal role of the integrated care manager in the future healthcare environment
    • Health Literate Care Model
    Web-Based Module Content (pathophysiology, evidence-based guidelines, behaviors needed for optimal condition management)
    • Heart Failure Condition Management
    • Diabetes Condition Management
    • COPD Condition Management
    • Depression Management
    Integrated Chronic Care Specialist Exam/Certificate
    • Integrated Care Management Specialist Trainer certificate received upon successful completion of seven-hour classroom session, web-based disease-specific modules, and a web-based examination
    • A professional distinction that will elevate your personal practice
    • Authorization to train your colleagues in your agency
    Designed for homecare clinicians, this combination of seven hours of classroom instruction with activities, five hours of web-based training, and an online examination leads to certification as an Integrated Care Management Specialist and Trainer.

    Participants will receive 12 CEUs for nursing and therapy in states that accept California awarded CEUs. This course is endorsed by the National Association for Homecare and Hospice (NAHC).
    Click here to download a detailed model overview.

    ICM Online Training

    The Integrated Care Management (ICM) training program offered by The Sutter Center for Integrated Care (SCIC) is now available as an online option. This online option is modeled after the live ICM Model training. The advantages of ICM Online Training:

    • Facilitates your agency's ability to meet the proposed CMS conditions of participation for providing person-centered, health literate care
    • Provides an engaging learning format via narrated content and interactive activities which enhances retention
    • Facilitates individualized self-paced learning sessions, with 24/7 content availability
    • Enables review of previously viewed content for concept reinforcement, with learner access for a period of 3 months from course initiation
    • Permits immediate application of learning into daily care activities
    • Eliminates expenses associated with on-site training
    This new option is being offered at a cost of $400 per student. It is intended for providers who do not wish or need to function as an ICM Trainer. To register, visit

    Integrated Care Management Transitions of Care (TOC) Training

    The Integrated Care Management (ICM) Transitions of Care (TOC) Program is founded on the principles of ICM, which are person-centered and evidence-based care delivery to promote care coordination and support patients across providers, settings and time. The TOC Program seeks to advance current best practices in care transitions across the continuum. In addition to the foundational ICM principles, TOC training specifically includes competency building around improving patient self-management skills. Topic areas include: methods to identify patients at high risk for hospital readmission, transitions-specific supportive interventions for standardization, transition planning for complex patients, best practices in medication reconciliation and medication management, and effective team communication.

    TOC training prepares providers to achieve the healthcare reform goals of improved quality, improved outcomes and lower costs through the development of competencies around:

    • Advocating for patients and families to ensure their needs are met as they transition from one level of care to another.
    • Coordinating and facilitating continuity of care, with a focus on avoidance of complications and a reduction in re-hospitalizations.
    • Ensuring “at risk” patient populations are identified and employing key best practice transition interventions, applicable across healthcare settings.
    • Supporting transitioning patients by functioning as a prepared, proactive care team.
    Eight CEUs are provided for nursing and therapy. This course is offered on-site or as a web-based course.
    Click here to download a detailed outline on TOC.