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You know, I've realized that a lot of health-care professionals do not know what healthplan case managers do. We do so much for members/patients, and this thread isn't to toot my own horn but you shine the light on what so many CM's do for members. Firstly, during and after the
hospitalization, we're the first to outreach the members. Personally, (before pandemic) I'd visit my members at the hospital and guide patients through the transition to home. A good 70-75% percent of the time, these patients do not know the plan of care. They don't know the 2/
disease process & what actually occured to them, and what the plan is now after discharge. Many patients are discharged with minimal info, days and days of hospital stay in 2-3 discharge documentation. We are in charge of going through HUNDREDS of pages of documentation (EMR). 3/
We discuss the plan of care and now connect these patients to the specialities they need to follow up with after a surgery (figure out if there's a global authorization or if we have to send the patient to primary care first for referral). Then, many patients aren't connected 4/
to primary care services. We schedule their first appointment with PCP, and find the barriers (social determinants of health) that can prevent a patient from seeing his/her PCP. Some barriers include lack of money, disease leaves patient unable to drive, inability to read 5/
the health care material or inability to express needs and concerns to PCP due to possible mental/behavioral issues, lack of translators, cultural & racial barriers. In the meantime, we're pulling all the discharge documentation from EMR and faxing it (because health plans & 6/
PCP's cannot have this info sent via emails due to HIPAA concerns, which is an entire other thread in itself) to a primary care doctor before the patient's appointment. How many times do you think a doc reads all that documentation? We recommend our patients to take a notebook 7/
in order to write down questions as well as remmeber what their PCP recommended. From there, we contact PCP's and have a PCP to nurse review and discuss what needs patients has and follow through. We will discuss medications and how to adequately take those medications as per 8/
recommended by physician. We will connect the patients to resources such as SSDI/SSI if needed, food stamps, cash aid when needed, address housing concerns, verify support group in the home, educate and reinforce teachings of their disease processes, assist them with their 9/
ADL's (activities of daily living) & help them apply for in home supportive services through the county. This is a routine patient. I haven't even gotten into the substance & drug abuse cases, homeless patients, elderly parents caring for their disabled adult children, mental 10/
and behavioral health cases that require so much more assistance and guidance. I also haven't mentioned our care plans and all the documentation that we also must do. I haven't discussed how we keep HHS & CDC/Public health notified of disease outbreaks, COVID cases. I know 11/
I've forgotten much more but if you're interested in discussing (just remembered, we also teach hospital case managers, medical assistants and skilled nursing case managers how to submit referrals for authorization because a lot of them don't know) any of these topics. Holler 12/
at your health-care professional AKA nurse case manager. #CaseManagement #COVID19 #nursecasemanager #Healthplan #CCM
I forgot to add, rinse and repeat PLUS add our new Covid patients/members who are having a hard time with resources from food, quarantine, to follow up's, etc.
I forgot to add, rinse and repeat PLUS add our new Covid patients/members who are having a hard time with resources from food, quarantine, to follow up's, etc.
