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You know, I& #39;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& #39;t to toot my own horn but you shine the light on what so many CM& #39;s do for members. Firstly, during and after the
hospitalization, we& #39;re the first to outreach the members. Personally, (before pandemic) I& #39;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& #39;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& #39;s a global authorization or if we have to send the patient to primary care first for referral). Then, many patients aren& #39;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& #39;re pulling all the discharge documentation from EMR and faxing it (because health plans & 6/
PCP& #39;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& #39;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& #39;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& #39;s (activities of daily living) & help them apply for in home supportive services through the county. This is a routine patient. I haven& #39;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& #39;t mentioned our care plans and all the documentation that we also must do. I haven& #39;t discussed how we keep HHS & CDC/Public health notified of disease outbreaks, COVID cases. I know 11/
I& #39;ve forgotten much more but if you& #39;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& #39;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& #39;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& #39;s, etc.
