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Care Management: The Crisis Connection


As active leaders in the healthcare industry, we feel the fear, stress, and isolation as we watch the daily news and do our best to balance our work/family life during this time. Imagine how our elderly, disabled and most vulnerable members must feel during this crisis. There are likely many members who rely on outside services for their daily support, who count on caregivers who may not live in their home, or who have no one.


As dedicated healthcare workers in MA plans, we must be the bridge to our members’ needs. But how, with so many things going on in the world? Care management. This is where our care management teams become critically important. These are the front-line connectors to the daily lives and needs of our members.


What should we be thinking about to be the connection? Here are a few thoughts and tips to bring back to the table within your MA or MA-SNP organization for consideration:


1. If you have not already done so: prepare a specific “COVID-19” care plan that includes the following:


Scripts/Detailed Talking Points: Develop scripts/talking points or instructions for members who are dependent upon outside help for their activities of daily living. If you have the system capability, identify those that may be homebound, caregiver dependent or live alone. Conduct proactive outreach. This could mean advising them to have hand sanitizer or sanitizing wipes on hand for anyone that enters their home. If they do not have the means to leave their home to get any items, connect them with a community shopper or an agency that can assist. Many of the large department/box stores have same day ordering/delivery. Make sure your care managers know your network availability as well when assisting members.


Re-Stratify: Identify those members who are most vulnerable with multiple co-morbidities and re-stratify them using the CDC guidelines for new risk levels in your care management program. Don’t forget to add the social determinant of health (SDOH) factors of living alone, aged, caregiver dependent and low-income levels. Many members’ risk levels change simply due to these SDoH factors and an outreach could mean the difference between a member’s needs being met or not. Make certain your care management team has strong knowledge of community resources, how members qualify and contact information at their fingertips. During outreach, encourage conversations outside of the normal care planning process. For example, a member may not have been interested in home delivered meals, but now because they cannot leave their home, they may wish to choose this supportive benefit.


Risk Level Data Sharing with Providers: Risk re-stratification also becomes important clinical information to share with your provider networks. Often providers do not have the care plan information detail care managers do, and if their new risk lever/vulnerability is identified consider sharing this information real time for providers to access, should a member contact their office for questions or support. Share with your network providers your planned messages, community resources and available supplemental benefits. This certainly could now be most helpful during this crisis.


ESRD Members: These are some of our most vulnerable members, whose needs have just been compounded by this crisis. Make sure you know if any dialysis facilities cannot support your members, are speaking with your members to coordinate continued services or report any members who may have been sick with COVID-19 like symptoms. The members who live outside of urban areas or are dependent on a transportation service may need faster interventions. Ensure you have the extra transportation support your members may need.


2. Consider offering expanded care management staff hours to support your members.

Taking the time to train your care managers on exactly how and when to help and arming them with the necessary resources can go a VERY long way in calming member fears and prevention of unnecessary trips to urgent care or the ER.


3. Lastly, support your members with necessary mental health services, increase access and institute telehealth services. Our elderly members often need extra support just to manage their daily living situation, so imagine how much more stress or anxiety the COVID-19 crisis adds. Warm transfers, appointment setting, or supportive calls can all be completed by the care management team.


Giving extra goes a long way now and everyday…that is what we as healthcare workers do. For other thoughtful ways to improve the care management connection, we can help.


Contact us: admin@rebellisgroup.com

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