Personal Nurses help navigate care system

Humana’s program creates health care concierge’

When Humana members have questions about their benefits, their condition, their upcoming hospitalization, or just need help navigating the health care system, they can call their "Personal Nurse."

Humana, a health benefits company with headquarters in Louisville, KY, began its Personal Nurse service after doing extensive research to find out member satisfaction with the health plans and health care in general, as well as what services Humana’s members would like to have.

"We knew we had a significant number of people who were really sick and needed high-touch resources, and we wanted to find a way to better serve them," says Jackie Willmot, RN, MSN, MBA, director of clinical interventions at Humana.

Focus groups and other research showed that members would find it helpful if they had one person they could call on for help in finding their way through the health care maze.

"We have moved from the paternalistic approach of feeling we know what people need and to a more personal approach in which we sat down and listened to our members and molded a program around that," Willmot says.

Humana serves about 6.6 million members in 18 states. Humana rolled out its Personal Nurse program in January 2001, and by the end of the year, about 30,000 members in all 17 geographic locations the company covers were enrolled.

"We spent a significant portion of this year refining the model and listening to members tell us how we can better serve them," she says.

Willmot explains the Personal Nurse as a "health care concierge" or a "health care navigator."

Personal Nurses call members prior to and after hospitalization. They also may identify others with specific chronic conditions and call to engage them in the service. The Personal Nurse assesses the level of interaction needed to get members armed with the tools they need to begin to make a difference in their health status.

Nurses who previously were employed by Humana in other capacities such as case management, utilization management, and concurrent review, staff the service.

"Nurses are key to this role; they are best suited to listen to and clinically understand what resources the member might benefit from. Culturally, we knew we had to make a huge change in order to migrate these nurses from their current role where they performed review, oversight, and member management activities to one where they were focused on relationship, service, and support," Willmot adds.

Personal Nurses go through a 40-hour training course at Humana’s Personal Nurse Academy and take an additional 20 hours of re-certification courses yearly.

The Personal Nurses are distinguished from case managers because they are not managing a case (a member), but they are getting members to information and resources so that they can manage their condition. "We have moved from a more paternalistic approach where we might have told a member what they should do [or do it for them] to one where we assess the member’s situation and get them to tools and resources where they are able to make informed decisions and act on them," Willmot says.

For instance, instead of asking them what their blood glucose A1C level is, the Personal Nurse would explain to the member why it is important to monitor their diabetes and point them to the tools they can use to track their blood glucose levels and help them figure out why their glucose levels are high every Monday morning.

This begins a process where members participate in their own health care activities and can see where they are having problems and act on them.

The nursing population at Humana is attached to the member population. One Personal Nurse may support a group of 5,000 members but have only 50-100 members they actively are engaged with. In addition to nurses, six full-time pharmacists who are available to help members understand their pharmacy benefits, review members’ prescriptions, and provide information to members, physicians, or the Personal Nurse support the service.

"If members are on prescriptions from multiple providers, the danger is that they may be prescribed two drugs for the same symptom or condition, one being generic and the other being brand," Willmot says. "Because two different physicians prescribe them, and the medication has different names, the member doesn’t realize the problem. We have numerous examples of the pharmacist catching problems of that kind, and by the member checking back with their physician and getting their medication regime changed, they are able to eliminate the risks associated with duplicate therapy."

The Personal Nurses are available during business hours and many flex their hours to accommodate member needs. Humana also has a 24/7 line where a member can call at any time of the day to speak with a nurse. Humana has a connection between the Personal Nurse and the triage line where member call in need of assistance. n