Targeting members for high-touch’ interactions

Personal nurses work with chronically ill

In a typical day, a Personal Nurse at Humana may guide a diabetes patient to the health benefit company’s web site for tips on managing his or her disease, explain the plan’s pharmacy benefit to another member, help a member facing orthopedic surgery come up with a plan for getting around at home after discharge, and explain the discharge instructions to a patient who is just home from the hospital.

"We feel that our members should have access to information, support in understanding the information, and the confidence to act on that information to best meet their individual needs. Personal Nurses interact with our sickest members, facilitating their ability to better understand and use the health care system," says Jackie Willmot, RN, MSN, MBA, director of clinical interventions at Humana. Here are some examples of how the system works:

• If a provider calls Humana for authorization for surgery, the information comes up on the Personal Nurse workstation.

• The nurse calls the member and helps him or her understand what to expect from the surgery and prepare for discharge.

For instance, in the case of orthopedic surgery, the nurse will ask if there are stairs in the home, and if the member has someone to prepare his or her meals after discharge.

"In addition to the pre-hospitalization call, our Personal Nurses may call members 24-48 hours after their discharge from the hospital," Willmot says.

• The nurses make sure the patient understands the discharge instructions and medication regime. If the patient had surgery, they assess whether the patient can verbalize the discharge instructions regarding how to take care of and assess the wound.

"People often are so anxious when they’re in the hospital that they forget their discharge instructions. If they have questions, they may feel they’re not important enough to call the physician. We connect with them in a time period when they may be entering a danger zone and let them know that there is someone they can call to help them sort through what they’re going through," Willmot says.

• In the case of people with chronic diseases who are referred to the Personal Nurse, the Personal Nurse identifies whether there are programs to meet the members’ needs and gets referrals to external specialty programs in the case of chronic diseases.

"We are building tools and services to support everybody, but we are focusing on high-tech services, such as the Internet site for low-risk members and high-touch services such as Personal Nurse for those at-risk who require some guidance," Willmot explains.

• The nurses help the members learn to navigate Humana’s Internet site in order to self-manage their conditions and to find out information to discuss with their physicians.

"We are available to support them and to help them traverse the system," Willmot says.

• The nurses soon will have the capability of getting on-line with the members, with their permission, and helping them navigate the site.

For instance, if a member has a question about something in the asthma management tool kit, the nurses can see what he or she is looking at on the screen and walk him or her through it.