Good communication and listening skills pay off
A diabetic who lived in Michigan had severe gastrointestinal problems, was making frequent visits to physicians, and constantly was in and out of the hospital when a California-based case manager at Beech Street Corp. was assigned to his case.
The first 90 days he was in case management, the man spent 80 days in the hospital, recalls Teri Howard, RN, manager of health care management for Beech Street.
The case manager looked into the situation and discovered that the man was homeless and had no one to cook his meals. He was hungry after discharge and would go to a fast-food restaurant for a meal. A few hours later, he was back in the emergency department with stomach problems. She found the man a place at the local YMCA and lined up home care nurses to make home visits to coordinate his medication. She found a physician to make a home visit to assess his condition and arranged for a local organization to deliver nutritious meals to him.
"Once we got him stable, he was out of the hospital for 40 days out of 90, all because of a coordinated plan of care," Howard adds.
The plan was developed and coordinated by a case manager who wasn’t even in the same city as the patient.
The story is one example of how Beech Street’s case managers collaborate with community providers through the company’s telephonic case management program.
Beech Street, one of the largest independently owned preferred provider organizations (PPO) in the country, operates a network of case managers who handle their patients’ care via telephone.
The company, based in Lake Forest, CA, was among the first organizations in the nation to receive accreditation for its case management services from URAC.
"Beech Street strives to provide a multifaceted case management program that focuses on providing personalized care for our clients’ patients," says Bill Hale, president and CEO of Beech Street. "Our strong commitment to quality and our flexibility in delivery methods are the keys to our success."
Beech Street contracts with more than 3,300 hospitals, 50,000 specialty care facilities, and more than 345,000 providers. It serves more than 16 million individuals through its network.
Most of the company’s case managers are located in Southern California and handle patients from across the country.
Some of the company’s case managers are located in several other areas of the country, in some cases at the request of the clients who ask that nurses handling their patients’ care be in close proximity.
"We don’t have the ability to see the patient in person, but our case managers have developed good listening and communication skills. They have the ability to determine how the patient is doing by the tone of his voice and to pick up verbal cues when there is a problem," says Nancy Neslen, RN, senior director for health care management.
The company allows case managers to telecommute and work from their homes.
"Having case managers who telecommute allows us the flexibility to find good nurses who are not just in Southern California. We set criteria that they must meet to be allowed the privilege, but it has worked out well," Neslen says.
The average Beech Street case management nurse has close to eight years’ experience in case management.
The nurses are able to access community resources in distant areas via telephone because of their years of experience, Howard says.
"Because we have a large PPO network, we can utilize that as a starting point. The nurses know our contractor vendors and network providers in each area. They may not be able to find the contracted provider they need in a given area, but it does give them a starting point," Neslen adds.
The case managers often e-mail or telephone each other and ask for suggestions and advice on finding resources in certain areas. "Our case managers really do work together even though they are not necessarily sitting next to each other in the office," she adds. If the case managers feel the need for a team conference, they arrange a telephone conference with the attending physician, hospital social worker, hospital discharge planner, or any other team members necessary.
The Beech Street case managers are assigned to particular clients so they can develop a close relationship. Because of confidentially issues, the case managers don’t e-mail any confidential information. Beech Street’s computerized case management program is a key to the company’s success in allowing employees to telecommute.
The company’s technology makes it easy for one case manager to pick up and follow another’s cases in the event of absences.
"We have minimal hard copy charts. Electronic records are particularly helpful because so many of our employees telecommute and yet can have access to all patient files, so if they’re going on vacation, they don’t have to move files over to someone else," Howard says.