Assistants free up case managers for clinical tasks

Teamwork is the key to program's successs

At Hudson Health Plan in Tarrytown, NY, case management assistants who handle non-clinical tasks that don't have to be done by a licensed professional are freeing up the nurse case managers for jobs that require their special clinical skills.

Hudson Health Plan is a not-for-profit managed care plan servicing more than 80,000 members in the Hudson Valley of New York.

"Case managers didn't go to school to do data entry and they like having help with the front-line things so they can spend time on other duties. Having case management assistants allows our nurses to carry a larger caseload and still have time to give the members the attention they need," says Margaret Leonard, MS, RN-B, C, FNP, senior vice president for clinical services.

Each program at Hudson Health Plan has a case management assistant assigned to work with the case managers in that program.

The case management assistants work closely with the nurses in the individual programs to which they are assigned. They are cross-trained so they can work in any program and with all populations.

"At this point, we are operating in silos. Nobody can learn one system and plug into any population. The case management assistants are knowledgeable about all the programs so they can fill in whenever they are needed," Leonard adds.

Most of the case management assistants have some college education and experience in health care or customer service. Many have worked for private physician practices or at health centers. All are bilingual.

"These are people with myriad talents. Some are experts in technology. Others have terrific people skills and are able to engage members on the telephone. All of them are eager to learn and have been cross-trained, so they can perform any of the jobs in any areas of the case management department," Leonard says.

The case management assistants are enthusiastic about learning more about the programs that Hudson Health Plan offers and are always willing to take on more responsibility, she says.

"When they take on a new task, we make sure we create scripts and standards so that everyone is giving out the same correct information," she says.

Here's an example of how the program works:

The asthma management program is staffed by one nurse case manager and one case management assistant who work together to coordinate care for members with asthma who meet the criteria for case management.

The health plan uses data from its claims system to perform the first layer of stratification for members with asthma who may be eligible for case management. The department receives a report listing everyone who has had an emergency department visit or been hospitalized for asthma as well as people who are taking medication for asthma.

The nurse case manager and case management assistant divide up the list according to the language spoken by the member.

The bilingual case management assistant calls the Spanish-speaking members and conducts the initial information-gathering assessment.

If a Spanish-speaking member meets the criteria for the program, the case management assistant transfers the member to the case manager for a clinical assessment and acts as a translator or sets a time when both can call the member.

When providers call for approval for a treatment or hospitalization, the case management assistant takes down the information and enters it into the system. If the case falls under the health plan's set criteria, the case management assistant has a script to use for issuing the approval. If the procedure is not on the list of approved procedures or more clinical information is needed, he or she will transfer the call to a nurse.

"The case management assistants are skilled at recognizing when they have reached the limits of what they can do to help the member and knowing when to triage the member to the appropriate personnel," she says.

The case management assistants work on the outreach portions of the program as well as handling some of the front-line intake and data entry.

They make outreach calls to members in the program to which they are assigned after discharge from the hospital. They ask members if they understand their discharge plan, if they have had their prescriptions filled, and if they have made a follow-up appointment with a primary care physician.

"When people are in the hospital, they are under stress and may miss some aspects of the discharge plan. This gives them another opportunity to ask the questions they didn't ask in the hospital," Leonard says.

If the member has clinical questions, the case management assistant refers them to a nurse.

"This makes the case management assistant's job more interesting. They do far more than data entry. They are trained to conduct outreach calls and to engage with members. This gives them that feeling of satisfaction that comes from helping someone," she says.

The department also has project coordinators, case management assistants on another level, who work with the nurses to collect and retrieve data from the health plan's information system for various projects.

Every morning, everyone in the department participates in a "stand up meeting" during which the staff discuss what they are working on, if they need help on a particular project, or if they are available to help.

"Our case management assistants are the best. Everyone in the department has a good working relationship with each other and we help each other out when needed," Leonard says.

(For more information, contact Margaret Leonard, MS, RN-B, C, FNP, senior vice president for clinical services, Hudson Health Plan, e-mail: mleonard@HudsonHealthplan.org.)