Face-to-face contacts help build relationships

Get to know your patients

As providers struggle with that small percentage of patients who consume the majority of healthcare dollars, they’re finding that having care coordinators who work face to face with patients often can help patients navigate the healthcare system and follow their treatment plan.

Getting to know patients in a face-to-face relationship makes it much easier for case managers to gain their cooperation as they coordinate care and help them adhere to their treatment plan, points out B.K. Kizziar, RN-BC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.

“Patients are more likely to pay attention if the information is coming from someone they know and trust,” she says. In addition, when case managers see patients in person, they can watch their facial expressions and body language to gain an insight into whether the patient understands and if he or she agrees with what the case manager is saying, she adds.

“In the case of elderly patients, many may have hearing or cognitive deficits, and seeing them in person helps the case manager know if they understand,” she says.

Getting to know their case manager in person often prompts patients to reveal information that they’d never tell to a disembodied voice over the telephone, Kizziar says. From the case manager’s standpoint, having a close relationship helps case managers determine the best way to help patients make the changes necessary to adhere to their treatment plan, she says. For instance, if you know the family’s cultural practices, you can help the patient choose a diet that he or she will enjoy and that doesn’t require that the entire family make major changes in their eating habits.

When case managers see patients in person, they put a face on the health plan and start to build a trusting relationship, points out Cassandra Holloway, RN, MBA, CCM, senior manager of utilization manager for Keystone Mercy Health Plan and supervisor of the Philadelphia-based health plan’s Acute Care Transitions program. The program embeds case managers in hospital emergency departments to work with patients who seek treatment or are hospitalized. The Acute Care Transitions program reduced emergency department visits by 21% and hospital inpatient admissions by 32%.

Andrew Kolbasovsky, PsyD, MBA, director of provider group clinical management for EmblemHealth, a New York-based health plan, calls the health plan’s decision to embed a team of care coordinators in physician practices “a win-win situation for us as a health plan, for the members, the doctors, and the case managers.” The plan’s pilot project, which embedded a nurse case manager, a social worker, a pharmacist, and two health navigators into a large medical practice, was so successful that the project has been replicated at other medical groups.

“Traditionally, we have provided case management telephonically, calling the members, and trying to provide services. There were limitations because it’s hard to reach members and when case managers call the first time, there’s no personal connection,” he says.

Enrollment rates for telephonic case managers and disease managers tend to be low, he says. “When patients are in the hospital, it’s sometimes the only time we know where to reach them. By being connected to a physician office, we’ve been able to enroll 93% of the targeted members,” Kolbasovsky says.

The program has slashed 30-day readmission rates, the number of hospitalizations, and the total number of hospitalized days.

Patients love the program, Kolbasovsky says. “I’ve seen frail elderly members come up and hug their case managers. They often bring the team cakes, pies, flowers, and other gifts. We’re not serving a wealthy community so these tokens of appreciation really mean a lot,” he says.

Members report that the team helps them find way to save money, such as working with the doctors to find generic alternatives to their medication or linking them to resources. “We get a lot of positive feedback. It makes the staff feel wonderful,” he says.

Tufts Health Plan provides face-to-face case managers in physician practices for the highest-risk members of Tufts Medicare Preferred, its Medicare Advantage plan. Eligible members have complex needs including chronic conditions, cognitive issues, incontinence, fall risks, polypharmacy issues, or a combination of problems.

“These patients have multiple comorbidities, psychosocial issues, and functional deficits and a high rate of morbidity,” says Jonathan Harding, MD, medical director for the Watertown, MA, health plan.

“Either the health plan or the medical group and the IPAs in our network are at risk for the total medical expenses throughout the continuum of care. We have a financial imperative to reduce the total cost of care,” Harding says.