Engaging Members in Health Management Post-Discharge with Case Managers, Outreach Calls

Tuesday, December 17th, 2013
This post was written by Jessica Fornarotto

“Member engagement is always the challenge, and it is no different for telephonic engagement,” states Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA), as he discusses how CBHA engages members in their telephonic case management program post-discharge. “We’ve found multiple venues to attract attention and begin the engagement process, including letters, outreach calls to members, and partnering with the discharging hospital. We want to be part of the discharge process, so telephonic case management is as much a part of the discharge plan as their visit with the doctor or therapist, medication regime, etc.

In HIN’s special report, Telephonic Case Management Protocols to Engage Vulnerable Populations, Jay Hale further describes the engagement process for CBHA’s telephonic case management program.

We are a small regional managed behavioral healthcare organization (MBHO), so our case managers also do utilization management. They identify the cases early and are able to talk to the utilization review (UR) people at the hospital and say, “This is someone that we have identified,” which helps with that discharge process. The earlier we can talk to members, the better. We want to talk to members as quickly after discharge as possible. Having the support of that hospital adds weight to what we do, so it is key that they do not receive a random call. We want it to be something that is related to their treatment process. That is why we want to be part of that discharging.

The next step is to call the member once they have been discharged. We obtain contact information from our records or from the hospital. Our records are based on what the person gave to human resources at some point along the line, so they may not always be updated. The hospital frequently has the most recent phone contact information.

We obtain the discharge recommendation, which is part of our UR process, including appointment times. I contact the member and engage them in the process to assure that they attend their appointments. We also call their providers to say that we want to make sure that the individual attends their appointment. We are the people who are authorizing the care, and these are in-network providers for us. Therefore, that is a relatively easy process. I feel comfortable with that because it is part of the treatment payment healthcare operations process. It also lets our providers know that we are doing this, so they should support us. It also lets them know we are not there just to plan, but also support what they do.

Once we get in contact with someone, we are going to describe this service in the way of how it can help him or her. “This is a service that helps you see how well you are doing.” Other phrases we use include, “We are here to support you in your recovery,” or “We are here to help you and your son/daughter.” We speak in a positive way, and we let them know that there is no cost to them for the program. This is part of their health plan, and we provide this service to help them see how well they are doing. That phrase works for them because it has a positive tone to it.

We also want to match case managers to the members as much as possible. As we manage care, we can see that individuals are more comfortable with a male or a female based on our UR information. They may be more comfortable with someone based on their issues, so we want to try to have the appropriate person do an outreach call to them. Because of that, we may learn about varying times of day to call.

We also found it is important for the case managers to know the therapeutic language that the member has learned. Specifically in substance abuse, we want people who are familiar with that language so that they can talk about supporting recovery, working a program, avoiding old playmates and playgrounds, working the steps, the big book and sponsors. There are certain words that are very specific to that language and to that program. If we can use that language comfortably, then that increases member engagement.

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