Posts Tagged ‘Telephonic Case Management’

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

December 17th, 2013 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.

Telephonic Case Management: Call Frequency Secures Relationship with Vulnerable Populations

April 10th, 2013 by Patricia Donovan
telephonic case management

Call frequency is a key factor of telephonic case management.

Determining the frequency of case management calls is a key parameter of interacting with populations telephonically, advises Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA).

We follow all of these members for one year because we are looking at helping people manage and maintain changes in their life over all four seasons. In addition to progression of the disease, lack of treatment adherence has also become a factor. There are social triggers in people’s lives that make a difference in whether or not they maintain their recovery, wellness and well-being. We want to support people through the holidays, major traumatic events, anniversaries of major traumatic events and other parts of their lives that may be significant for them.

With telephonic case management, it is important to call often up front to start and maintain a relationship. It is not so much the amount of time spent on the call, as the frequency of calls that helps secure the relationship with members. We want to talk to individuals frequently and spread it out over time by increasing the length of time between calls.

We want to get the relationship started, maintain the relationship and then pull back as the individuals begin to work on their own and become more successful in their own wellness/recovery program from mental illness or from an addictive disease.

Our ratio protocol was very aggressive and optimistic. We originally had weekly calls up front for the first month, spreading out to biweekly calls and monthly calls, and bimonthly calls as it went on throughout the year. That was a very aggressive idea. The reality was that much of our population is a working population because we have all self-insured or privately insured members. Therefore, they have a difficult time maintaining that kind of protocol. We backed off that a little bit, and we went to biweekly phone calls up front. Then we spread that out over time to monthly calls and then bimonthly calls as people begin to improve.

Listen to an audio interview with Jay Hale.