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Imagine being discharged from the hospital with a long list of care instructions. You may be returning home to an empty refrigerator or unreliable electricity. You could be unsure of what you should do to support your recovery or in what order to take your medicines. Even if there are community resources that can help you restock your refrigerator or pay your rent, you may not know how to contact them.

These scenarios have been too common in the past and as a result, more people than necessary were readmitted to the hospital. More people went to the emergency room than needed to, raising costs for everyone. Early signs of illness were missed. Chronic conditions got worse. 

Elevance Health listened to members, saw the trends, and initiated new ways of managing care; one way is through dedicated care managers. Sometimes called a case manager, a care manager works in partnership with health plan members and acts as an advocate for them, helping to connect the member with their various doctors, nurses, pharmacists, and specialists. A care manager can help coordinate services that address a member’s health-related social needs, whether that’s food delivery, transportation, or finding housing. They also help arrange for home health care, physical therapy, rehabilitation, or pharmacy needs.

What is care management?

Care managers support a variety of health-related activities, including creating a customized care plan for each member. Such care allows for treatment at the most appropriate time and place and prioritizes preventive care. Some examples:  

  • A man experiencing homelessness was severely burned after building a fire to warm up and lost a portion of his leg to amputation as a result. His care manager helped him secure housing upon his discharge from the hospital as well as the mental health care he needed to address anxiety.

  • A mother of two was diagnosed with Crohn’s disease after several months of confusing symptoms. Through concierge care, a digital care management approach, she could connect with her care manager several times a day, learn more about how to manage her symptoms, and talk with other people who also live with Crohn’s disease.

  • The parent of a two-year-old who would need hospitalization unless he could have a very specific type of formula, contacted her care manager for help locating the formula during the shortage in 2022. Through the network of care managers throughout the country, the care management team located enough formula for the family to continue feeding their son.  

“Care management is just better care,” said Dr. Adrienne McFadden, chief medical officer for Medicaid at Elevance Health. “It's the right thing to do and aligns with our purpose to improve the health of humanity.”  

Members most commonly learn about care management services upon hospital discharge or diagnosis of a chronic condition. They can also become aware of it in conversations with their care provider, when they need transportation, when they need financial assistance, or when they experience a significant life change, like becoming pregnant. 

And matching care managers with health plan members is a very intentional and thoughtful process.

“We match care managers with members with artificial intelligence technology,” McFadden said. “We don’t randomly assign people; we strive to match them based on expertise. By approaching this aspect of the care process in a more scientific way, we can help build a relationship, and a higher level of alignment, authenticity, and trust.”

Benefits of successful care management

Care managers can help a member attain their best health. They help connect them with specialists, track referrals and tests, and make sure the proper follow-ups happen. This leads to better collaboration and communication with care providers, an emphasis on preventive care, and treatment at the most appropriate time and place.  Care managers help members address social drivers of health and improve outcomes. They also form strong bonds with members; 87% of members who participate in care management report being satisfied with their care manager.

With this whole-health view, care managers can build trust with members, help them take control of their care plan, and teach the skills necessary to maintain and improve health. Participating members see the value in these relationships too, and more than half the time, members are initiating outreach to their care managers through an online chat function. 

“We’re not in the business of delivering care,” McFadden said. “We’re in the business of facilitating the care plan, and that leads to better health.”

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