Personal touch pays with Medicare HMO patients
July 1, 1999
Personal touch pays with Medicare HMO patients
Seniors are encouraged to call or drop in
Establishing a personal relationship with Medicare HMO patients has paid off for the Browne-McHardy Clinic in Metairie, LA. The practice has the lowest disenrollment rate with all health plans and among all provider groups in the area, says Kathy Calahan, RN, director of health services, utilization management, quality assurance, and provider relations.
At Browne-McHardy, senior care coordina - tors evaluate the senior citizens, act as a liaison between them and their managed care plans, and encourage them to call or drop in if they have questions or problems. The senior care coordinators are a registered nurse and a licensed practical nurse strictly devoted to Medicare patients who are in a managed care plan, Calahan says.
As soon as the practice receives its monthly notice of patients who have enrolled, the patient care coordinators call the patients, introduce themselves, and invite the seniors to come into the office for an interview and a health risk assessment.
"We want to identify the needs of older patients as soon as we can," Calahan says. The interview and risk assessment allow the practice to get a handle on older patients who have a history of ongoing illnesses, Calahan says.
Patients are scored according to severity of need, and those who are most severe are given an early appointment with a primary care physician.
The senior care coordinators handle durable medical equipment needs and transfer the care to a contracted provider. If the seniors are receiving home health services, the care coordinators evaluate them for appropriateness and transfer the care so there is no break in service.
A key to the patient-friendly approach is to help the seniors deal with their HMOs. "We educate them on their Medicare HMO and help them understand how to access care through their primary physician. There is a lot of confusion among seniors as to how their Medicare HMO works," Calahan adds.
If the senior citizens have to have medical care when they are out of state, the senior care coordinators help them negotiate the paperwork when they return. "They act as ombudsmen for the patients. The patients love it. They love having the personal touch," she says.
The practice looks at the Medicare HMO disenrollment rate every month to keep up with trends. Unlike commercial HMOs, where patients have to stay in for a year, Medicare HMO patients can choose to leave the plan as early as 30 days after enrollment.
"We want to bring them in and make them happy. We don’t want them dropping out," Calahan says.
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