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Proactive approach to keep your clients healthy
Case managers have an opportunity to help people
As the cost of health care continues to soar, employer groups and health plans are focusing on wellness programs that help people who aren't sick now change their lifestyles and avoid developing chronic diseases, such as emphysema, heart disease, or diabetes.
"The health care system is beginning to take a more proactive, rather than a reactive approach since we know that preventing illness is much more cost-effective than treating illness," says Connie Commander, RN, BS, CCM, ABDA, CPUR, president of Commander's Premier Consulting Corp. and past president of the Case Management Society of America.
"In the past decade, the health care system has offered disease management programs for people with chronic diseases to help them stay out of the hospital, but there haven't been many programs that support people who are trying to stay well and take the next step to quit smoking, start exercising, or lose weight," says Cary Badger, MPH, vice president of market development for Regence BlueCross Blue Shield.
"The emphasis among insurers is shifting more to consumer engagement and away from managing the patient. We want to empower the consumers to become an active partner in their health care decisions," Badger adds.
Regence has launched a program called Activate that allows participants who engage in healthy behaviors to earn up to $600 a year that can be applied to their deductibles and co-pays.
When health care costs were absorbed by employer groups and the consumer paid significantly lower out-of-pocket expenses, the focus was not on prevention and wellness as it is today. Individual consumers wanted to be healthy but were not financially vested in the process. But now that the health care system is facing a financial crisis and health care premiums are rising, people are paying attention, Commander says.
"There is an increasing emphasis on healthy living and prevention in the health care arena. Employers and health plans have been spending a lot of money on unhealthy employees. Now they're looking at offering programs that can prevent, rather than treat, illness," Commander says.
The shift in emphasis from curing illness to educating people on how to stay healthy is a great opportunity for case managers to make a difference to their clients, Commander adds.
"As case managers, a lot of what we do is teaching. This gives us the opportunity to share knowledge about healthy choices and give consumers information they can use to motivate themselves and embrace changes," she adds.
No matter what setting they practice in, case managers have the opportunity to teach their patients or clients about healthy behavior - no matter what the initial reason for the contact, says Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy & Associates, a case management training and consulting company.
"We can't spend all our health care dollars on sickness. Many practice settings for case managers focus on illnesses, but nurses are grounded in promoting health because of our orientation and education. We have to take a proactive approach and help people stay healthy and avoid needing health care interventions," she says.
It's all a part of advocating for your patients, Commander adds.
"Part of the case manager's goal with an individual with an illness or condition is to empower them to take care of themselves. If we include a wellness component in the self-care education, we can help them improve their outcomes and avoid a recurrence," she says.
Getting someone to stay well is no different from motivating someone to take their medication for diabetes, Commander adds.
"Most people need a hands-on approach, and we need more case managers on the front line helping people adopt healthy lifestyles," she says.
Case managers have so many teaching opportunities when they work with their clients, Mullahy points out.
"The entire conversation doesn't have to be about the illness. They can encourage people to return to normalcy by adopting a healthy way of living," she says.
Mullahy advocates integrating wellness efforts into disease management and case management programs.
"Whether case managers are capturing people in the initial stages of a chronic illness or assessing them for something like orthopedic surgery, they can educate them about behavior that will keep them healthy," she says.
For instance, when Mullahy owned a company that provided case management services, her case managers recorded every client's height and weight, no matter what the diagnosis, and determined his or her body mass index (BMI). If the BMI was not within normal range, the case managers counseled patients about healthy lifestyle changes.
Case managers should take every opportunity to promote wellness by looking for teachable moments and embracing them, Commander says.
For instance, when you are working with diabetics to get their conditions under control, educate them about healthy habits that can help their children avoid developing the disease, she says.
"When case managers work with a client, they can take the opportunity to talk to the entire family about healthy activities," she says.
Hospital case managers are particularly challenged to approach patients with wellness information because the patients whose care they manage are very sick, Mullahy says.
"We need to create a balance between getting people out of their medical crisis and promoting good health," Mullahy says.
Keep in mind that when people are recuperating from a serious illness or injury, it may not be the best time to tell them that an unhealthy lifestyle was what put them in the hospital, Mullahy warns.
However, a health care crisis can plant the seeds of healthy lifestyle changes, she adds.
"It's more effective to ease people into a healthy lifestyle as they are headed toward the road to recovery," she says.
Patients may promise themselves that if they get through the crisis, they'll change. Case managers need to be aware that while these promises are well intentioned and patients may be able to sustain their commitment for a time, they may fall back into their usual habits, she says.
It's wise for a case manager working with a patient who says he's learned his lesson and plans to exercise and watch his diet to recognize that human behavior is likely to take him back on the same road, Mullahy says.
"Congratulate them and encourage them for their resolve to mend their ways, but recognize that their commitment may diminish over time and reconnect with them to continue to reinforce their good habits," she suggests.
No matter what setting in which they practice, case managers have the opportunity to refer their clients to programs that can help them stay healthy, Mullahy says.
"Most case managers are not in the business of wellness, and often their caseloads don't allow them to spend a lot of time on healthy behavior, but they still can educate patients about the wellness and fitness plans available through their hospital, their health plan, their employer, and in the community in hopes of moving them into a healthy way of living," Mullahy says.
Some resources may include wellness programs offered by health plans and employer groups, hospital-sponsored weight reduction, smoking cessation, or aerobics programs, as well as low-cost programs at community agencies such as the YMCA and online programs such as Weight Watchers.
Health plans and employer groups are offering health promotional programs, including discounts for gym memberships or weight loss programs or economic incentives to enroll in a healthy living program, as well as wellness and prevention pieces, in addition to disease management and case management programs, Commander points out.
"Now that people are experiencing higher deductibles and co-pays, we may find that they are going to try to stay healthier and avoid going to the doctor's office. All of us in the health care field know that when people access the system, it costs a lot of money. Now, we have to come up with ways to motivate individuals to have a healthy lifestyle," she adds.