Surveys and IVR are a big turn off to most members, but that reality doesn't seem to penetrate leadership's thick sculls. We are losing members like crazy, and will continue to once auto dialer starts. Our members pick up because of the relationships we have built with them. Once the Rostered member go into a Que, we will lose more. Right now I am a health coach to 2 doctors, because I do my pre-call research and I charm them and I figure out their needs and try to keep them away from the rote survey BS. As soon as the auto-dialer kicks in , members like that are gone. There are not infinite members. They will not be able to keep enough people engaged to keep all of us. I could go on for hours about my issues with survey design. Cognitive survey, WTF! People are high in the cognitive domain on the MDAT because they are non med compliant. If you want to design a cognitive survey, ask about ROI'S and memory exercises and organization systems. Functional Survey, WTF! If people can't walk a quarter of a mile, first figure out if their issue is pain, or shortness of breath, or a recent joint replacement before you insult them by implying they are a vegetable and completing the whole functional survey. Preventative Screening HEDIS. WTF! We can auto-populate Hedis gaps to AMP and CGX alerts but we can't auto-populate on the Hedis survey. I am so excited that I get to ask about 500 80 year olds this year the exact date of their colonoscopy. If we have to stick to surveys, for the love of God make them smarter!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Or let us do our research and not put Rostered members on auto dialer.
14 replies (most recent on top)
I know someone who is an Hcm ss, and they said they get all the med requests since the phc and CM don't research it to help, that's what they're doing, based on the surveys, I guess
So s---s
We were hired into roles like "personal health coach", "nurse navigator", and "care manager" and thought we were here to help members through education, support, and an interdisciplinary approach. The focus is more on completing surveys to ensure more payment for the leaders (how much was your raise last year?) and less on actual care which is what many of us thought we were hired to do. Always a joy to have a member say she can't afford her insulin and you instead spend the limited call time pushing her to finish a survey instead of researching ways to help her because you only have 20 minutes for a call since you still have 5 more to get in or your "metrics" will be off.
This reimbursement is how we are all paid. That data you shared the link of is a few years old. If we are filling out the surveys accurately and capturing info correctly, it's legitimate payment for telehealth services.
I also just researched the links and I am shocked. All those chronic condition surveys are done in order to increase the bill Medicare must pay. Check out this interactive explanation. It is our diabetic survey almost verbatim. https://www.publicintegrity.org/2014/06/04/14865/how-risk-scores-work
Poster, thank you for the links. Do you know what the actual reimbursements are related to the assessments done ?
A quick Google search on Medicare Risk Score explains it.
Go to publicintegrity.org and search the company's name.
So how is Humana paid by Medicare?
Well said, Original Poster. The relationship with the CM is what drives the member to pick up the phone-not the desire to complete yet another survey.
The surveys are a waste of time to members and employees. We are not able to help members whether they score high or low. The surveys are simply a tool the company uses to get more money from Medicare. Basically, the more diagnosis/care a member needs = the more $ Medicare pays the company.
MF was determined to turn this into a call center and he succeeded. IVR and autodialer have no place in care management of the most vunerable. The concept of calling someone to discuss their needs without pre-call review is idiotic. But that is what happens when "business people" are put in charge of healthcare.
I think that makes sense. If you have built a case load and have proved you can pull down good numbers accross the board, you should be able to maintain it. The auto dialer is going to subtract for these associates, not add to them.
It would be better to put people with bad metrics on the autodialer. Or make people with bad metrics do the RS position.
As a PHC who was just moved to auto dialer and an RS role to "assist business needs" along with my whole team let me say, it's no picnic.
I am just breathless at the stupidity of the autodialer for this position. People that are good at this job research. Leaders, put together a committee. Interview the PHCs that have the best retention rates. You will find that they do PRECALL RESEARCH!!!!!!!!! KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME KNOW ME
As a PHC the thought of auto dialer makes my stomach turn. I feel like the only rationalization behind this is that leadership does not trust us to manage our rosters and members. It is yet another way leadership demonstrates they have zero regard for the preference of our members and no trust in us as employees. I am interested to hear what kind of spin they will put on it. The reality is for me to be the most effective care manager and serve my members well, I need time to reach each member prior to the call. I need time to review my notes and prepare for the call. I feel so bad for our poor members because they are the ones that will suffer if/when this rolls out