I haven't figured out how they plan to halt enrollment in the Stay Healthy program and graduate 18,000 members, slow HCCP enrollment and move out 3,000+ members to the Personal Nurse Program and now graduate LTIH members and still maintain the current workforce?
Unless they are going to lower metrics for the members sake or increase wellness time for the associate sake, I think we may take another hit. And soon. You don't have to be good at math to be concerned about these numbers...
Yes, we are still calling doctor's offices for alternate phone numbers. Most will help out because you can tell them name, date of birth, and current phone number. Others won't or say that they have to ask member's permission. Declination of program is looked at monthly so we do get reprimanded if the number is too high. I never enroll members in IVR unless they agree, but I have received some members already enrolled with memory problems and some that are hard of hearing. Some of our newer reassigned members are open to program but we get those that were coerced into the monthly calls and the UTC cycle continues.
I think there is s difference between harassment and necessary-for-business communication. Harassment is when a member says they really don't need the service, and the CM leaves them in the program to be called again. Does this happen? Is there a push from top down to allow this to happen? Yes and yes. Harassment is when members are signed up for IVR calls without a say in the matter. Does this happen? Is there a push from top down to allow this to happen? Yes and yes. When I worked there, we were calling doctor offices for mbr's numbers without their permission. I'm unsure if this is still being done, and I don't really know if this conflicts with HIPPA, but it is an intrusion. I had doctor's office staffers get very angry at me for calling without the patient's permission. These were members who stopped answering the phone and just wanted to stop being bothered.
Part of the problem with the amount of calls has to do with tasks and referrals....and pharmacy reorders, issues about claims, etc.....some of the amount of calls are generated by us, the CMs, we refer to social work, or another program, and then there are other things going on, it's not an isolated model....all departments have their standards for Utc and follow up, there's really no way around all those calls!
I can see how graduating "healthy" members makes sense for business. On the flip side, the members who vocalize that they feel bombarded by calls and are telling their friends, neighbors and families who Humana never stops calling, I fail to see how that part of the program is good for business. The telephonic HAH program is very aggressive and we are hearing members complain about being harassed every day.
Because it is an model based in return in investment and the costs outweigh the savings in medical costs. You may not like it but case management is there to save claims cost and targeting the right people is the only way to do it. It makes perfect sense and there is nothing wrong with it.
"Wouldn't it make so much more sense to let the Stay Healthy program whittle down membership through attrition."
Agreed! Why keep calling the ones who feel harassed while letting go of the ones who feel the program is helping?
I went to get my hair cut and the lady cutting my hair said to me, "oh you work at Humana? I would never use them again. When I had them, they would never stop calling. It was every day!"
Does Humana think this is good for business? People sharing with others how they feel harassed?
Here's a novel idea. Maybe let the care managers make some decisions, as health professionals, regarding who could benefit from the service, as well as how to best limit the harassment factor, which tarnishes our reputation, and creates the perception that we are telemarketers with nothing to offer, out to rip off Medicare, stalk members and inflate risk scores.
"All I know is that our team has been trained to not ask questions"
To the poster who wrote the above quote, you are not alone! Who knows, maybe we are on the same team, but any conversation outside of how lucky we are to be at Humana is discouraged. The only feedback we get from our coach is what we are doing wrong. The rest of the time? Coaches IM status is "away" and it takes 2 weeks to get a response to an email.
It is miserable. Nobody even tries anymore. Chat is silent and team meetings are a joke. Because....what's the point?
I've worked for other areas within Humana and Stay Healthy has been the absolute worst when it comes to communication. We don't even ask about what the job security situation is, or where our program is headed, and we don't bother with suggestions or ideas because we know better at this point. All waisted breath.
Wouldn't it make so much more sense to let the Stay Healthy program whittle down membership through attrition. Call me crazy, but I think members have the best idea of whether they benefit from health coaching. Also, they should totally push PHCs to put unengaged mbr on 6 or 12 month contacts. That way we are a minor bother, but can still help them through crucial alerts like post discharge.
I noticed that at least 10 people from my graduation list have already been transferred. I think to myself, should I ask my coach if they know about this? Are any of my new transfers scheduled to graduate? Do they realize we are doing extra pre-call research? How are we supposed to fit 90 extra calls into our MOC (130*(2/3)). But I stopped taking these kinds of questions to my coach my first year at Humana. I've learned that you don't invite scrutiny, and leadership doesn't appreciate logistical problems, nor does it solve them. From what I have heard of the Stay Healthy Coms, they are numbers-obsessed and anti-feedback. But I don't actually have any first hand knowledge of the Coms, as we are super-isolated and work only with our coaches. All I know is that our team has been trained to not ask questions.
How did they select members to force graduate? They sent us a list of people that had CBA scores of 8750 or less. We each got a list of about 130 members that we had to call all of them within about 3 weeks and tell them they are being graduated. (PS, there is no feasible way to fit calling all of these people into our model of care. I have worked through 2/3 of my list. Some PHCs are ignoring their list entirely and just following their HCAT roster.) I talked to my coach and started making a case for why all of these people legitimately belong on my caseload. There are people with chronic conditions, people who are working on goals, etc. My coach basically said graduate them unless there are major red flags, like they are about to fall and break their hip and cost Humana. It is super confusing. One person on my list now has a 22000 CBA, but I made my 2 outreach attempts and they will be closed. I have started checking CBAs and a lot of the people not scheduled to graduate have CBA scores less than 8750. Maybe those people will be force graduated with the next round of layoffs?My coach kept talking about how it is UNETHICAL to coach someone with a CBA score below 8750. CBA is not an indicator of health, but stands for Claims Based Algorithim, how expensive they are to Humana. It is a super confusing sh*t show. If someone understands this better, please explain it, because my coach has no idea what or why or how.
Hopefully, we get some clarification at all associates meeting as to the future of these programs. HCCP merging with Stay Healthy but there is no new enrollment in Stay Healthy, while at the same time there is zero communication about what's next with staffing.
Our team meetings are all about competing with other coaches for zero declinations and the most IVR's. That's all I know. We are competing with other coaches - that's the priority. Job stability? Meh....
This certainly seems logical. I guess we just sit tight and see how this continues to unfold.
I believe they are too healthy and no longer eligible for the program.
why are they graduating 18,000 members?