Today in Town Hall and earlier in the power point it was said that telephonic CM is sending to monitored more often than expected. It is also said in both that doing so has negative consequences. Yet does upper management and exects know that Coaches are pressuring CMs to move them to monitored irrespective of if the grad survey says they are ready? Many CM are putting them into monitored to keep the coaches off their backs (and to stay off any possible RIF list in the future), knowing that it not good for the mbrs. The problem here is the pressure the CMs are getting to move them to monitored.
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Dear "It's not my job",
I have been doing this for a long time and some programs are difficult for members to understand or they have forgotten. We are all in this together. It does not hurt to try to explain to members the benefits of the program. We need some togetherness on this mission. We are a team.
Perhaps if it was explained to us simple minded folk we’d understand a bit more and may be able to do our roles better. It is a complex situation. Explain to us, so we are all on the same page.
Yes it's so esoteric how could we possibly understand? Who knew healthcare was hard?... get off your high horse before you hurt yoursel
They do. There are many pieces you either don't understand or are not privy to with these programs. Your comments are very shortsighted and simplistic. You can't apply that way of thinking to a complex situation.
It seems like the role care manager is misnamed. The whole concept of what they want us doing is educational and coaching, as evidenced by the care plans we have, so we aren’t managing, we are to coach. Which is why the moving to monitored is an issue. Many of the members need to stay managed to be coached.not managed. I think higher ups need to actually look at the roles we play and actually do, before they start making changes
We have been selling this program for years. In the beginning, all coaches were pushing to move members to monitored. Then, it was too many. Some of those members who went to monitored were calling too often and probably should have never moved in the first place. I know I tried to move several who weren't emotionally ready and they told me that they didn't mind getting 2 calls per month. Active care planning is the key but I still struggle with many members with this. This job has gotten more frustrating each year. I am exhausted every work day. TGIF!
I agree with not sending too many overrides. But the coaches are making us. if they have been in the roster for a while it doesn't seem to matter to the coach that they had a fall or new diagnosis and was in the hospital or whatever. She wants them moved to monitored. So yes they are going to have a higher hospital rate, I didn't want to send them to monitored, my coach is making us. I have heard that some other coaches are doing this, not just mine. May be coming from up above the coaches. It just seems like we get batted around a lot.
From my understanding (based on meeting and what coach has said) the issue is overriding a graduation survey to move member to monitored. For example, if the answer to the first question about recent hospital stays on the grad survey is yes, then the mbr is not appropriate for monitored. They are concerned with these types of overrides because these members are using ER and being admitted to hospital. We were told to thoroughly document reason for placing mbr in monitored if the survey was overridden. Basically, to me, this boils down to money. Either they are paying too much in claims, or not meeting revenue expectations. I am getting frustrated because it seems like referral specialist are not thoroughly explaining program to new members and when you call them they decline service. I feel like they are expecting CM's to "sell" the program to members. That is not our job.
Well, whatever the problem is it must be the CMs fault not misdirection or poor planning of leadership.
I don't know if the ones sent automatically are considered overrides though. I think the overrides, largely are due to the CMs being pressured to dump them into monitored so they can assign more to the CMs.
I thought some are moved automatically