Trained health care managers should serve as the point of contactfor members who don't understand what the physician just told themduring their office visit, or what the potential impact of aplanned surgery might be. (Photo: Shutterstock)
Hospitalizations are a big deal, both financially andemotionally. Reducing hospital readmission rates is good for everyoneinvolved. For patients, it means less time spent away from familyand work, less stress and better health outcomes. For employers, itmeans reduced health care expenses and improved productivity.
It's a win-win, but keeping readmission rates down can betricky. Often it involves helping recently discharged patients getto “YES” on the three key questions.
1. Is the member informed about their condition and treatmentplan?
When determining that a member requires medical care or a doctorhas diagnosed them with a serious condition, it is important toconduct outreach. Trained health care management professionals,like those on a health care management team, should ensure that thepatient understands the diagnosis and the treatment plan that theirhealth care provider outlined, and find answers to any questionsthe patient has. They should serve as the point of contact formembers who maybe don't quite understand what the physician justtold them during their office visit, or what the potential impactof a planned surgery might be on the member and their family.
2. Is the member receiving and taking their medications asprescribed?
In an equally important part of the process, that health caremanagement professional should also conduct follow upcommunications with the provider to get any clarification thatmight be needed regarding treatment and rehabilitation plans. Thecare that members receive should be medically appropriate andprovided in an appropriate timeframe by the most appropriateprovider, and health care management professionals can make surethis happens.
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