Unique Qualities in a Managed Care Setting Community Connectors have a special and unique role within a managed care environment. Because their role is community-based, it is considered a high touch service. • Integrated Care Team member • Community-based • Eyes and Ears for the Case Manager • Connectors to care
The Spectrum of Core Roles There are five key areas in which Community Connectors will have an opportunity to impact members’ lives and to promote healthy behaviors . . .
Core Role - Community Knowledge Community Knowledge • A key function is to link members to community resources • As you listen to members’ stories, you are given opportunities to connect members to resources • Build a relationship with members who are in crisis
Core Roles - Health Coaching Health Coaching • When performing face to face visits with members, they will disclose barriers to accessing care • Focus on the here and now and assist member through problem-solving • Support the team to ensure member’s compliance with treatment
Core Roles - System Navigation System Navigation • Members will report they do not know how to find a doctor, how to replace a member card or where to go for a mammogram • Our job is to help members understand how to be connected to the right kind of care, at the right time, and the right place
Core Roles - Health Outreach Health Outreach • Home visits are an extension of case management services • Meeting members in their homes or in the community will provide you with an increased understanding of their lives: their strengths, risks and needs • Take advantage of this high touch contact to provide benefits education
Core Roles - Capacity Building Capacity Building • Members do not often know how to advocate for themselves, how to ask for the help they need or who to ask for help • There is opportunity here to support and encourage members to develop self advocacy skills: how to talk to their provider, how to ask questions and most importantly, to gain an understanding of what they must do to take care of themselves
Approaching member with service and care People listen to those they trust; Upon initial contact, community connectors work toward fostering trust by demonstrating empathy and compassion We will be more successful in seeing behavior change if we demonstrate empathy and compassion Engage member by asking questions that show concern, respect and attention
What we learn from member Perhaps, the member we thought was noncompliant: • Is facing barriers for accessing care • Has limited health literacy that he won’t share over the phone • Doesn’t know how to take his medicines • Can’t read a bus schedule to keep his appointment • Doesn’t know he has a transportation benefit • Is scared to hear his doctor tell him his cancer has returned
How are members dealing with their health needs? • Less likely to: • Measure blood sugars • Use preventive care • Know how to use inhaler • Get the flu vaccine • Comply with treatment • Take medications as prescribed • Ask for help • More likely to: • Visit the Emergency Room • Have frequent hospitalizations • Be at risk for early death • Be sick when seeking care • Have a harder time managing a chronic illness
Home visits: Why face-face contact is valuable • Helpful way to reach certain members: those who find it difficult to leave their home due to an illness or disability • Meeting members in their homes will provide an increased understanding of their lives and barriers they are encountering in accessing care
Introducing Yourself to Member The general public is not accustomed to home visits by insurance company representatives, thus the importance of extending a caring attitude is critical to begin the foundation of building trust. “It is this a good time for a visit?” is a safe way to allow member to continue with the visit or reschedule
Explain the Purpose of Visit • Explain to member why they are receiving the service • What are their primary healthcare concerns • Is member established with a Primary Physician • Does member need community resources information • Does member have knowledge of Molina benefits • Are there any preventive screenings to complete
Addressing Barriers to Care • What environmental barriers or challenges does member face? How can we help? • Provide community resources information • Report home observations to Integrated Care Team • Learn community resources • Provide support to follow-up with resources referrals • Assure member of your commitment to service
Explain Next Steps Thank member for their time and hospitality Give encouragement, support and demonstrate a caring attitude!
What is Advocacy in the Healthcare Field? • The act of appealing or arguing in favor of something, such as a cause, an idea, a member! • I AM A PERSON who speaks up for and defends the rights of our members.
Social Determinants of Health • Read the following sentence: • sdnuoW edulcni, stuc, separcs, sehctarcs dna serutcnup. • ekaT eno llip hcae thgin. The circumstances in which people are born, grow up, live, work and age and the systems put in place to deal with illness World Health Organization
How Poverty Effects Member’s Care • POVERTY - Members will have a: • Decreased knowledge of how to care for self • Greater risk for disease • Lower likelihood of receiving preventive care • Higher likelihood to seek care in the ER
Connecting to Community Resources FOOD SHELTER CLOTHING If these needs are not being met, our members may not be able to focus on their healthcare needs: keeping a medical appointment, changing their diet, measure blood sugars, completing preventive screenings, will be difficult for them. Our responsibility is to connect members to resources that may assist them with food, housing, utilities, etc. Know your community resources!
Community Knowledge • Why should we know the local community resources: • Builds TRUST: member believes you care • Builds CONFIDENCE: member now has options • An opportunity: CONNECT members with RESOURCES
Recognizing Positive Outcomes We will see positive outcomes when the member is making behavior changes. It is a result of demonstrating a genuine interest and concern