Any further speculations on when Home and Community can expect any answers? I guess we all feel like we are waiting around until 10/29. It feels like a lifetime’s worth of waiting and not knowing (with certainty at least) how it’s going to be determined.
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Anything new today knowing tomorrow is the 15th?
@29z wonder where she's going?
@29g
LD Preservice Director is jumping ship. Last day 10/15.
What does this mean for the rest of us.
@263 Is this Alysia?
@25s yes email was sent today and looks like her last day is 10/15. Sad- she was here for a while and worked her way up.
Is one of the directors leaving?
@24p all I know is they are still working on selecting the DCC team which will take another 1-2 weeks. I would bet we hear about layoffs 10/29.
Does anyone know if Home & Community SICCs will be Rif’d this week? I know there has been talk about things happening in October but curious if there is any new ‘confirmed’ information. Thank you.
@1e3 it's all UHG
@1ak I think Optum owns InterQual vs UHC.
Where did the other home & community thread go? I swear there were two threads recently.
@190 and UHC bought / owns Interqual
@18b nH predict is known to be patterned after Interqual. Interqual is just a clinical decision-support tool that DOES NOT say how long a patient needs to stay hospitalized/admitted. That is the beauty of it.
nH Predict, on the other hand……
@188 an algorithm that predicts how long someone needs to stay... takes the need for experienced people out. NH doesn't / didn't hire experienced case managers that didn't need a predict..Its all about $.. optum thought it would save billions. Now they're changing it, and have had to actually start using CMS criteria.
@185 naviHealth built their company because of the nH Predict. That is what Optum bought the company for. It is proprietary and there’s nothing like it for SNF continued stay assessement.
Onsite or telephonic engagements - they are just added bonuses that don’t really contribute to the work process. Tons of UR companies and insurance companies for CSRs without needing to engage.
@16b it was the cornerstone of naviHealth. Yes there were sites that were telephonic only but nH built their brand on onsite engagements and patient relationships. It was that way for many many years until the company was bought out by UHG for $2 billion dollars.
@16a
And the “new contracts” will allow offshoring too. Bottom line is we are more $$$ than overseas people and we are sc--wed. I think they don’t care about quality that much. If overseas can barely pass quality wise, they are tolerable.
@141 naviHealth has had CMCCs who are telephonic even before the UHG acquisition. That role has existed since the Jurassic era. The enterprise is not operated by onsite CCs only. Tons are telephonic. So onsite engagement is not the “cornerstone” of naviHealth.
@ws Don’t believe everything you hear from management. They probably have no clue themselves. The “new contract” saga - I have been hearing that since last year. It’s a tall tale at this point. LOL
@x2 I agree. The new Discharge Care Coordinator role will really take your soul. Why one would apply for that job is beyond me.
@ws Right? The Predict should go. I would rather use Interqual or Milliman with a big portion of clinical judgment.
@159 Do we get referral bonuses for freshers?
They will layoff people - for sure on the Preservice side.
They hired 130+ offshore PCRs. Hence, they will axe at least equivalent amount of US based staff.
Much more so that Preservice auths are dwindling even before Humana exit.
@141 yeahhhh but again, it is all just rumor and speculation at this point. Hopefully we find out soon.
@13v interesting. So it seems that the cornerstone of onsite engagement that naviHealth promoted so heavily is perhaps now going to the wayside. Dollars mean more than onsite relationships and engagement it seems.
@13n I have gotten the impression that it will be largely metrics based and that onsite does not automatically mean you are safe. It has sounded to me like a lower performing onsite CC may be replaced with a higher performing CC from a heavy Humana market who would then just manage telephonically.
@13n have no idea
@x5 Do you think those who are currently assigned the high volume facilities with onsite presence will be spared? Or will RIFs be strictly based on metrics?
@x2 we're told still onsite for facilities that have enough volume . Loss of Humana could greatly affect the volumes in those buildings depending on how much Humana is in those states.
@ws
So what is their plan for SICCs / continued stay. Will they still want you to do onsites for high volume SNFs? Or are they switching telephonic? I heard about the new Discharge Care Manager? That position will take your soul.
@wa this is feeling like home health all over again
@wm the siccs were told there were new contracts in the works too... that has been a while ago now, no word on that since. Im guessing nothing went as hoped. We just got training announced about the "new prefict" thats not going to be called that anymore. The emphasis so far is on using it for discharge planning. That thing has been the biggest problem we have had all along. They just can't seem to let go of it completely for some ridiculous reason.
@wj
Facts!!
Past meetings, they said don’t worry we have contracts coming in yada yada.
That will not be enough as they transferred 90-95% of cases outside of US.
All is left for local PCRs are low volume states and low volume health plans that they can’t offshore.
@vm the are not being transparent! They told us initially that the global cases are only around 30-40%. When they had us change to not pick up any global cases, that number was significantly different. Closer to 90+%. The cases the week before that were not marked as global, now all of a sudden were too.
@vm
Preservice was told to stop grabbing offshore eligible cases this week. Local PCRs queue went virtually dead. They said they are closely monitoring the numbers. Can only assume they are monitoring the numbers on how many local PCRs they will layoff and how many more offshore they will hire.
@vm
Almost all US states and several Health Plans allow offshoring. There might be a limit on how much percentage they can offshore, but it looks like they will maximize offshoring. Rough week for PSCs. No cases left for US based clinicians.
Will it be the 15th or the 29th? Surely we won't be kept in the dark longer than that.
Can someone that works in pre-service tell me what their managers are telling them about the offshore workers taking their work? How are they justifying it to you guys? Are they being transparent?
@ma
US based Preservice are basically hitting refresh every second waiting for a new auth to magically appear.
This week has been rough.
Out of 8 hour work day, we are lucky to snag 1-4 requests to review.
@ma
US based PCRs barely have any caseload now. They have shifted 70-90% of work to offshore people. Management increased PTO to 40% for all US PCRs this week. Imagine what it would be like when Humana sunsets on December 2026.