Home and Community Care Transitions, Care Coordinators: While our Preservice colleagues are being replaced by Optum Global Preservice I can't help but think we are being short sighted by only worrying about the Humana sunset. Remember when we got that "lift" of our UHC members' discharge record Predicts being completed by the Global team? What a "lift", teaching offshore nurses to do the Predict Discharge Assessment. My prediction is the next logical step for Optum will be to have these Predict assessment trained global colleagues to do the Initial Predict. And the name change to "care journey guide", alongside the removal of Applied Cognition score, and the updating of the disclaimer are all to soften that transition to Global. Applied Cognition is very difficult to score and requires more digging and understanding to get correct. It also can't be pulled by the AI models from the evaluations. The disclaimer is going to soften it and water it down to meet whatever legal/compliance issues are in the way with transitioning to Global. Be prepared for layoffs and downsizing and shifts even after the Humana dust settles. Care Coordinators, get ready, we are next if they've figured out how to replace PCRs.
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For Pre-service peeps, take your PTO and save severance handbook.
Any managers or anyone who’s able to shed light when they will eventually layoff US citizens?
@af this is true. Preservice is being replaced by Filipinos who make the equivalent of $4-8 USD. That’s why we are being thrown out on our arses and our gubmint allows it
@d5 I’m tired of this company. I cannot wait for RIF that I sent my notice the other day.
And yes, I’m absolutely certain that the Predict rebranding has something to do with the, ahem… legal pursuits. Kinda like Navi to HCC.
I can’t wait to get a “lift” right out of this company honestly. I wonder if the name change on the predict also has something to do with the negative press it’s gotten lately. “A tool not a rule” yet they use it as a tool alright … to scrutinize care coordinators with “cms audits” for members that go over outcome. It’s just so disappointing what they turned Navi into. We were painted this beautiful picture of how joining a bigger company would open us up to opportunity. Maybe for some but the majority has gotten sc--wed
@ct I have spoken to many UM RNs working for other health plans or providers who are not required to call patients/family members. They might call a provider for clinical docs but that’s about it.
Discharge planning should never be the job of people working for health plans. That is the job of a case manager and/or social worker, IMHO.
@ak my theory is they are trying to move to what other companies are doing with straight UM and no engagement. Mainly because if you look at other companies, they do not pay what UHC/Optum pays- likely because of the engagement and case management piece. If you’re doing only UM, the pay is less. This would save them even more if AI and other roles can cover the engagement and admin tasks. Leave clinicians to do what AI can’t yet- look beyond the words and see the person. However, this is a process and would take some time to reorganize. Other smaller companies are doing better re t because they started this way and are building their business without all the engagement.
@ak Exactly. Honestly, if I were a patient, I’d rather have a longer SNF stay (within criteria) that is not spewed out by a calculation even without someone engaging with me, than having a rep call me several times, only to cut me after 14 days.
100% agree, they can make the CC predict less clinical easily and with removing the cognition it’s one less area that needs interpretation. I keep checking the WARN notices however nothing posted for here in Texas although we keep being told it will happen this month.
I’m looking forward to not working with my supervisor anymore anyway..
I’ve asked friends from other continued stay UR companies. They never call members and provider for “engagement” and “IDT”. They also don’t have Predict that is questionable to begin with. They are not boxed with the provided “DC date”. Guess what? They have lower appeal %.
They might do away with onsite SICCs. What can onsite do really with appeal % and decreasing LOS? It’s like talking to a wall.
Some SNFs already have APC to be the onsite HP rep.
Wait, help me understand your theory:
The the Global Team will do the initial Predict scoring?
That Applied Cognition will no longer be part of the subsets?
I’ve been saying this since I got hired - our jobs can easily be replaced by non-clinicians. We are glorified data-entry clerks/telemarketers. Since AI is able to scan and pull out data from clinical documentation to fill out sections, who’s to say that AI can’t scan each and every page of the clinicals uploaded?
Patient engagement, as much as they put value to it, is hit or miss. I don’t see much value to it because patients file appeals regardless of how soon or late you talk to them. The reason behind appeals is the predict report. No amount of patient engagement can cancel out an ELOS of 15 days for a hemiplegic, CVA patient.
@O They are a “global” company and can and will hire overseas and pay them much lower wages than US employees.