I an an rn cm and we have been mandated to move all of our legacy members over to a monitored status with the triage team. Most on my team have had some of these members come back to our rosters for management since they were recently "graduated". Supposedly humana makes less money on legacy members so they have to go to triage so we get more high dollar new members. Is humana double dipping on the legacy members coming back to managed? I've been told countless times by my coach that legacy members are not returning a high enough return on investment. These legacy members are mostly old, sick, many are poor, cannot afford medicines or healthcare because of high copays and deductibles. Through our work as nurses we have educated, found resources, saved lives and comforted our members with continued support. We have saved humana mega bucks for managing our members and preventing unnecessary hospitalizations. Now we have thrown legacy members away to take on new members that were not even aware they had been signed up for humana at home services. A lot of these new members are not picking up their phones when we call and I had one block me, and a couple yell at me for calling them. I don't know how medicare reimburses humana, but something appears to be unethical if not illegal. Humana at home has become a culture of fear, intimidation, bullying, and a hostile work place as they try to squeeze more money out of their members, medicare, and fire seasoned nurses to save a buck. I think hah is circling the drain.
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Thelonger you work here, the higher wage you get. When you top out they look at cutting the budget. The highest paid VP at Humana got the ax this year. Under the guise of Retirement just like the Eastern Division Medical director. Most likely these folks are all around the age of 60. Remember 3 years ago, Humana offered early retirement to folks age 60 and older. Yep. 3 years later, those are the same targets with less lucrative settlements or none at all. A general axing of heads with a minute mistake pointed out, OFF WITH YOUR HEAD.
@10sKIefB-9iju
Who is being sold? Humana? Where are you getting info?
And that is not why the PHCs went away. When humana went to shrink the model and refocus they put their money on licensed healthcare professionals. The thought was a medical professional could potentially get more bang for the buck. But that has not 100% paid off either. So then they began molding and shaping the work even more.
@10sKIefB-9iju How do you know they are terminating older workers?
Here is what is happening. They are being sold. They need to reduce the amount of employees so a selection is being made per dept by management. Starting with the older worker. Termination, so no severence, only unemployment if they qualify. Fine how do you do to workers that made the company their entire life, My mistake. They are hiring nurses temporarily until Dec. There is nothing you can do but leave now before the market gets flooded with Humana employees all vying for the same positions.
@10sKIefB-5sky Revenues drop and the lay you off. If sales drop in a department store they close it. SEARS....
Looks like more layoffs to me but I don’t have any concrete information. Never had a roster this low in 7 years
So, what happens if new members are not answering and legacy members are in monitored status? What happens to revenues, just saying.
Thank you everyone for the clarification. Wondering why there was a push to move legacy members. I completely agree with the person who posted new members are not answering. Vicious cycle that is stressing me out. New members seem to have less needs.
I think the term is ROI. It costs more to provide management to some members than is returned in investment, savings in health care dollars. I always thought Telephonic Care Management was an add on Benefit not mandated by any Govt body. Looking at it this way, it's better to invest your time (and money) where the greatest savings are. Greater savings means you can do more. That's why the PHC program went away, they were not saving as much as they were costing.
In the telephonic world...what does legacy members mean?
predatory is the word
Sounds like it is widespread. RN here too. Being reminded multiple times daily to get these legacy members off our rosters. Not seeing many new members at all.
Well said and so true. Have been questioning the legality as well.