A Town Hall has been scheduled to address the recent events. All we will get is hot air and fluff. We will hear how we all have to step up our game. We will not hear any leadership take the blame for any of this chaos. All of the top needs to resign.
3 replies (most recent on top)
The ROI on Care Management did exist until they tried to upscale the operation. The technology required to run these programs is significant and expensive, just one server for call centers costs in the millions. Care Plus spent a fortune on new software for CM and then abandoned it. Verint Workforce Management software and the teams hired to implement it were wildly expensive.
Care Management was a useful tool to encourage behavior change but that was negated by the insistence that CMs managed people who didn't want to be managed. Spend time with those who wanted to make changes and let the rest sit on the couch watching Oprah and eating burgers.
I recall the hiring binge maybe it was 2012 or around there maybe later, we were interviewing hundreds of nurses and standing up teams at a whirlwind pace. St Pete and Ohio was in a constant cycle of hiring and training, we even did some at NetPark in Tampa. It was wild and unsustainable. BB never missed an opportunity to latch onto the next big thing and the people reporting to him were not honest about the costs or the realistic financial benefits.
Humana used to be the company that said NO. No to insurance claims mostly. They have tried every trick in the book form hospitals, insurance, nursing homes and even trailer parks. In the history of the company they have never developed true expertise in any area.
To former CM RN- been saying exactly this about CM ROI for years. There’s none and it’s probably costing millions! These old sick elderly people don’t want to change because they’re set in their ways. They figure why should I eat better or stop smoking or get my blood pressure under control when I would have to make changes that weren’t fun. I’m not gonna live that long anyway and I might as well keep doing what I’m doing. And you’re absolutely right about all they want is their bills being paid because that’s what they have insurance for - so it pays the bills! Many of these people have signed up for bargain basement plans that have sky, high deductibles, and out-of-pocket cost and don’t pay for anything yet then they wonder why their bills aren’t getting paid. Duh you’re in a managed care plan - they don’t pay.
Wouldn't that be a trip if they ever acknowledged they sc--wed up. Well they will not and they will imply it was frontline workers to blame. They will talk vaguely about "changes" and imply there will be layoffs to make people work harder. No specific plans will be shared. As an ex RN at Humana I can say that I think the care management programs are completely worthless. You will not change people's behavior because they dont want to change or make an effort to be healthy. If they wanted that they would do it themselves. They dont prevent admissions or readmissions. You spend most of your time leaving messages for people who dont want to talk to you. They just want their bills paid. Total nonsense. The ROI on these programs has always been pitiful. On commercial side many years ago I had a large hospital chain who complained their staff were overweight and we weren't doing anything. Upon questioning the staff they said they had McDonald's with a good staff discount on the ground floor so they all ate there instead of going for a salad in the staff cafeteria. One told me that "I would not be able to compete with the smell of fries when she was hungry..." (Meaning our discussions about healthy weight) When I pointed this out to the hospital chain they said they made a lot of money from the rental to McDonald's. While bi--hing that we were not effective. Then the big care management pilot recently I was dragged into. They explained it to me and I said wow thats going to be super high cost though. They still went ahead - it took a lot of time and effort to set up and train and produce policies and processes etc .. then guess what it was shut down as being "too expensive". Dont ever think these Directors or VPs and higher are any smarter than you - they absolutely are not. Sorry for the rant. I have a million more examples.