How many of us will still be here in two months with that new survey, by the hcmss either resigning due to the expectations of the tool, or because we weren’t verbatim bombing on reviews?
24 replies (most recent on top)
The problem is the inappropriate tasks when they are done, and the attitude of why sone CMs don’t task, all in all, it is a bad situation
So is the problem CM’s tasking or CM’s not tasking?
That is the problem in a nutshell, below poster..sometimes we can do squat because there is nothing that can be done, related to their income, med situation, lack of resources in their area, or a variety of reasons, that you may not understand, but may if you read our charting...there are income guidelines, waitlists, time frames, etc.....or sometimes the member doesn’t follow up. We can’t control the la k of resources, that is not an hcmss doing squat, and yes, this attitude and lack of understanding is why the hcmss are leaving....the hcmss did squat? Perhaps it was a housing task and the me,vet didn’t tell you they were a felon and couldn’t get into public housing. Perhaps their income was over cap for programs and you just assumed they could get into it, perhaps they refuse to take the public transportation because they don’t like the wait time...perhaps the grant closed or they aren’t eligible for a pap. That isn’t the hcmss doing squat, but researching and seeing what is there and sometimes, it’s nothing. Your attitude, poster, is the problem, you don’t understand, so you just sit there and dump more crap of verbal misleading crap
I quit tasking HCMSS a long time ago. Every time I ever tried to get you to help with any social worker tasks you didn't do squat for my members. When someone is having financial difficulty, can't afford their meds, etc. you wouldn't ever be any help. I quit wasting my and the members time.
This is a mixed bag. Either the RN is doing too much or not enough. No wonder I am frustrated!
I agree this is a mix of a humana created problem and the attitude of some, not all, CMs. In the 5 years I have been here, there has been countless things that have gone out on appropriate tasks, tasking levels, etc. one coach asks their team to “educate” the cm when something is amiss. It’s not their role. And the education that has been sent over the years, appears to not have been read. Why keep sending it, if it does no good? I think it’s the part humana created in letting the “bad apple” CMs be able to continue with their attitude and perception of the hcmss and how the dump benefits them, not the team. If there are any cm coaches out there reading this, you may need to meet with your teams to try a task attitude adjustment...and soon.
@ above post - I don't believe I said anything about assisting me, of course I meant assisting the member. Maybe I was wrong to show my appreciation if everyone has an attitude like yours, it s---s and you are a part of the problem.
@SqUixt5-pbfx I think your post demonstrates perfectly the problem. Social Workers are professionals and assist the member not the nurse. You shouldn't need a list. If you don't need a specific skill to do something or there is a task you would pass to a junior aide, you shouldn't be sending to a Social Worker. Although I appreciate you don't have CNA's do do your menial tasks, it would be appreciated if you would refrain from tasking them to us.
I am an RN and I can honestly say that I don't really know what exactly the HCM-SS can't assist with. I am sure there are things that appear to be "dumped" but it would probably help all of us if we could have a "list" per say of what the HCM-SS can assist with. I am sorry you guys are feeling this way, I know that is not my intention and I greatly appreciate all of the help I receive from you . I know the nurses are really frustrated with the way things have been around here but I think we need to remember everyone is probably feeling this way. Hope we can all figure this out and work like a team! You are appreciated HCM-SS 's :)
Ok, poking the bear. Are the nurses responsible or humana? Do we need this adversarial relationship or did this company create it? Nurses do not want to do social work. Social workers do not want to medically manage. In most settings we work together but distinctly, because our training, education, and focus is DIFFERENT. Humana sees us as interchangeable, nondistinct, and a means to a financial end.
Really really mad? It feels good to finally tell the truth, sad I only felt comfortable enough to say it after I resigned. The Rn being mad doesn’t change what they do or how they do it....what are they going to do to retaliate in our wonderful world of collaboration? Dump work on the few remaining hcmss? When will they realize they created this mess and can stop it, too?
Fecal matter hits the rotary impeller. Don't call out an RN's for their BS. They are going to be really really mad at you.
I’m an hcmss, and while it is appreciated you try to help the members, we are the ones that have to sort out the tier exceptions and programs you all incorrectly refer to....we would ask that you let us do our jobs for the members, sometimes, when you try to help, it makes it worse, unless you are well versed in what we are knowledgeable in. Thank you for not dumping, but we also hear “my cm said I’d be eligible for this”, when they aren’t. A long time ago, a year ago, things were done more appropriately, so I I don’t think it’s like ever the poster who said it had to do with going hourly, I think it has to do with the CMs who think they are hah, and no one else can do what they do, even if it completely incorrect, the information they give out , or feeling they can’t complete something, so their ‘secretary “ can do it. The hcmss. There are some amazing CMs out there, and you are a complete joy to work with, but some of you CMs, wow, you really are pushing us far out that door so we are looking for places we are valued....it’s the coaches who allow this to go on, and you all who do it, and you know who you are...keep it up, and you will have to deal with your own crap, because there will be no hcmss left, they’re so fed up....and we are hourly, too, and can’t do all the dump work and the real tasks that are needed to be done. You all created this mess. You do not see us as a team. Working for the members good, if you did, you would connect people to CS, or if a person has a question how the VA works, did you ever think to ask the member to call the VA???? We don’t work for the VA, and the member has to wait two weeks for us to suggest that? Your lack of initiative hits at strange times.
I am on a team that does not dump. We rely on each other for guidance for prescription assistance programs and call HCPR ourselves and help members. We do conference calls to CS, doctors offices, Humana Pharmacy, OTC reps. When we refer to HCM SS it is appropriate. I appreciate everything that the SS does for us!
Cm, i appreciate your honest, but your desire to meet your metrics is pushing hcmss out the door, there is anger, resentment and the dumping continues, though you know it’s wrong, and it’s the member that gets impacted. The system is so screwed up right now, hcmss have metrics and time frames, too , and your quest is causing us to not be able to meet some of ours.....I get what you’re doing and why, but the impact is going to be more far reaching than you realize, with only 90 Hcmss or so for all of hah, and the dump sh-- that’s happening, that number is getting lower and lower, and pretty soon, it will all be on you for the implosion. Thank you for acknowledging what we hcmss have known, and why....which we knew, too. We wish we could figure out a way to make it stop and work together for the members, but that isn’t happening....and this also went on before we went hourly....
Okay, I’m a CM and I’m not going to deny that this sort of “dumping” is commonplace now. The reason is having to log out at exactly 8 hours. CM’s are having difficulty getting through calls to meet expectations. Any conference call with cs support or assembling information for a member and calling back - it hurts the cm in the metrics.
I’m not saying this is right, I’m just saying this is the reason for the increased “dumping,” and I for one see your posts and Im going to make a better effort not to overload you anytime I can help it.
Your posts make a difference, maybe more will follow suit. However we need to recognize and communicate to our leaders that the expectations- for my role, for hcmss, for other roles I don’t doubt - are causing folks to seek out shortcuts.
Yes, yes, yes. Thank you for saying that poster, as an hcms, the crap that us dumped is mind blowing. We are not a team, we are not collaborating. We are the assistant to the cm, to do the grunt work they don’t want to do....not all the time, but it is more noticeable now, with the urgent tasks that should’ve been dealt with by the cm dealing with risk, to the warm transfer calls they could’ve done.....and while they are so far behind, do they even get how much their dumping has put on the hcmss that we have a huge queue of crap, some are valid tasks, most aren’t to get through because of the dump? Warm transfers aren’t going to be starting back up for while, CMs.....if you want to be collaborative and a teammate, then help out the hcmss....you connect the member to CS about their benefits, to claims about their bills, and for f---s sake, you can call CS about in network providers for behavioral health, stop the crap that only the hcmss can do that, and you were told to refer to hcmss. You can easily call CS or bh to get in network providers, why make the member wait weeks for an hcmss to do the call. Don’t even get me started on the “collaborative “ care plans we now have to do since the CMs couldn’t be bothered to read an outcome note. Hcmss has to learn a new system, and the CMs STILL don’t bother to read our documentation.....perhaps that would stop the sheer stupidity of the task that says member doesn’t have referrals from hcmss, please give again, when it is documented right under he note you did.....stop tasking hcmss to send out info, it is the Che that does it, why does the hcmss have to continually educate you on what needs to be done, when we know you know how to do it....The reason hcmss are leaving? You, CMs...your coaches and the system that sports the dumping.
Yes! And so do the COM's
Please...a cm assesses and dumps, some basic things, gets dumped on hcmss, that’s one reason they’re leaving...question about their benefits? Why spend the moment to connect the member? Dump it. Someone has a question about Medicaid? Why tell them to call Medicaid? Dump. Your hcmss are leaving because the CMs treat them like they are their secretaries. The hcmss have more education and skill sets, as needed to carry those initials after their name and the CMs dump crap. Things they can easy do to assist a member to pioneer that simplify, but the CMs dump.....they’re refusing the responsibility of being a mandated reporter, dump it on the hcmss. Ask the hcmss that are leaving...the CMs treatment of the role is a huge part of it....and the CMs coaches allow the crap to go on
I am not a social worker, I am a nurse- I left because I was supposed to assess members but no longer able to task social workers or other professionals. Why am I assessing if I can't offer resources? It's a liability. Interdisciplinary? I call BS. I value the input and skills of my social worker colleagues. Insurance companies value numbers. Not my cup of tea.
Below poster (@SqUixt5-inde), I completely concur, and am reminded of an LCSW license test question: (don't quote me) "if your employer requires you to do something you deem unethical, should you do it?" The answer was (again, don't quote me) "it is at the employer's discretion, and as an employee, you are bound to comply." The answer went on to explain the employer has liability insurance, La, La, La, but the question brought home how important it is to work for an agency that you feel represents your own clinical practice standards.
Humana is not going to change their practice. In other words, it is Humana's sandbox; they make the rules, and they provide the sand and the box...makes me think of kitty potty boxes. :) Anyhow, just know that you are doing your best to help those who need a voice, and maybe consider moving to another sand box that represents what you feel is ethical and kind.
And, there’s no post survey to measure success or change.
The hcmss survey doesn’t help, as they aren’t clinical in their role, they are task based and the possibilities of linkages they can offer is a call to CS for in network providers that members can’t afford to start. We need MAP back
Original poster,
It is an absolute travesty to continue the metric requirement, to expect robotic-like documentation accuracy, to demand verbatim solicitous statements from clinically trained professionals (Motivational Interviewing be dammed), and to put forth and insist Humana members be peppered with invasive and emotionally challenging questions, to which, no solutions within the scope of the HCM-SS role are readily available.
*Patient safety is the main concern for any good therapist; hence surveys, such as the PHQ-9 for instance, have undergone quantitative and qualitative studies measuring its effectiveness and are regularly used in clinical practice to guide prescribing or to measure recovery and response to treatment.
*Here at Humana, the new HCM-SS Needs survey has been modified (PHQ-9 questions have been included) to look like and read like a true evidenced based questionnaire; however, adding empirical questions to an already existing non-empirical survey does not make it valid or reliable, and therefore outcomes will not support the survey's validity. The lack of empirical evidence supporting or opposing the solicited response outcome; correlation vs causation. What are these questions attempting to do? Where is the data supporting the validity of these questions? What is the expectation?
The sad truth is the people making the decisions about productivity, what does or does not go into quality scores, needs surveys, and the like, are interested in being relevant, not valid or reliable.
HCM-RN here, forgive me, but what’s the new survey?