Another pilot - moving SNP associates to HUMCS to address social determinants of health. SNP audit was predicted this year so there has been all this pressure to address GIC’s and review to IHWA and MOP. Now we need to move to HUMCS pilot and cold call members to address social determinant of health needs. How do you help with housing, food, medical equipment, transportation and other needs so that members can go to the doctor and get needed care. Agencies don’t have $$$ to help with food scarcity. There is no low income housing available - Not accepting applications or waitlists. No transportation in rural areas or members cannot afford. Members having to choose between food or meds or housing. Utilities turned off because of reduction in LIHEAP assistance. The democrats gave up. Republicans have cut off financial support for social programs. Without the financial assistance programs, people cannot meet their very basic needs. It shouldn’t be this hard to ensure that people have housing, safety, healthcare, food, etc. Many members have income of $1000 or less per month. Could you live on that? This is not about politics - it’s about people helping people, kindness, and basic humanity. Vote, donate, find little ways to advocate for others, speech up, educate others. Let’s do this together. Let’s believe in and support each other. Let’s lead with love and not hate.
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@h0 absolutely loved the Plan Omega idea.. let's team up!
CM, in specific SNP, has become a joke. People are being fired left and right and these managers provide lame excuses, I've knowledge of this happening when not even a PIP has been implemented.
They offer ERP and most likely there are RIFs in the near future, and in the meantime, they have been interviewing for care management non stop for weeks. "Easy" jobs are being given to care coaches (onshore and offshore), and OMG you should read those charts. These aren't nurses and they're doing nursing tasks (patient education!!).
This company is becoming a huge joke. I think they're hiring people to click on the little hearts ❤️ during town halls, seriously.
@12b
May be government need to stop taxing working Americans. See how long it will take to crumble on its weight.
Maybe people need to stop expecting the government to solve all the social problems.
At this point, why shouldn’t insurance companies start buying & invest in funeral homes? Let’s be honest: in America, dying is often cheaper than getting treated—and insurers already profit more when you get less care. Owning the last stop on your healthcare journey would simply complete the business model.
Plan Omega : Coverage for your Final Exit.
A perfect product for the uninsured and underinsured millions who can’t afford preventive care, can’t afford specialty care, and often can’t afford to stay alive in the wealthiest nation on Earth.
Plan Omega would finally align incentives.
It creates the ultimate vertically integrated ecosystem: deny care upstream, and monetize the consequences downstream. Wall Street would call it genius. Ethicists would call it dystopian. America would probably call it “the free market at work.”
And imagine the marketing Advertisement :
“Plan Omega: When your insurer can no longer help you live, we can at least help you leave.” !
@OP
In American healthcare, it has become increasingly clear that we don’t really practice care management. What we practice—what we’ve perfected—is profit management.
For all our talk about patient outcomes, coordinated care, and “putting the patient first,” the real engine of our system is billing optimization. We have world-class revenue-cycle departments, armies of coders, and software that can squeeze reimbursement out of a single lab test like it’s a lemon at a Michelin restaurant. But when it comes to keeping people healthy, preventing disease, or helping patients navigate chronic conditions, the system suddenly becomes clumsy, expensive, and strangely disinterested.
Because prevention doesn’t make money. Fragmentation does.
Always been a hot mess over in CM. You can thank the climber of the year, RM for that!!
Humana laid off all the Home CS associates and now they need to close all the Gaps in Care to increase Stars rating, so they dumped 35 SNP SW to clean up the mess.
RIF generally comes after ERP, voluntary separation with severance, then a couple of months until RIF. My mental health was a mess the last time this happens in 2021. Not sure that I can’t handle do it again.
Yes!!! We need to work together, especially in these difficult times. I’m rather new to care management. I heard ERP was offered before I was hired. Feels a bit unstable now. Does RIF follow retirement buyouts? I have gone through that at another company and just don’t know if I can’t handle it again.