Health homes, a patient-centered initiative that provides coordinated care for high-risk Medicaid beneficiaries with multiple or severe chronic conditions, offer huge new opportunities for case managers, says Margaret Leonard, MS, RN-BC, FNP, senior vice president for clinical services at Hudson Health Plan, in Tarrytown, NY.
In the past, the highest-cost Medicaid patients often received care from a variety of different entities that did not always coordinate with each other and often provided duplicative services, says Deirdre Astin, health program administrator, New York State Department of Health. The health home model aims to change all of that, she says.
The care managers at St. Vincents Hospital and Saint Josephs Medical Center never know what the day may bring, says John Francis, LSCW, who oversees the care managers.
Sometimes the best lessons come when things do not work out as planned. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, learned that in the aftermath of a project for his masters degree three years ago. At the time, he was assistant manager in a neuro intensive care unit.
It is not always easy to get people to change behaviors. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, experienced that when he tried to get nurses on a neuro intensive care unit to start giving report in the room with patients and their families. There was always a reason why some nurses just couldnt do it.
