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How We Care for More Than Our Members’ Physical Well-Being

Here’s how our care management program benefits all our members and how we take a longitudinal approach to care.

Teresa Hall, caring for our members' well-being

I started my career as a physical therapist in sports medicine—mainly dealing with patients experiencing neck and back pain. During my time working one-on-one with patients, I noticed that I was treating people who had behavioral health issues that weren’t being addressed. These issues that always seemed to surface were barriers to the patient getting better or fully healing because the physical therapy I was providing was just a small part of a much larger and complex health care puzzle.

In many cases, I noticed that a lack of community resources was preventing many patients from getting the holistic treatment they really needed. Patients really needed help navigating the system—whether it was addressing mental health concerns, managing pain, or simply getting to and from appointments. This is how I knew there were significant gaps in the health care system and that there was room for improvement.

Every member care managed

Some people view care management as caring for a known health issue, but the SelectHealth approach is much more than that. We’re concerned with our members’ overall health status. Care management really begins the day a member enrolls on a plan with a proactive approach that includes reminders about preventive care, such as immunizations and recommended screenings.

We’re able to identify members who have chronic conditions and barriers to care such as transportation issues or access to housing. It’s important for us to connect members with the community services they need, because without addressing all social determinants of health (e.g., education level, financial security), it could affect the member’s ability to adhere to his/her recommended medical care. 

To provide a successful and seamless care management experience for our members, we partner with our Quality Improvement and Medical Home teams to coordinate care—this allows us to stay aligned  with recommended treatment plans, which may include ensuring members adhere to their medications as prescribed, get to scheduled doctor’s appointments, and address potential mental health needs. We recognize the importance of mental well-being, because a lack of mental health and clarity (first and foremost) could alter a member’s ability to effectively manage all of their necessary care.

And if a solution isn’t readily available, we can help augment treatment until the patient can seek care. This can include creating an action plan with a member on how to manage a mental health issue or connecting a member to a Primary Care Provider (PCP) who may be able to prescribe a medication while waiting for other treatment.

How care management bridges the gap

Our integrated relationship with Intermountain Healthcare helps us to ensure that our members receive quality care that is consistent and coordinated at all touchpoints. Even if a member doesn’t have a direct relationship with Intermountain Healthcare, we still benefit from Intermountain Care Process Models (CPMs) and clinical programs that are considered best practice, and we’re able to align SelectHealth policies with those clinical recommendations and benchmarks.

We recently identified a member who was frequently visiting the emergency department (when urgent care wasn’t necessary) and wasn’t following their current care and treatment plan. One of our care managers quickly sprang into action—she met with the patient, the patient’s family, and the patient’s PCP. Together, they created a path for appropriate and consistent care.

Without effective care management, this patient could have fallen through the cracks of a fragmented system. But because of our coordination and integration, the patient received the necessary support to improve health and outcomes.

How we’re connected to our members

Before I worked at SelectHealth, I’d always admired the company from afar. I knew our mission of Helping People Live the Healthiest Lives Possible, and I wanted to be a part of it. Now that I work here, I get to witness firsthand how truly connected this organization is to its mission and values.

SelectHealth is a leader in member-centered care, and we’ll continue to be as long as we’re committed to our mission. I currently work in administration, but I feel just as connected to our members as I did when working in direct patient care—that says a lot about the work we do for our members and the communities we serve. We’re truly here to help members get the care they need.

Related: How Identifying Your Mission Helps You Stay The Course In An Ever Changing World 

 

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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.

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Post Author

Teresa Hall
Teresa is the director of Health Services at SelectHealth, which includes a team of dedicated employees who support coordination of care for members of SelectHealth. Teresa is passionate about improving the health of our communities and driving advances in health care delivery.