“Organizations with a proven track record that also offer on-the-job training are key to attracting nurses and other individuals with clinical backgrounds as they may not have worked in a managed-care setting before,” said Rohit Gupta, director of Medicare at Inland Empire Health Plan, a company that will be offering coverage under California's dual-eligible demonstration. “Any organization that helps bridge that gap will not only attract care managers, but will see them remain in the long run.”
Training is a major issue for the fast-growing profession. Even nurses with decades of experience need new skills to take on the multiple tasks required in care coordination. For instance, changing patient behavior can be crucial to lowering medical costs, said Grace Chambliss, who manages cases for MissionPoint Health Partners, an ACO owned by St. Thomas Health in Nashville, which serves dual-eligibles.
A nurse with more than 20 years' experience, she is now in a multiweek coaching course that's teaching her skills including motivational interviewing. It's a question-and-answer technique that encourages patients to adopt healthier lifestyles or lose weight.
“In my previous life, I would have been bossy and said quit eating fried foods and go walk,” Chambliss said. “Now I say, how about trying to walk more? Or is it possible to eat just one piece of fried chicken?”
Care-management training programs also include education about relevant state and federal policies that affect the targeted patients as well as briefings on local community services. The goal is to put care managers on a more solid footing. “Things are changing constantly. There are various regulations and you need people to be fully updated,” said Claudia Fine, chief of professional services for Humana's SeniorBridge division. “You want them to feel confident.”
Like most subprofessions in healthcare, care coordinators are stepping up their self-organization efforts aimed at credentialing and education. Registered nurses in the field last summer created the Registered Nurse Ambulatory Care Coordinator Association, which recently formed a partnership with Cincinnati's Xavier University to provide a certification program in population health management. “My personal dream is that we create a place where we can share best practices,” said Lisa Cobb, a cofounder of the association.
Yet companies are looking beyond a single-professional approach to ensure there is an appropriate balance of skills in multispecialty teams it usually deploys to coordinate care. AmeriHealth Caritas, a Medicaid managed-care company and Independence Blue Cross subsidiary, has its nurse care managers primarily focus on the medical needs of clients while community health workers focus on the social or community issues. A community health worker usually has a better grasp of the services available in the community.
While most nurses might be open to attempting social service work when they first become care managers, “after a while, they'd move on to something else,” said John Baackes, president of the Medicare division for AmeriHealth Caritas.