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Manage Member Care

Learning Objectives

After completing this unit, you’ll be able to:
  • View a member record.
  • Assign an educator to a care plan.

Coordinate Member Care

Richard Yang is a care manager for Makana Health. Makana allows him to track member health outcomes, and Richard’s members consistently stay healthier and recover more quickly from problems. It’s because Richard diligently follows their health and recovery plans and follows up when he needs to.

Richard opens his Today page from the navigation bar first thing. It shows that he has 12 tasks to accomplish. One of them is to contact Charles Green.

Today page for Richard Yang

Richard sees the Chatter message from Erica. He’d planned to call Charles today, so he’s happy to hear he’s on the line. He takes the call.

View Care Plans

Richard looks at Charles Green’s member record and sees some red flags.

Charles Green member record. Member Alerts & Notifications (1) is highlighted with a warning that Charles didn’t pick up his Glucophage (Metformin) refill. The Member Card is also highlighted to show Type 2 diabetes mellitus, uncontrolled (2).

In the Member Alerts (1) section of Charles’s record, it looks like he hasn’t filled his prescription for Metformin even though his member card says that he has uncontrolled diabetes mellitus (2). Richard gets to work right away.

Richard clicks All Care Plans and sees that Charles has a Diabetes Care Plan in place. He clicks the arrow next to the care plan to see what’s been going on.

Charles Green’s member record with All Care Plans selected. The Diabetes Care Plan is open and displays tasks, including Monitor blood glucose levels twice a day and Diabetes self-care plan implemented.

When Richard asks Charles if he’s monitoring his blood glucose levels, Charles says that he isn’t because he doesn’t know how. Richard opens Diabetes self-care plan implemented and discovers that Charles hasn’t received any training, even though it’s listed as a high priority. That’s not good.

The task owner is Harry Friedman. Richard sees that Harry has reached out to Charles three times, but Charles never responded to the requests. Charles explains that he was busy but is ready for his diabetes training now. Richard can see that Harry is on vacation, though, so he needs a backup.

Richard clicks the task to edit it. He changes the task owner to Kiara Shah. Kiara is accepting new members and she’s good at providing diabetes and medication adherence education to reluctant members. She’ll get Charles on the road to wellness.

Richard reassures Charles that Kiara is going to contact him later today to set up a time to start training him in diabetes management. Charles is relieved to hear it. He’s glad that Richard took the extra time to keep him healthy.

Richard thanks him for calling. He’s glad to have made a difference for Charles.

In this module, we’ve learned about the power of Health Cloud for Payers. We’ve seen it in action as Erica and Richard helped their first member of the day. Charles’s question about his claim was promptly answered, and he got help managing his diabetes. A healthier Charles helps Makana Health reduce costs while improving his quality of life. Did you know that Makana means gift in Hawaiian? Today they gave Charles the gift of health.