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The difference you can make when you're all for health.

A simple solution for complicated care

At 74, Rosella's health care needs are complicated.

Until recently, she had a hard time managing them all. She is borderline diabetic and needs a kidney transplant. And she struggles with back pain and keeping track of her medication.

But life got easier when Highmark stepped in with a solution.

Highmark connected Rosella with a nurse care manager through its Enhanced Community Care Management (ECCM) program. Now Rosella talks with her Highmark nurse every day and follows her advice. She feels better and is self-sufficient.

Rosella is Living Proof that even complicated health problems don't have to get in the way of independence.

A personal care advocate

Highmark set up that first meeting between Rosella and Gina, her nurse care manager. Gina is part of a team of special nurses dedicated to helping members with complicated health issues. They have an office right in the doctor's office so Rosella can see them both in one visit. Nurse care managers serve as a bridge between Highmark and doctors.

Gina and Rosella's doctor worked together to develop her customized care plan. Rosella had many interconnected health issues. She also needed coaching to help her learn how to take better care of herself.

Their first priority was to convince Rosella of the urgent need for kidney dialysis. She didn't understand how kidney failure affected her body. And that the dialysis would make her feel better.

"The doctor and I talked to Rosella, explained each step and process, and related it back to her health," said Gina.

After Rosella got to know — and trust — Gina, she finally agreed to the treatments. And their relationship grew beyond tests and procedures.

"I know all about her husband and her grandkids," said Gina. "We made a personal connection. She's like my Grandma. She's such a sweetheart."

Because Gina is there for Rosella, Rosella feels more confident about managing her own health. And she is enjoying life again.

Making complicated care easier

Nurse care managers like Gina help coordinate a member's health needs, including pulling in teams of different specialists on her behalf. They also help members become more involved in their own care.

Gina saw Rosella struggling with a variety of issues and knew exactly how to help. She coordinated Rosella's kidney dialysis treatments and set up appointments with a neurosurgeon and a pain specialist.

With Gina around to answer questions and schedule appointments, Rosella finds it easier to follow her doctor's advice. Without assistance, she missed doses of her medication and struggled with pain.

Gina even visits Rosella in her home. And Rosella knows who to call when she has a question about her medicine or needs a ride to see a doctor. Because Gina helps her keep track of her health care routine, Rosella feels better and can stay independent.

"We discuss where she needs to go, what she needs to eat, and what concerns she might have," said Gina.

This whole-health approach to coaching has helped Rosella see positive results. She's been able stay on a healthy path and avoid trips to the emergency room. Plus, she's able to do things she couldn't do before. She can prepare meals for her family and be more involved in her grandkids' lives.

Ongoing health management

Enhanced Community Care Management (ECCM) is part of Highmark's initiative to help make care more manageable for members with complicated health conditions. The program matches eligible members with personal nurse care managers who make sure they get the right treatments at the right time and place. And make it so that the treatments are easy to access and afford.

Because nurse care managers become familiar with a member's medical needs and health issues, they are a knowledgeable, personal resource for advice and answers. Members who follow their doctors' care plans are able to keep their health more stable. And they cut down on emergency room and hospital visits. This also saves them time and money.

ECCM nurse care managers monitor members' progress to make sure they are following their care plans. They take note of upcoming appointments and medications that are due. They also watch for any changes in their conditions.

"I see in my database that Rosella is due for a flu shot, so I call her and get it scheduled," said Gina. "It's about preventing the problems before they happen."

Members enrolled in the ECCM program represent about 5% of the total population. But they use as much as 50% of the health care resources. These members also have a 70% chance of going into the hospital within 6 months. The chances are much less if a health care professional takes action.

ECCM results show that when members get connected with a nurse care manager, their likelihood of going back to the hospital lessens immediately.

And nurse care managers feel good about the difference they make in people's lives.

"It's definitely a challenge," said Gina. "But I want my patients to know that I'm more than a nurse in the office. I'm someone who actually cares about you."

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