Voice of a Trusted Care Manager Helps Member Receive Emergency Care

To better help our special needs plan members, Humana’s Care Management Support Assistant (CMSA) team reaches out to members to conduct an annual health risk assessment (HRA). This helps us to understand the member’s current health and assess any social needs they may have.

When a member of the CMSA team reached out to Richard, 64, a Humana Medicare Advantage Dual Eligible Special Needs Plan member, to conduct the HRA, she learned that Richard was having difficulty breathing. Alarmed by this detail, Kayla Roberts, RN, a care manager with the Special Needs Project Health Care Management team immediately stepped in and contacted Richard. As Kayla spoke with Richard, he shared that he also had swelling in the lower body, legs and feet, making it hard for him to move. 

“Richard kept saying that he could not breathe, and his lungs were filling up with water,” said Kayla. “He was adamant about needing oxygen while we were talking.”

While Kayla kept Richard on the phone, her teammate called the local emergency medical services (EMS) to help. She carefully explained how important it was to be seen by a doctor and once EMS arrived, he agreed to go to the emergency department. After testing, Richard was admitted to the hospital for congestive heart failure, a potentially life-threatening condition. 

“While our goal is to keep our members healthy and out of hospital, I was glad Richard received the care he needed before his symptoms worsened,” said Kayla. “When situations like this arise, it can be stressful. But some of our members, like Richard, live alone and do not have in-person support to be able to see their distress and encourage them to seek medical advice. I’m glad that I was able to be a voice of reason and that Richard accepted assistance.”

Humana’s nurse care managers help our members every day in ways that encourage them to take control of their health and to know when to seek help. 

If you’re interested in making a difference in patients’ lives, visit careers.humana.com to learn about open opportunities.

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