Meet Nicole: The care manager who clears hurdles to your health
Receiving a new medical diagnosis can be scary and overwhelming.
As the doctor explains the diagnosis and the medications or treatments that it requires, you might wonder…
How will I get to my treatment?
What foods should I avoid?
How might this impact others in my life?
How much will it cost?
Nicole, a Care Manager Lead at Capital Blue Cross, understands those concerns.
As a former labor and delivery nurse, Nicole sometimes saw non-medical factors prevent the best health outcomes for her patients. Finding solutions to those barriers led her to Capital Blue Cross.
“When I was a nurse, I only saw the patient for a short period of time and could only do so much,” Nicole said. “I learned there are more things that impact your health than just the care that doctors and nurses provide.
“That definitely drove me to Capital Blue Cross,” Nicole added. “I wanted more impact on the entire process.”
How care managers help members
Nicole leads a team of care managers and social workers at Capital. They collaborate with members’ healthcare teams to solve barriers to care – whether it’s helping members understand the diagnosis and treatment plan provided by their doctors, obtain transportation to a doctor’s appointment, or pay the lowest price for medication.
The story of one member shows how Capital’s care management team can assist in lowering costs while working toward the goal of a good health outcome.
Nicole said the member, who was pregnant, needed medication to manage a thyroid condition. Even though the member had health insurance through her employer, she could not afford the cost of medication – about $25 per month – and could not easily travel to the pharmacy where it was filled.
The member decided not to get her medicine. Nicole knew this not only put the member’s health at risk, but also her baby’s.
So Nicole researched alternative options and found that an online discount and price comparison site had the same medication for $1 per month. She then arranged for it to be filled at a pharmacy within walking distance of the member’s home.
The member took the medication, managed her thyroid condition, saved hundreds of dollars, and gave birth to a healthy baby.
How care managers speak your language
Studies show that nearly nine out of 10 adults in the U.S. lack health literacy – or the skills needed to effectively manage their health and healthcare. For that reason, Nicole obtained a health literacy certification and trained her team to speak the members’ language.
Instead of saying “hypertension,” her team uses more relatable terms like “high blood pressure.” By helping members better understand their condition and care, they could improve their chances of staying healthy.
Trying to walk in the members’ shoes has also enabled Capital’s care management team to ask deeper questions and uncover barriers that might prevent doctors from delivering the best care.
“Instead of focusing on the fact that a member was not following their doctor’s guidance, we view it from the perspective of why they’re not following that guidance,” Nicole said. “Is it because they don’t understand something? Is it because they don’t have transportation to an appointment or exam? Is it because they can’t afford their medication?
“Our team really thinks about whole-person care – not just those medical pieces, but also those social pieces that tie really close together.”
Connect with Capital Blue Cross
Capital Blue Cross employs nurses, care managers, dietitians, and other healthcare experts who can provide personalized support for members to make healthy lifestyle changes that improve the quality of their lives. Call 888.545.4512 to talk to a care manager or learn about one of our virtual programs.
This is not medical advice and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. The information provided is meant for a general audience. Capital Blue Cross and its affiliated companies believe this health education resource provides useful information but does not assume any liability associated with its use.