Caitlin Whyte (Host): Welcome to Hally HealthCast the wellness podcast from Hally health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and wellbeing, bringing in expert doctors, therapists, and specialists who offer advice and answer your most pressing questions.

April, of course, is springtime. Warmer days, blooming flowers and, of course, just getting outdoors and active again, many of us for the first time in months. But it's also a time of new starts, like taking advantage of some very healthy perks. You may already be entitled to under your health insurance coverage. So today, we're discussing care coordination and health coaching, two popular health plan benefits that really come in handy this time of year.

Here with us are two experts. Anne Himmell is a registered nurse and specialty care coordinator at Health Alliance in Champaign, Illinois. And Devin Richardson is a licensed clinical social worker and specialty care coordination supervisor for Hally Health in Champaign. Welcome to you both. And thanks for being with us today. Anne, let's begin with you. Given our topic today, it's hard not to notice that both of you have specialty care coordination as part of your job title. So obviously, care coordination is pretty important to Health Alliance, right? So, tell us about care coordination. What is it exactly, and how does it work?

Anne HImmel: Absolutely. Care Coordination is a service that's a free benefit to our health plan members that partners members with a nurse, with social services, pharmacy, and even dietary support to assist them with health goals or challenges with their health conditions that they may be having. The care coordinators work with members to identify their goals, and then develop a plan to help meet them. We address challenges such as understanding the diagnosis, following treatment plans, understanding how to self-manage these conditions, and just guiding members to identify possible solutions to these challenges.

Host: Thank you, Anne. Excellent explanation. So Devin, how would a person like me benefit from working with a member of your care coordination team?

Devin Richardson: Yeah. I think, in general, it is a huge benefit to our members because they can get questions answered about any disease process that they may be associated with. And it kind of helps ease anxiety about who turn to for questions. It's really a great partnership between the member and the care coordinator, but also helping the member partner with their care team a little bit more specifically and better.

We also help members understand their health by understanding what they know, identifying those knowledge gaps, and working to close those gaps. So, a couple of examples of how we might be able to help members, anything from helping members understand, that when they have diabetes and they have an acute illness perhaps their day needs to be a little different and their management plan for their diabetes needs to be a little bit different than it would be when they don't have that acute illness, and also making sure that we are helping members advocate the best that we can to get their needs met when they do meet with their providers.

Host: Well, thank you, Devin. Love to hear those terrific stories. It sure sounds like you have a pretty sharp team over there. Okay, Anne, you both have a mighty convincing case for all that care coordination has to offer. But I'm still curious about the specialty care coordination team that you and Devin are part of. So tell me, please, why would a health plan have a whole team dedicated to supporting members with chronic conditions?

Anne HImmel: We believe, of course, that by supporting members with the health plan in this way, they will feel an overall great improvement in their wellness, but they gain confidence to work with providers. They adhere and are proactive with managing their treatment plans better. We help reduce risk factors. We improve their satisfaction. Our goal is to improve their satisfaction, of course, with the health care they're receiving. Members that have more impactful diagnoses require more specific and expert level of support, and that's where our specialty team has the privilege of supporting members that need this level of support with their diagnosis.

So, our specialty care coordination team works with members with specific disease conditions, and those are conditions like end-stage renal disease and transplantation, oncology, prenatal, infertility treatments. Members that are pediatric in that pediatric population. We have a specific behavioral health care coordination team with tracking and then the holistic Behavioral Health Care Coordination Program, where the focus is not just on managing medical issues, but also those mental health issues together.

Host: Well put, Anne. Thank you so much. That makes it much, much clearer. Now, Devin, we've been talking mostly about the work that care coordinators do. But what about those health coaches? What do they do? And how is it different from care coordinators?

Devin Richardson: Health coaching is different because they really focus in on members that are at the beginning spectrum of any disease processes. And so, they are more likely to impact their diagnosis with lifestyle management. So, they focus on a lot of things like nutrition, exercise, and that impacts diseases like diabetes, hypertension. And the style is very similar to how we partner with people in care coordination, but the areas of focus are a little bit different, and they are more general than something like our specialty care coordination programs.

Host: Great. Thank you, Devin. You made that distinction perfectly distinct. Well, Anne, we are sold. This sure sounds like something we'd like to check out. When we do, what can we expect when we work with care coordinators and health coaches?

Anne HImmel: When a member is outreached and decides to enroll in the program, that member then will have an initial enrollment call with a nurse, care coordinator that's matched with their specific needs, to discuss all sorts of things. Their medical history, medications, their general function at home and barriers that they have. We screen for fall risk. We screen for mental health concerns. We screen for cost savings opportunities as well, partner with pharmacy and just helping them understand emergency management planning and how to best access the right level of care. We again work with them then at that point to develop a plan and then set up a cadence of phone calls to set goals for those calls and then support the member through just guided conversation to help them understand how they can meet those goals with specific types of interventions.

So then in between those, of course, during those calls, we provide education about the just in time needs, those gaps in knowledge that we identify. They might also need resources to help them. We can partner with social services to bring those in. We help brainstorm those ideas. And then, a lot of processing with members just to help them understand how to discuss with their providers, their concerns, and providing them tips as well to help manage and work through these goals on their own.

 This is the more general care coordination, but we also have, again, those specific specialty care coordination areas that really focus on the specific needs for those members in Oncology, Transplant, Mental Health, Fertility, and then pediatric members as well. Our goal, of course, is to help the members become very independent with managing these conditions, and then be able to navigate those barriers and symptoms that come along with the chronic conditions that they have.

Members can expect the care coordination to listen to their concerns, and that's a big one. We hear a lot from our members that they feel heard when they speak with a care coordinator. We help gather information. We really seek to support them and all those barriers they're facing. And the education that we provide is best practice and targeted specifically for their needs. We respect their decision-making autonomy when we're guiding with them, helping them to reduce those risk factors and helping them remain safe in their home. We help them avoid unplanned emerging care needs, events such as falls or medication errors, ED visits, or even hospitalizations if we can to help plug in the needs that they have at the right time with the right level of care.

And then, for successful outcomes with Care Coordination Services, members are encouraged to share all the details of their barriers that they're facing. And then, we set SMART goals with them, helping them understand that the goals that they set need to be realistic and attainable. And that is the key through a process called motivational interviewing. And sometimes that's just meeting the members where they're at with their education needs. Again, a lot of processing of ideas to get started. Encouraging them to speak with their providers about provider recommendations who know the best their health history. And they remain then engaged with care coordination and calls that can be anywhere from weekly or up to every 30 days for about six months to receive that support. And really feel like they move from the feeling of stuck to having more confidence and knowledge with managing their health care.

In care coordination, we can't direct care or diagnose, but we again don't take the place of that provider-patient relationship, but we are a support to that relationship, helping them along their journey.

Host: Wonderful, Anne. Thank you for yet another insightful answer. And that leaves it to you, Devin, to tell us how we go about getting our own care coordinator or health coach. How do we contact your team? And what other kinds of programs do you offer your members?

Devin Richardson: Great question! If anybody is interested in care coordination or even just learning more about it or health coaching, they can always call the number on the back of their Health Alliance member ID card and ask to be transferred to Care Coordination. We have a team of people ready to take your call during normal business hours and we would be glad to talk with you about how we can help.

Also, you can visit hally.com/care, or you can email care.coordination@healthalliance.org and just explain a little bit about what you are looking for as far as care coordination, and we'll reach back out to you to try to set up the process of getting started.

As far as additional benefits go, you can always go again to hally.com/care and see some of them outlined there. But off the top of my head, we also offer virtual visits to many of our members through MDLive. We have a 24/7 nurse advice line for our members that can be a great resource when you're just not quite sure if you need to be seen or not. They can help you triage that.

And then, we also offer a smoking cessation program for those folks that are looking to quit using tobacco products. So, those are just some of the benefits that we offer, many more. And again, hally.com/care is a great starting point to take a look around and see what could be a benefit.

Host: Wow. That's a truly impressive array of benefits, Devin, and a great way to wrap up a wonderfully informative conversation. You both have truly been such outstanding guests. Thank you so much, and Devin for joining us today and for all that you do every day at health Alliance and Hally health to help so many individuals and families throughout our communities.

That concludes today's Hally HealthCast tune in next time as we tackle yet another important topic for your health and wellbeing. And remember Hally Health is your partner in helping you live your healthiest life. Visit Hally.com. That's H-A-L-L-Y.com. For resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.