by Carol Morrison, RN, BSN and
Deb Liptak, RN, HNE Health Services Team Leaders

HNE employs nine Registered Nurses, dedicated to providing case management services to our members.  Each of these case managers is assigned to providers in a specific region of HNE's Service area (or, for some HNE products, to specific employer groups).  This allows one case manager to follow a member throughout the entire continuum of care.  Since each case manager is responsible for coordinating all of the components of a member's care, the member and the provider have one direct contact at HNE for medical concerns.

We designed the HNE Case Management Model to ensure the continuity of care for all members across the healthcare continuum.  HNE employs a multi-disciplinary team approach that includes care management, behavioral health, pharmacy and disease management professionals.

HNE also takes an innovative approach to the management of high-risk/high-cost cases using a proprietary predictive modeling software application.  This system allows us to identify prospectively high-risk populations and provide outreach services in order to effectively manage the condition and prevent future complications.  Members are also referred for case management by provider referral, as well as through an identification process that is part of our disease management and case management programs.

What is Case Management?
Case management is a collaborative process through which the case manager and the care team assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health care needs.  This process relies upon communication and identification of available resources to promote quality, cost-effective outcomes.

A wide variety of members benefit from case management, including individuals in the acute phase of illness or with a chronic condition. The best way for the process to work is through early referral to case management, which will decrease fragmentation of care, enhance quality and improve cost containment.

How Can We Help?
HNE's case managers are available to:

• Act as a link among the member, the providers, the community and HNE.
• Assist members in achieving an optimal level of wellness and function by facilitating timely and appropriate health services.
• Assist members to self direct care appropriately, self advocate and make decisions to the degree possible.
• Ensure that services are generated in a timely and cost effective manner.
• Maximize efficiency in utilization of available resources.

Know of a specific HNE member who might benefit from case management?  Please call HNE Health Services, 413-787-4000 ext. 5027.