Health Break: What is a care manager and how can they help me?

Camille: Welcome to Health Break by UPMC Health Plan, your quick guide to health, wellness, and how to make the most of your health insurance plan. I’m your host, Dr. Camille Clarke-Smith. I help to oversee the quality of the plans and programs we offer at UPMC Health Plan.

Angelo: And I’m your co-host, Angelo Bartic. I’m a health coach who works with our members on making healthy lifestyle habits and setting goals. This is your…Health Break.

Hey, it’s Angelo Bartic. We’re joined today by Mandi Batykefer to learn more about the care managers at UPMC Health Plan and what they do to support members. Mandi, thank you so much for spending some time with us today.

Mandi: Thank you for having me. I’m so glad to be here.

Angelo: We’re excited to have you. Can you tell us a little bit about, what is a care manager?

Mandi: A care manager is a health care professional that works to support members in meeting their health care goals and effectively navigate the health care system. One of the ways that we’re able to engage with our members is through Prescription for Wellness. Prescription for Wellness is a physician-prescribed health coaching program. Providers can write a prescription for their patients to speak with a health coach like you, Angelo, for a variety of reasons such as diabetes management, hypertension, weight management, and stress management. We really see this as a prescription, just like they would write a prescription for a medication or for physical therapy. After engagement, the care manager is also able to provide feedback to the provider. Members can also self-refer to care management if they find themselves needing some additional support.

Angelo: So who are care managers, and tell me a little bit about the background that they have.

Mandi: Sure. So care managers are typically nurses or social workers. We come from a variety of backgrounds. Many of us have had extensive clinical experience in the hospitals, home care, nursing homes, and also in physician offices.

Angelo: Mandi, you’ve done a great job of telling us what care managers are and who they are. Can you tell me a little bit about what they help with?

Mandi: We can help with a lot of different things. We can help to provide care coordination such as locating providers, getting connected with appropriate providers and services, scheduling appointments, medication management, including referrals to our health plan pharmacists and medication prior authorizations. We also educate about disease processes and disease prevention, as well as suggested lifestyle changes such as diet, exercise, and stress management. We help to facilitate provider communication. For example, many members are not able to see their doctors in a timely manner, and care managers can help to bridge that gap by identifying concerns early on that may negatively impact a member. This can assist with minimizing trips to the emergency room and even hospital admissions. We also helped to remove certain barriers for members such as transportation needs, medication costs, and food insecurity.

Angelo: It sounds like care managers can bring a lot of value to our members. Can you give any examples on how you personally have helped our members?

Mandi: Overall, we really help them to make sense of difficult and challenging situations. When members and their families are catapulted into the health care system due to catastrophic illness or diagnosis, such as cancer or other life-changing event, the members often feeling overwhelmed and unable to articulate what questions they have to ask providers. So care managers can help members to verbalize their fears, concerns, and transform medical terminology into easily understood concepts so members can make the most informed decisions that could potentially impact the rest of their lives.

Angelo: Mandi, thank you so much for taking a Health Break with us, talking about care managers and most importantly, what they do to support our members.

Mandi: Thank you for having me.

Angelo: Find show notes and more information at upmchealthplan.com/podcast. Join us as we continue exploring health, wellness, and how to make the most of your health insurance plan in the next episode of Health Break.

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their personal care provider. Views and opinions expressed by the hosts and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.