GRIPA Care management provides many services, each customized according to the needs of the person yet all with a focus on improving the health of a community as part of a health care team that includes the primary care physician, specialist, and hospital.
Medications are an important part of treatment for many conditions. Some people are unable to get the benefit from medications because they are too expensive, side effects are too great, it’s hard to remember to take them, or they simply don’t understand the best way to use medications. GRIPA care managers work with doctors and you to overcome these challenges, as the following stories demonstrate.
A Child Can Breathe a little Easier
This employee’s daughter has asthma and was admitted to the hospital for asthma exacerbation. The employee contacted GRIPA Care Management Services as she was having difficulty paying for her daughter’s asthma medications, and the hospitalization was largely due to her daughter not consistently taking one of her medications. The GRIPA Care Manager/Pharmacist sent the employee several resources/coupons for reduced copayments on the medications. The Care Manager/Pharmacist also worked directly with the daughter’s physician to change one of her medications to a very similar and appropriate medication that was eligible for discounted copayments. After receiving this assistance, the employee is able to better provide for her daughter’s medication needs.
Finding the Right Medications
A GRIPA Care Manager reached out to this employee regarding management of their chronic condition. The Care Manager, who is a pharmacist, noticed that the employee utilized several medications to manage the condition and was experiencing some unpleasant side effects. The employee indicated that these side effects were interfering with their work. The Care Manager was able to suggest an alternate medication that would have a similar outcome but would not have the same side effect. After working with the employee’s PCP to change the medication, the employee indicated that they felt much better and was able to concentrate more at work. The Care Manager also encouraged the employee to follow up with their PCP regarding another concern with the chronic condition.
When Half is More
This employee contacted GRIPA regarding saving money on prescription medication costs. The GRIPA Care Manager was able to direct them toward copayment coupons for a brand name medication that does not have an equivalent generic. The Care Manager also learned that they were not taking the prescribed dosage of a certain medication as they did not have a good way to cut pills in half. The GRIPA Care Manager provided the member with a pill cutter and followed up to ensure that the proper dosage is now being taken.
Going to the hospital can be an overwhelming experience and one that often leaves substantial lifestyle changes in its wake. But making change is hard. GRIPA care managers follow closely the discharges from the hospital and emergency room to offer assistance and guidance when needed, as these stories illustrate.
With Many Happy (Paper) Returns
This employee was recently discharged from an inpatient stay for an acute condition. After discharge, the employee complied with all outpatient treatments and requested that her Primary Care Physician (PCP) would recommend a return to work. The PCP could not make that recommendation as he did not have all of the paperwork from the outpatient treatments. A GRIPA Care Management Services Social Worker stepped in to advocate for the patient and facilitate the necessary paperwork. The interaction with the GRIPA Social Worker increased the communication between the employee and the PCP which allowed the employee to return to work more quickly.
Making Healthy Changes
GRIPA contacted this employee following an inpatient hospital stay. A GRIPA Care Manager who is a pharmacist helped the member understand the medications that had been given while in the hospital as well as the medications that needed to be continued after discharge. The Care Manager also discussed the importance of a structured exercise program and how it impacts the employee’s chronic condition. In working with the employee, the Care Manager learned of the employee’s desire to quit smoking, and they discussed the benefits of smoking cessation medications. As of the most recent follow up, the employee is smoke free.
Part of enjoying good health is finding a balance between stress and relaxation, between disease and management, between work and home. GRIPA care managers understand the larger context of health as illustrated by these stories:
Getting Help In a Stressful Situation
A GRIPA Care Manager who is a Social Worker was contacted by this employee about conflict and stress in a relationship in which they are involved. The discussion led to the agreement that the employee would benefit from therapy, and the Care Manager gave a few provider options. The employee has been receiving therapy from one of the recommended providers, and the GRIPA Care Manager continues to check in with the member periodically to monitor their progress.
Better Understanding Leads to Positive Health Benefits
About a year ago, a GRIPA Care Manager reached out to this employee regarding an overdue lab test relating to their chronic condition. The Care Manager helped the employee understand how their current medications affect the condition and discussed strategies with diet and exercise that would also help manage the condition. This interaction formed the base for a trusting relationship. Over the past several months, the same Care Manager has assisted the employee with a few other medical issues and has been a positive resource when the employee has health related questions.
Taking Control of Diabetes
This employee contacted GRIPA Care Management Services regarding the management of her diabetes. The Certified Diabetes Educator/Care Manager from GRIPA met with the employee several times – both face to face and over the phone. After discussing the importance of nutrition, physical activity, and healthy lifestyle, the employee felt empowered to begin managing her diabetes. She concentrated on small, attainable steps to lead to diabetes control and to enhance her feeling of success. The GRIPA Certified Diabetes Educator collaborated with the employee’s physician to optimize the pharmacological treatment of her diabetes. After working with the GRIPA Care Manager for three months, the employee’s blood sugar level decreased from 8.8 (uncontrolled) to 6.5 (controlled).
In today’s healthcare environment, communication is essential for good health, especially among healthcare providers. GRIPA care management actively works to re-connect patients and their doctors, sometimes advocating, sometimes educating, but always with the goal of improving care, as these stories show:
Finding a Doctor
This employee contacted GRIPA Care Management because she was looking for a new primary care physician and needed an appointment immediately. The GRIPA Care Manager arranged for the employee to see a new primary care physician in the GRIPA network the next day. The GRIPA Care Manager facilitated having the employee’s medical records transferred to the GRIPA physician from her previous physician who was not a part of the GRIPA network. The previous physician personally called GRIPA enthused that the employee was seeking regular medical care as she had not done so in the past. The GRIPA Care Manager explained to the previous physician about the GRIPA Clinical Integration Program and how the employer was working to keep its employees healthy. The previous physician was very impressed with the program and its effectiveness to get the employee to seek regular care.
Getting Good Follow Up Care
This employee had a specialized procedure many years ago, but had not seen a physician concentrating in that area in several years. The employee asked the GRIPA Care Manager for a recommendation of a specialist in that area. After providing the physician information, the GRIPA Care Manager followed up with the employee two months later and learned that they had not yet made an appointment. At the most recent follow up, the Care Manager learned that the employee saw the recommended specialist and is doing well.
This employee reached out to GRIPA Care Management for advice and support in maneuvering the healthcare system while researching a certain type of medical equipment. In addition to education on options and costs, the Care Manager provided guidance in finding the most appropriate specialist to work with this situation. With support from the GRIPA Care Manager and the employee’s physician, the employee was able to make an educated decision and receive the needed equipment.
Preventing a disease or condition, or stopping it from progressing is much better than treating the consequences later. GRIPA care managers work hard to impress the value of preventive care and good monitoring so health can be enjoyed long past the golden years, as these stories show:
An Ounce of Prevention
This employee has elevated blood pressure and possibly elevated blood sugar levels. A GRIPA Care Manager asked to send a consult letter to their Primary Care Physician regarding these issues, and the employee agreed. Subsequent lab work showed the employee is a pre-diabetic. The Care Manager introduced the member to the GRIPA Care Management program and discussed diet and exercise with them. In a follow up call to the employee, they stated that they are starting to exercise regularly and will be meeting with a dietician to more fully understand the role of nutrition in pre-diabetes. The GRIPA Care Manager encouraged the employee to participate in the American Heart Association Start! Heart Walk for additional benefits.
Putting the Squeeze on Blood Pressure
The Employers Health Office referred an employee with uncontrolled high blood pressure to GRIPA Care Management Services. The GRIPA Care Manager/Pharmacist spoke with the employee, discussed his medications, the best way to monitor his blood pressure, and involved a GRIPA Care Manager/Nurse. The Nurse met with the employee at the Employers Health Office during the employee’s lunch break and discussed lifestyle changes such as diet and exercise. Two weeks later, the employee had avoided high sodium foods, fried foods, and had exercised regularly. His blood pressure was under control without the need for additional medication.
This employee with past high cholesterol levels was contacted by GRIPA Care Management as their last LDL (“bad cholesterol”) level was higher than goal level, and the employee was overdue for a check of their cholesterol levels. The GRIPA Care Manager contacted the employee with information about cholesterol and a reminder to contact their physician for a lab slip. The Care Manager followed up with the employee a few weeks later to ensure that the lab work had been completed.