I was not laid off and feel for those who do. I can only dpeak to the hcm rn role as that is what I am. 10 contacts a day is reasonable and can be done in a normal work day. I take lunches and breaks and use my wellness time consistently. I see a lot of nurses who do everything for their members, and that in itself is the problem. As Case Managers we are to guide members to doing things for themselves. I know there are members who need the extra help, most don't need help with simple things, like making a call to silver sneakers. So many nurses "take over" instead of guiding in this role. Sometimes we make more work for ourselves by not holding our members accountable for their own health. Our job is to educate and encourage, not do for the member when they can do for themselves. Someone once told me that the goal is to educate a member why not to smoke so they can make an informed decision. We have not FAILED if they do continue to smoke. We have to met the member where they are and that gets lost when the Nurse takes over. I do think peer average is crazy though. People need to work 8 hour days and quit doing more. If everyone did this, averages across the board would decrease. We are in this boat because people worked the overtime to met numbers. We only have ourselves to blame. Everyone needs to work diligently for 40 -45 hours a week (standard for general salary employee) and let the cards fall where they may. Nothing is going to stop more layoffs, so take your life back and stop the madness.
21 replies (most recent on top)
So well said! You hit the nail on the head. Maybe that post can be emailed to a higher up to advocate for getting rid of the metrics
I understand the guiding but we need to realize this doesn't work with all people. It is difficult for a generation who has grown up with TV and technology to understand those who didn't. I am not saying all are this way but think about this. The Medicare members who are under 70 often do well in self-reliance, give them the info and they run with it. Realize many of those we serve do not have internet, do not want a computer or a smart phone. Many find just having a flip phone is as far as they want to go. This is a generation who grew up with true service, someone pumped their gasoline, eating out meant a waitress and not standing in a line, attendants in the dressing rooms, etc. When someone wanted to know where something was in a store, a person didn't point to guide them, someone actually took them there or they brought the item to them. When buying clothing, they would go to the racks but an attendant would also bring new items to them. When they needed to be connected on the phone long distance or needed a number, there was a person on the phone who talked to them, found out their needs and actually connected them. They didn't get recordings and given a number. Now they are more elderly and often have problems just dialing a number, they need service more. I think this is where we fail as a nation for our seniors. While I don't want to be told what to do, this generation is often different. It is difficult to have them start to take charge of their life after 85 years being told what to do, some don't want to change. When they were younger people didn't try to be an expert in every field. Some were mechanics, they were the experts in cars, people relied upon them to know what to do with their car and tell them what to do/what they needed. Their doctor was the expert in health, they relied upon the doctor to tell them what to do in order to take care of their health. The plumber was the expert to take care of their complex plumbing needs. People had basic knowledge of things but for the most part, they relied upon people who worked in a particular field to be the expert to tell them what to do just like they were the expert in their field. It wasn't that they didn't want to know, they just wanted someone to take the time to provide great service. I think this is where the conflict comes in a business where there isn't a product being produced but rather a service. The attitude of guiding someone is correct but so is the attitude of providing totally service, it depends upon the age group you are serving. Each person is correct depending upon who they are servicing.
My team was moved from HCCP PHC to enrolling members as an RS for other departments for "as long as needed". Nothing says motivation to get out like job hunting while strapped to my desk on auto dialer
Not ICT, ICP. ICP means "individualized Care Plan."
You must be with SNP. my department doesn't do ICT.
The policy exceeds NCQA guidelines, but we are still responsible for following written P&P.
The policy reads "The care manager schedules follow-up contact with member to review and update the care plan. ICPs are created, reviewed, and updated at a minimum with each successful member contact according to the level of intervention." That means it is not a successful contact if you don't update the CP. If you don't believe me, email the project manager and ask her.
Per NCQA, cps only need to be addressed monthly. Of course it is preferable to do every contact but it is not required by NCQA.
Coaches do what they want, always have. I have never understood how the company can be okay with flex time, but the coach is not. Who works for who? Used to be the leadership would say we have 12 hours to do a 8 hour job. Now, if we need to pee, we need permission to get up from our desk. It's crazy. And what's worse is that the people that could make changes don't care.
Love this post
I see the numbers
I also agree with others who replied. If you coach is asking more or you than the HAH metric. Bring it to leadership if that is not satisfactory to you copy thier leadership and HR4U.
Some teams have 95% of rosters with no red other teams have 95% of rosters with alot of red.
This tells me that the metrics are fair. Perhaps the training or the motivation or the coach is the fault or perhaps it is work habits. If you let people do as they wish with little / no guidance then you apply restrains to that it is very uncomfortable.
To the person saying care plans are only for MOC, you're wrong. You need to read the policy. The policy clearly states that care plans are addressed at every successful contact.
One comment at the bottom of this thread states that the new daily goals don't allow for flexing time like we used to. My team has been told no more flex time. So even though we are salaried and may only miss a short amount of work on a certain day, we have been told we must take PTO now. Even though most other days we all work well over 8 hrs, with 10 being average. So even though we used to work late some days to make up that time, our team doesn't allow flex anymore. So I need to take PTO for check ups. This is most likely to force me to use up all my PTO so when I am laid off they don't have to pay it all out. No more MD appts for me since my doctor only works "banker hours." So much for the Wellbeing we were promised. I can't take my lunch break and my wellbeing at the same time anymore to accommodate these appts. Has anyone else been told no more flexing? I guess it depends on the coaches. I didn't realize other team's had coaches that demand more than the Humana metrics either.
Very interesting responses, I agree that a lot of Nurses spend to much time with members holding their hands, I also agree that some teams are not doing as much as others. No one has mentioned how bad some of the care plans coming across my desk are, honestly 🙄
Problem it seems is the differences in teams. Some coaches have weekly goal, some want daily. The person who says goal of 13 + contacts is following a coach goal, not that of Humana at home. HAH is going by peer average. The coach demanding 13 contacts a day is the ones who are causing the averages to go higher and higher and that team should be pushing back. As far as what constitutes a contact, there is policy on file and email came out several months ago with additional information. If you get medical information, it is a contact, regardless of care plan. You do not have to go by having a care plan to get a contact but you need to ensure that care plan is addressed per Moc. Sometimes that means you have to follow upwith the member again in a few days. That is the policy is for HAH. If you are being told differently, address with your coach, look up the info in sharepoint where your coach can not refute it, and follow the policy. Seems like these coaches making up their own rules is the major issue!
Exactly! Cheating the system. Well said! When I started their was a team calling our members specifically and only for wellcheck ivrs..and they got a successful call without checking on the member. We cant get calls when other coaches are taking our members.
Those of you still there haven't got your NEW metrics yet. One team is on 13 PLUS a day, 24 call attempts, 7 successful ivr a weekmnot rejectedt ivr, 3.2 talk times (for some it is a challenge), etc. They want to see that PLUS so you can make your coach #1 amongst leaders. Yes, 10 is fine if you dont have a hectic day. Some warm transfers are like talking to a brick wall and dumber than a box of rocks. Not to mention the next round of layoffs in April. Bite that tongue now anonymous typer. You could be next. Did you see the change in execs? Out with the high paid and in with the new..people are pulling shared profits and cashing out. Humana is in a pickle. People are searching jobs and scared. They are taking the joy out of the company job. A job shouldnt be this stressful. I loved my job. Do I see why I was in downloadbesttorrentblog.ru round? NO. I exceeded humana goal and team. Bad luck. Did you see cobra prices? $1441 for a family monthly..ma month! I have a disabled child. The land of opportunities is not at humana.
I always and still do just do not believe in the whole concept of metrics and numbers and the competition to make more contacts than the next HCMRN or the next team. Its ridiculous and meaningless. Like others have noted, metrics can be made high when its a call that really isn't about much, or metrics can be low because an HCMRN had to do extra things for a needy mbr ( one who is not capable of doing it on their own) ...And the concept brings out the competitive spirit in those who like to be best most fastest, and as we know the RN field is full of highly competitive people. Which then jacks up the averages. I am not saying the best most fastest HCMs should slow down or change, I just believe the WHOLE concept of the competitive numbers game is not valid when it comes to talking to people as care managers. Sure, make sure we make a reasonable minimum, but comparing one to ones peers, it is discouraging and meaningless regarding quality.
The problem is with daily goals. It does not allow for flexing like we used to be able to do. So if I have an md appt that last 2 hours, I need to work late the same day. We used to be able to flex anytime in the week.
Part of the problem is that exempt employee status....there is no overtime, the hours don't matter, and if it takes longer to do the job, it takes longer, with no compensation. I think that higher ups should listen to what the average person can do in an 8 hour day, and base things on that, and make allowances if there are meetings or trainings....we are told on my team to try to do more on other days to make up for those times...it's a no win situation
I work in the PHC role and I also agree that ten contacts a day is successful on most days. I agree that leadership can have an unrealistic expectation in relation to this number because of team members who do not take break, complete trainings in evenings after work or on weekends. I understand the immense stress to appear exceptional particularly while layoffs are ongoing but this does not help us as a whole. Leadership needs to have a clear understanding of our ability to meet goals while completing trainings and navigating system issues.
Yes, consistency has been and is an issue
The biggest problem with the metrics is they don't mean anything. With some coaches telling their teams they don't have to do the care plan on every successfull call and to do follow up calls to pad their numbers, well those teams have really high metrics. Which skews the numbers for the rest of us who actually follow the policy. We struggle to meet 10, because of teams that make 12 every day cheating the system so that they can be on top.
Just my opinion, I agree that 10 contacts in a day of working smart and staying on task is completely within reason, but no time is allowed within that work day for mandatory CBT's and dealing with other issuers, CICO's for example--- then you have half your "peers" working 12 hours because they want to--- peer average is going to 11 on my team, I cannot always achieve that, and if I need to call a post discharge member back for an urgent issue, no credit for that--- maybe I am keeping them from going to ER, but no "credit". This is not the position I signed on for, and somebody is not seeing the big picture. It's all metrics and fear of being next!