Medical Management

Feb 25th, 2013 | by CareSource

Taking a week to recognize a team is a CareSource tradition. During those five days, we get to learn more about the department and the impact they have on our employees and our members. This week (Feb. 25 – March 1), our focus is on the Medical Management team. The theme for this year’s celebration is simple, yet powerful: “Making a Difference”.

In 2012, our Medical Management team answered over 120,000 calls from providers. On average, they responded to these calls in less than one minute. Think about that. When was the last time you were calling a company for information and had your call answered in less than 60 seconds? For that matter, when was the last time your friends, family or spouse picked up the phone that quickly?

Another major way this team impacts CareSource is their review of medical resources. The team focuses on recommendations made by the providers and the overall impact it will have on our members. Think your to-do list is long? On a typical daily basis, nearly 1,000 requests of various concerns are submitted to the department.  Wow. Processing and answering those requests in a timely manner is certainly a way of making a difference.

As a part of our festivities, the team is kicking off their week by sharing the ways they are making a difference.

This is one of the many ways we demonstrate the “CareSource culture.” Keep up the great work!

 

Finding Treatment

Jan 21st, 2013 | by CareSource

By Jennifer Dozer, Behavioral Health Patient Care Coordinator, CareSource

Finding treatment for a child or adolescent with mental health issues can sometimes be a challenge. The good news is that with proper treatment and support to their families, most children can do well.

If you have a concern about your child’s mental well-being, start with your child’s primary care doctor. This could be either a family practitioner, a doctor who manages the care for children and adults, or a pediatrician. A pediatrician is a primary care doctor who specializes in medicine for children and adolescents only.  If you have a concern about your child’s behavior, your child’s primary care doctor will be able to determine if that behavior is expected for a child in his or her developmental stage, or if that behavior is concerning. (What are some normal developmental milestones? Click here. Could there be a more serious issue going on? Try here.)

If the behavior needs more follow-up, the primary care doctor can then refer your child to a child and adolescent psychiatrist or a counselor who specializes in working with children.  Unsure which behaviors to worry about and which will require more help? You can look up a comprehensive list, according to behavior, on Kidshealth.org. If there is a serious issue, the sooner you find treatment, the better for your child in the long run.

It is true that there is a shortage of child and adolescent psychiatrists throughout the country. If you live in a larger city, you may have a shorter wait time before your child can see a specialist. If you live in a rural county, you may have to travel to a larger city, or wait several months before seeing a psychiatrist. If this is the case, and you feel your child needs assistance sooner, the Ohio Department of Mental Health has helped to create the Pediatric Psychiatry Network. Your child’s primary care doctor may call them at 1-877-PSY-OHIO 24 hours a day, 7 days a week, to consult with a psychiatrist who specializes in children. Please note that this number is only for your doctor to use.

If your child is referred to a psychiatrist or therapist, please know that CareSource has a large network of participating providers. If you would like a list of participating providers, you may call Member Services at 1-800-488-0134 (TTY for the hearing impaired: 1-800-750-0750 or 711), or look up a list online at the CareSource website. Along with psychiatry and therapy visits, CareSource offers benefits for medically necessary inpatient psychiatric hospitalization and inpatient detoxification from substances. Partial hospitalization programs and intensive outpatient programs in a general hospital outpatient setting may be a covered benefit, although a prior authorization would be required.

CareSource.com – Designed by Members

Nov 28th, 2012 | by CareSource

We recently redesigned our website, CareSource.com, to assist people with real-world advice on staying healthy and living well. The website was designed with feedback from our members.

It’s important for us to create an excellent consumer experience at every touch point we have with our members. That’s why our new website was designed with input from our members all the way through the development process.

The new CareSource.com has been optimized for mobile devices – now everything you can do on a computer can be done on a smartphone or tablet device. There are no logins or passwords to remember. It’s your one-stop shop for:

• Healthy living advice
• Tips on reducing stress
• Coupons
• Simple, healthy recipes
• Nutrition advice
• Exercise tips
• Family fun activities
• Understanding your health care
• Ordering an ID card
• Finding CareSource in the community

 

When you get a moment, let us know what you think by emailing our web specialist, Trica Sloan. We appreciate your feedback.

 

A Dream Come True

Jul 17th, 2012 | by CareSource

By Jim Gartner, Vice President of Pharmacy

CareSource recently announced the start of our new Medication Therapy Management program. This program is geared towards helping our members understand their medications better and to help make sure the medications they are taking can be taken together and safely. This program will be available from our local pharmacists who are there to help.  In many cases a pharmacist will reach out to our members and ask if they are interested in learning more about their medications. They are asking because they want to help. Did you know pharmacists are one of the most trusted professions? 

I have been a pharmacist almost 30 years and have truly enjoyed the profession. I have had the opportunity to work in the retail setting many years in Ohio and equal amount of years in the managed care setting, mainly in Minnesota. During my years in retail, I also had the opportunity to work in the nursing home setting where I acted as a medication reviewer for the patients in the nursing home.  It became clear to me that many people were in the nursing home mainly to monitor their medications because they did not have the support at home.

At the same time, I was completing my MBA and had to write a paper in one of my health care administration classes. In 1996, I wrote a paper entitled “Pharmaceutical Care Management Offered to Passport Members Can Keep People at Home.“ This paper talked about the importance of a pharmacist reviewing people’s medications and if that happened, it could keep people in their own homes. It became clear to me that the pharmacist truly needed to do the same thing in the retail setting. I began to dream that one day this would come to fruition.

About a year and half ago, I was approached about a job at CareSource to lead the pharmacy efforts. It required a major change for our family and a move back to Ohio. Somehow I knew it was the right thing to do, little did I know that CareSource was a place that I could bring my dream to life.  

As an organization that lives the mission of “making a difference in the lives of the underserved by improving their health care,” the fact of improving our member’s medication regimens resonated. Working with our partner in this initiative, Outcomes®, our intention is that our members have safer, more efficient treatments with medication and that we reduce the amount of emergency room visits, physician office visits and adverse reactions because of improper medications. This is a win-win for all – CareSource, our members and the pharmacist community who will help make a difference. 

And on a personal note, if you see the smile on my face, it’s because it brings me great joy to know that I was able to help drive this initiative and realize one of my dreams that I have had for quite a long time.

For more information about Medication Therapy Management email questions@caresource.com.

Training, Coaching and Guiding

Feb 23rd, 2012 | by CareSource

We are honored to be recognized for a third year in a row as one of Training magazine’s Top 125 companies that excel at staff development and training.

Listed at #14 on the Top 125 list, we join the ranks of some of the nation’s largest and most successful organizations including Farmers Insurance, the United States Navy and Coldwell Banker. The past two years, we have been ranked in the top 15.

“We are honored and extremely excited to be recognized again,” said Pamela Morris, President and CEO. “This is a testament to our exceptional training and development programs that continue to evolve and grow.”

With choices from more than 500 curriculum offerings, CareSource University provides career planning and development resources to all employees, including clinical licensure programs, new employee training, leadership and career development and coaching.

“Our organization is unique in that we place a high emphasis on learning and career development,” stated Jackie Smith, Vice President of CareSource University. “I believe successful organizations, like CareSource, realize the importance of training their employees as well as offering ongoing coaching and development programs. I am honored to be a part of an organization that places such a high value on employee development.”     

Two CareSource employees know the the importance of ongoing training and development firsthand.

“Over the years I have had the privilege of working for several large Fortune 500 companies, but none of them had a training program as relevant and accessible as CareSource’s,” Mark Quick, Business Analyst, stated.

“I am grateful for the opportunities I have been given to learn and grow,” said Heather Boehmer, Grievance and Appeals Specialist. “The skills I have gained through the development classes have not only helped me earn a promotion and grow professionally, but have led me to take a far more active role in my own destiny.”

 Training magazine selects 125 global and national organizations annually that exhibit best training practices, evaluation methods and outstanding training initiatives. Honorees range in size from Fortune 500 companies to smaller organizations of 100 plus employees. Judging is based upon elements such as scope of development programs, financial investment in employee development, and how closely training efforts are linked to business goals and objectives.

“We are honored to be recognized again and to be in the same category with nationally known organizations,” Smith added. “We look forward to continuing to train our employees in a way that is innovative, personalized and immediately applicable to our organizational objectives.”

It’s Good to Be On Top

Jan 30th, 2012 | by CareSource

We are honored to be named 1 of 60 organizations on the Dayton Daily News’ Top Work Places list. We placed #8 out of 10 in the large business category.

This is a testament to all of our employees not just in the Dayton office, but in Columbus, Cleveland and Lansing, Michigan. It reminds us of the outstanding culture and professional environment we have cultivated. 

Join our team. We are hiring! View our jobs and apply online.

Top 10: Large Business Category  

1. Coldwell Banker Heritage Realtors 
2. MacAulay-Brown Inc.
3. The Hospice of Dayton Inc.
4. Miami Valley Career Technology Center
5. Gem City Homecare
6. St. Leonard
7. Hillsboro City Schools
8. CareSource
9. Comfort Keepers Miami Valley
10. Dayton Children’s Medical Center

Can It Happen to Your Baby?

Jan 19th, 2012 | by CareSource

Guest post by Jessica Bertolo, Credentialing

While most birth defects cannot be prevented because their causes are not known, women can take a number of steps before and during pregnancy to reduce their risk. These steps include taking a multivitamin containing 400 micrograms of folic acid daily starting before pregnancy and in early pregnancy. This helps to prevent serious birth defects of the brain and spinal cord, including spina bifida, and may also help prevent heart defects. Another step is getting a pre-pregnancy check-up and making sure that the medications you are taking are safe to use during pregnancy.

The March of Dimes is a great resource to pregnant women, especially those at risk for birth defects.

Since the late 1950’s, The March of Dimes has developed and promoted numerous initiatives to advance this field as part of their mission to improve the health of babies by preventing birth defects, premature birth and infant mortality. March of Dimes also awards research grants aimed at understanding the causes of birth defects and advocacy priorities focus on authorization and funding for birth defects surveillance, research and prevention at the federal and state level.

Many families walk and raise dollars to support the work that the March of Dimes conducts targeting birth defects. The Cornell Family of Dayton reached out to the March of Dimes following the birth of their son, Carter, in January, 2011. At twenty, parents Blair and Kat found out that their new baby would be a boy. That same day, they also received news that their baby appeared to have multiple birth defects. After additional testing, it was confirmed that their baby would be born with clubbed feet and that his brain had multiple signs of developmental abnormalities. Eventually, their baby was diagnosed with a birth defect called Dandy-Walker Malformation, a brain malformation that occurs during embryonic development and leads to abnormally high pressure within the skull and swelling of the head that can lead to neurological impairment. Doctors prepared Blair and Kat for a baby with moderate to severe physical and/or mental disabilities in the event he would even survive. With these brain abnormalities it was highly likely that their baby would also be born preterm creating additional health concerns.

Carter Thompson Cornell was born full term, just one week before his due date, miraculously eating and breathing on his own. He had a shunt placed to drain excess fluid off of his brain when he was just six days old. Over the past year, Carter has had many medical appointments as his team of doctors attempt to diagnose and meet his medical needs. He is currently undergoing treatment for his clubbed feet and is receiving occupational and physical therapy on a regular basis. Although, Carter is developmentally delayed he is gaining strength and making continual progress. In his spare time, Carter loves to laugh and play with his big sister Caitlin. He recently reached his one year goal of sitting up on his own. He is one special boy! 

In 2011, employees and clients of UBS Financial Services, Inc., Blair’s employer, raised $10,000 to support the March of Dimes work to fight birth defects. This April, the Cornell Family along with the UBS

Financial Services Team will once again be walking at the Miami Valley March for Babies. For more information on the Dayton March of Dimes chapter, log on to  http://www.marchofdimes.com/ohio.

What You Think Matters

Jan 11th, 2012 | by CareSource

If you are a CareSource member, join our new iConnect program and share your ideas with us. Your point of view helps us design medical benefits, customer service and wellness programs. iConnect will let you choose how you want to communicate with us. You can text or email us or join us on Facebook and Twitter.

We’ll also give you the chance to come to face-to-face meetings. Some members will be picked
to join our CareSource ambassador program.

This is your time to be heard. To join, call (888) 882-3613, email iConnect@CareSource.com or fill out our web form at www.caresource.com/iconnect. As a thank you, we will send you an iConnect t-shirt.

Now’s your time to be heard.

CareSource Named Healthiest Employer

Jul 8th, 2011 | by CareSource

CareSource was named one of Dayton Business Journal’s first ever Top 10 Healthiest Employers. The awards are given to Dayton-based organizations that incorporate wellness programming in the areas of culture and leadership commitment, foundational components, strategic planning, communication and marketing, and programming and interventions.

The Healthiest Employer program participants were scored after completing an online assessment that measures wellness programming in six key categories.

Over five years ago, our passion for health and wellness led to the creation of our official employee wellness program. The mission of our Employees First wellness program is to establish, encourage and maintain a culture of health and well-being that promotes healthy lifestyles through education, environment and policies to support employee efforts.

 The Top 10 winners are:

• Brower Insurance Agency 
• CareSource
• City of Kettering
• Dayton Metro American Heart Association
• DMAX Ltd. 
• McGohan Brabender 
• Midmark Corp. 
• NewPage Corp.
• Shumsky
• YMCA of Greater Dayton 

Pinnacle Award

Jun 9th, 2011 | by CareSource

CareSource was recognized with a Pinnacle Award at the 2011 Ohio Association of Health Plan’s Annual Convention. The Pinnacle Award is presented to the top overall entry in each category. There were only three Pinnacle Award winners. Our Care Management team was recognized with the top honor in the Health Care Programs category for their Neonatal Intensive Care Unit (NICU) Care Transitions Program.

The CareSource NICU Care Transitions Program eases the transition for babies in the NICU to home by pairing experienced NICU Case Managers with parents and providers to create a comprehensive transition plan. The program works to safely send high risk infants home and to lower utilization and reduce hospital stays.

Congratulations to the Care Management team for their outstanding Care Transitions Program and for being recognized with such a prestigious award.