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When you think of the health care workers in your life, your primary care physician is probably the first person who comes to mind. But so many more people in the health care world can play a big role in keeping you healthy, says Nicole Wolf, RN. She’s an Aetna Dual Eligible Special Needs Plan (D-SNP) clinical health services manager.
The ways these professionals help can go well beyond giving you the checkups and treatments you need. For example, you might need help getting healthy foods, safe housing and education. All of these can play a major part in your physical and mental health.
That’s why if you’re an Aetna D-SNP member, you have an entire care team assigned to you. The care team’s job is to save you time and stress while helping you stay as healthy as possible. They can:
- Guide you through the plan so you can get the most out of your benefits
- Work with you to create a care plan that meets your personal needs and goals
- Put your care plan in motion
- Jump into action if you have a problem that may threaten your well-being
“The care team is a safety net for our members. We’re there for members, often in their darkest times,” Wolf says. For example, Wolf remembers a call a care team got late on a Friday. The member had lost his caregiver. He had no backup plan for food or home care.
“Our team was able to set up meal delivery and arrange emergency caregiver services. We also searched for a long-term replacement,” says Wolf. “Without that support, the situation could have become dire.”
If you enroll in a D-SNP plan, you’ll meet your care team within the first few weeks. Here are the MVPs who may be on your care team, plus other Aetna professionals who are there to help D-SNP members.
Health survey specialist
Within 90 days of your plan’s effective date, a health survey specialist will call you to do your health survey. You’ll be asked to complete a list of questions about yourself, your health and your history. “This survey helps our care team understand and meet your health care needs, and also identify important benefits,” Wolf says. Whether you become a first-time D-SNP member or have been one in the past and are joining again, be sure to take this call to make sure your survey is up to date.
Nurse care manager
Once your health survey is filled out, it’s sent to your care manager, who is a registered nurse. Your care manager will review the information and then give you a call. During that conversation, you’ll be able to talk about which parts of your health need the most attention. They’ll ask you about your health goals and challenges, Wolf says.
After that, a nurse care manager can create a full care plan that’s tailored to your needs. Then the plan is put into action, along with your doctor’s participation. “Think of your care manager as the captain of your ship who can draw upon other crew members to help meet your goals,” Wolf says.
For example, a nurse care manager might see that you need help managing your diabetes. But what if you want to find long-term housing first? Based on your conversations, your nurse care manager can decide what should come next. A social worker or Medicaid paperwork expert might be called in, for example. Your nurse care manager also works with your doctor to keep an eye on your medical issues and other needs.
Social worker
A social worker helps with basic needs that affect your health. That may include finding safe or permanent housing, paying for utilities and getting healthy groceries. “We know those kinds of things can be barriers to staying healthy,” Wolf says. The social worker can answer questions about social services such as food assistance and affordable housing. They can also connect you with the right programs.
Care coordinator
A care coordinator knows the health care system inside and out. This expert understands all the Aetna D-SNP benefits and can find the best way to help you use them.
“Care coordinators play a large role in easing your burden. They navigate complex systems and services for you,” Wolf says. For example, they may be able to help you:
- Schedule a doctor’s appointment
- Arrange transportation to your doctor’s office
- Get authorization for home medical equipment and have it delivered
- Get authorization from your doctor for a different medication
Member advocate
“We knew it was important to have a team member who specializes in Medicaid,” Wolf says. That person’s mission is to keep an eye on members who may be in danger of losing Medicaid benefits.
Whether you’re already a Medicaid recipient or need to apply for the first time, a member advocate can help you understand the requirements, applications and verification papers you need. You’ll get help with gathering everything they need to get certified again for Medicaid. “This is key. If a member fails to recertify for Medicaid, they may lose benefits,” Wolf explains.
Pharmacy team
At least once a year, a pharmacy team will review your medications. Then they’ll make recommendations to your doctor and/or nurse care manager about any medication changes that might benefit you. “This is useful, since information sharing can lead to better health outcomes,” Wolf says.
Behavioral health care manager
Mental and physical health go hand in hand. At some point you may need help dealing with an occasional mental health concern, such as grief or trauma, Wolf says. Or you may have a more chronic issue, such as depression or anxiety. In those cases, your care manager may call on a behavioral health care manager to help you get the mental health support you need.
Whatever the issue, emergency or question you have, your entire care team is ready and waiting to help. Best of all, it takes just one phone call to get their help. One team, one call for assistance, answers, quality care — and peace of mind.
Disclaimers
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our D-SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.