The C3 care management team supports network providers by outreaching patients following hospitalizations and ED visits. This helps reduce the risk of readmission by ensuring patients have the resources they need to self-manage at home. In Q1 2021, the C3 care management team reached out to more than 1,000 patients across the C3 network.
Our team is made up of the following individuals:
- Nurse care managers focus on patients requiring more complex care interactions. They contact patients after a hospitalization and specialize in interventions that reduce the likelihood of the patient returning to the hospital. They also work with patients who have complex health conditions; high ED usage; or complicated social situations that may create need for extra support navigating the health care systems, understanding how to self-manage health conditions, or obtaining supportive services. Our nurse care managers are Michael Uhrman, BSN, RN, CM; and Analisa Cole, BSN, RN, CM.
- Population health specialists contact less medically complex patients after emergency care visits to reduce the possibility of those individuals returning to the ED. They also provide education on appropriate ED usage. Emergency follow-up calls is a strategy supported by our payers to decrease cost and utilization. Our population health specialists are Angie Cook, NCMA; Heather Hubach, NCMA; and Alfonzo Munoz, LPN.
- Clinical pharmacists focus on medication issues that affect patient outcomes. They collaborate with care managers when a patient expresses confusion about their medication regimen or have difficulty obtaining medications. They also identify patients on high-cost medications and work with providers to switch them to lower-cost alternatives. Our clinical pharmacist is Keri Hogan, PharmD, BCACP, CLS.
If your practice is not currently receiving care management support and would like to utilize this free service, please contact Jenn Countryman.