Nurse care managers bring compassion to health care

National Nurses Week is a time to recognize, appreciate and celebrate all that nurses do – and at Point32Health, we have an incredible team of nurses that support our members with certain chronic conditions. Through Point32Health companies Harvard Pilgrim Health Care and Tufts Health Plan, our nurse care managers work directly with members dealing with certain chronic conditions to provide personalized support to help them navigate a complex health care system. They can help to manage treatment of existing conditions, as well as plan, implement, coordinate, monitor and evaluate a member’s health care options and services.

Learn more from one of our own nurse care managers, Denise Picard, on how she guides and empowers our members to healthier lives.

Q: What is a typical day like for you in your role?

Denise Picard: Much of my time is spent on the phone with members. To prepare for those calls, I typically spend my mornings researching any new members I’ll be working with for the first time to get an understanding of their condition and health history, as well as checking up on any health changes and updates among existing members on my caseload.

Depending on a member’s needs and where they are in their care journey, my day can be spent working on several different hands-on support and advocacy strategies. You might find me developing customized care plans with other teams internally, coordinating appointments and services for members, monitoring member progress or pulling together educational resources. During this time, I’m also reviewing these strategies with my members. I try to empower them to be their own advocates and health managers by educating them on how to take care of themselves and what to look for when it comes to changes in their health.

Q: Which chronic conditions do you specialize in and help members to support?

DP: Being a nurse care manager is an opportunity to provide a unique, robust health resource for members. While I do have over 30 years of experience managing all different health conditions at a greater Boston area hospital, as a nurse care manager I specialize in chronic health conditions, including chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure and various types of cancer. I also work with members who recently underwent surgery or visited the emergency room.

We can really help people manage their chronic conditions, teach them how to care for themselves and be their own advocate. As part of the larger clinical care team that I’m a part of, there’s also social workers, pharmacists and behavioral health service navigators within the organization. Having this clinical care team in place provides support and collaboration internally, which in turn allows for more comprehensive, personalized health solutions for our members.

Q: Are there any barriers to accessing health care that you see when working with members?

DP: One of the biggest problems I’ve noticed is wait times to see a specialist. A lot of people are having a hard time getting appointments. The provider offices are just so busy. And then there are members who are wanting to see their primary care doctor at each visit, and there are times that the appointment is with a nurse practitioner or physician’s assistant.

I really try and work with members to advocate and push to get the appointments they need in a timely manner, though I also step in to help when I can. Sometimes the person scheduling the appointments at a provider’s office may not be aware of the urgency of something. If I can call on the member’s behalf and explain why they need to be seen sooner, sometimes that can make a difference.

Another barrier I’ve seen is that there is a shortage of certain medications that are used for both diabetes and weight loss, which can make it difficult for members trying to access these medications.

Q: What do you enjoy about your role as a nurse care manager?

DP: I enjoy educating members and helping them to work on their goals. For example, a lot of people with type 2 diabetes would like to work on their medical condition, with the goal of stopping their medication and managing their disease through diet and exercise. We can help the member with obtaining a nutritionist, communicating if their health plan offers a fitness reimbursement and sharing resources and information on healthy eating. We can also assist the member with obtaining a specialist to manage their disease.

It’s fulfilling learning what motivates a member to liver healthier and being able to help with that goal. Whether it’s encouraging them to advocate for themselves to get an appointment or checking in to see if they’re working on their fitness goals, it’s great to be a part of their support system. As a team, we can assist the member with social determinants of health (SDOH), along with assisting and supporting the member’s mental and emotional well-being. Seeing a member have good outcomes with their health or goals is such a great feeling as well.