A chronic condition or acute illness is a lot to manage. Patients often juggle care among multiple doctors’ offices, pharmacies, labs, and community health care services, and they do so when they’re not feeling their best.
To help ease the way, every Zing Health member has a care team to help guide their care.
Who Is on The Care Team?
Each care team includes a physician or nurse practitioner, registered nurse, behavioral health specialist, and social worker. They work together to identify individual patient needs, then reach out to Zing Health members by phone call or text message to help them get the care they need. In some cases, a physician or nurse practitioner may visit the patient for a 45-minute in-home evaluation to review all medications and health concerns.
“We start with a health risk assessment on all members and continue to do this once a year,” said Karen Wohkittel, vice president of clinical operations for Zing Health. The assessment goes beyond medical history and asks about access to fresh food, exercise routines, and other daily activities. Other disease-specific assessments check for current risks and conditions that might get worse over time.
Care teams remain in touch with members to evaluate additional needs over time. “We have many members that lean very heavily on their care managers,” said Wohkittel. “They're calling them almost on a daily basis. So, we're developing those types of relationships where we want our members to lean on us and ask questions, call in.”
When appropriate, care team members also:
- Make sure patients are up to date on immunizations and routine health screenings.
- Assess whether members have trouble with medications or treatment plans.
- Help members find a primary care provider (PCP) or connect with a specialist.
- Consult with physicians on behalf of the patient in cases where the patient is having a difficult time adhering to the doctor’s prescribed plan, or if they feel that a medical intervention may be unnecessary.
Also, when members call the Zing Health 24/7 Nurse Advice Line or request a telehealth video visit, the care team will receive a notification so a care coordinator can make sure members get the follow-up care they need.
Team Addresses Social Determinants of Health
Community health workers, usually social workers, help patients overcome some of the socioeconomic barriers that lead to health inequities. For example, they may arrange rides to physician appointments for members without transportation, or meal delivery services for individuals who need additional support after discharge from the hospital. They can connect members with financial assistance if they are unable to afford their prescriptions, groceries, or utilities. Zing Health care team members may also refer members to in-home caregiving or companionship services.
“I may know that I need to exercise and eat right because of my diabetes, for example. But if all I’m thinking about is how I’m going to get the food or items that I need just to survive day to day, I’m not thinking about the long-term impacts of an unhealthy diet,” said Wohkittel. “The long-term implications of having diabetes, for example, can include amputation, blindness, kidney failure, and dialysis. Many of those can be prevented if we can help patients with gaining access to healthy food, physical activity, and seeing their doctor regularly before complications develop.”
Specialized Assistance Continues After Hospitalization
Care can also extend post-hospitalization. Patients may need guidance managing an unfamiliar diagnosis or new medications. In one case, a member received printed hospital discharge instructions and new medications, but he was unable to read. Wohkittel said he needed help in understanding how to take care of himself and properly administer his medications after his hospital stay.
“I wouldn't say that this replaces what's being done in the physician's office, but it's an adjunct,” said Wohkittel. “We've invested in this care team because we believe that it's the right model for our members.”
Zing Health members can connect with their care team by calling 1-866-946-4458 (TTY 711).