Client Advocacy That Empowers: Education as a Pathway to Care
Sometimes, getting care in place starts with client advocacy and education. Knowing what to expect and how to speak with a doctor about care needs can make all the difference. That was the case when Colorado-based Senior Case Manager Jessie Howell, received a new client referral.
A Barrier to Care
After gathering information for Betty, a prospective Professional Case Management (PCM) client in need of home health care, Jessie sent the documentation to a new physician for review. When it came back, the required U.S. Department of Labor ICD-10 diagnosis codes had been crossed out by the provider, as she did not agree with them. This left key information missing and prevented the admission from moving forward. Instead of sending it back and hoping for a correction, Jessie connected with Kim Ewig, a Nurse Administrator for PCM, and together they took a more direct approach by walking both the provider and the client through the requirements.
“I’ve been with PCM for a few years, and I’ve completed my fair share of new admissions and client reauthorizations,” Jessie shared. “Throughout those experiences, there have been many learning opportunities on how to most effectively get the physician on board and support our clients in this program. One of my biggest takeaways is that physicians want to hear from their patients. The more patient-driven and patient-supported the request is, the more likely we are to have a smooth admission and a strong partnership moving forward.”
Going the Extra Mile
Jessie then scheduled an in-person appointment and drove over two hours to meet with Betty and the physician. She made sure the client had the support she needed from the start. Ahead of the appointment, Jessie spent time preparing Betty so that she felt comfortable speaking about her needs. The impact of that preparation was evident throughout the visit. Betty clearly shared her care needs and answered many of the physician’s questions on her own. Instead of relying on Jessie to lead the discussion, she advocated for herself in a way that helped move things forward, while Jessie remained present to assist when needed.
“I was very nervous heading into that visit,” Jessie said. “But afterward, I felt proud of how I supported Betty and kept her well-being at the forefront. This experience gave me another opportunity to grow and build on my skills. When I step up to a new challenge, even though it may be intimidating, I’m setting myself up for future success and for the ability to serve PCM and our clients better!”
A Collaborative Outcome
By the end of the meeting, the physician signed the paperwork and ordered the care Betty needed. He also shared his appreciation for the EEOICPA program and the support it provides. Jessie’s straightforward and collaborative approach helped move this case forward and gave the physician a clearer understanding of the process, which will support future patients as well.
From Kim’s perspective, the outcome reflected Jessie’s commitment to her clients. “Jessie is often meeting with both providers and clients,” Kim said. “I never doubted for a minute that she would make it happen. She is excellent in her role.”
The paperwork was under review, with approval expected soon, and it was clear that things were moving forward. Betty was getting closer to the support she needed, and a medical provider gained a better understanding of the EEOICPA program for future cases. Throughout it all, Jessie’s commitment to client advocacy helped keep things on track, showing how persistence and collaboration can make a real difference.
Soon after, the update everyone had been waiting for arrived: Betty was approved for her care. Authorization came through shortly after, bringing the story to a positive close.
To learn more about PCM home care and the services we provide, please call 866.387.2123.
