Cutting medical costs

A Blues on Call registered nurse called a middle-aged female Alcoa member following hospitalization for a blood disorder.

The nurse discovered that the member was on 23 medications and was hospitalized frequently for back pain, abdominal pain, constipation and urinary retention as a result of her blood disorder. And, for the last four months, she had been unable to obtain supplies to give herself necessary IV fluids and pain medication for her disorder.

As a result of intensive case management services provided by the RN, the member is now receiving all necessary supplies needed to continue self-administration of the IV fluids and pain medications through in-network providers. Additionally, the member recently reported she hadn't been hospitalized for pain management for 15 weeks.

Kicking the habit
An outreach call was placed by a coach to a middle-aged male with a heart-related diagnosis. The coach learned that he smoked one pack of cigarettes per day, had previously attempted to quit without success and would like to try again.

She helped him identify barriers to quitting (including spending time with two smoking friends) and to set goals, including a quit date. The coach also supplied information about tobacco cessation programs. When he did not successfully quit on the date he'd selected, the coach helped him to set new goals and another quit date. She also discussed adding medications to his tobacco cessation program.

As a result of the coaching, education, and support provided by the coach, the member contacted his PCP, obtained a prescription for Chantix, and restructured his time with his smoking friends, all of which were instrumental in helping him stop cigarettes completely.