Concierge Spotlight: This is what personalized care looks like. | hioscar Blog | Oscar
Concierge Spotlight: This is what personalized care looks like.
We take a closer look at the personal care and compassion our Case Managers and Care Guides provide for our members.
Getting CareMember Resources
6 min read
Share article
In our new Concierge Spotlight series, we’ll take a closer look at the personal care and compassion our Case Managers and Care Guides provide for our members.
Concierge Case Managers are nurses and social workers who help out when our members require an extra level of care. Whether that’s preparing them for an upcoming procedure or arranging transportation to their next doctor's appointment, it’s personal support from someone on our team. Our Case Managers work alongside our Care Guides, who handle the insurance side—bills, claims, out-of-pocket max, authorizations, and of course, answering member questions.
We sat down with Wendi Newbury, RN, a Case Manager in our Tempe office to talk about her recent experience working with a breast cancer survivor. Wendi has been a nurse for 13 years, and has been on the Oscar team for 2 years, and she explained to us how she came to work with this patient in the first place.
“When I see that somebody has recently gotten a cancer diagnosis, I will go ahead and send them a secure message letting them know about our case management services,” Wendi explains. “Then I’ll usually follow up with a phone call a week later to see if they are interested. The majority of the time, cancer patients are interested in having a nurse case manager. It’s that extra support system that’s going to follow with them on their treatment journey.”
Oscar has a search tool (opens in new tab) that allows our members to quickly find local, in-network specialists. But when a member needs serious medical attention—like an oncologist, surgeon, or radiation oncologist—case managers like Wendi get involved.
"It’s that extra support system that’s going to follow with them on their treatment journey."
“When a Care Guide finds a doctor for the patient, the network navigation team calls the doctor’s office to give them the necessary health info ahead of time,” says Wendi. This is to ensure the doctor fits the member’s specific needs and will be able to treat them. “We want to make sure that the member isn’t going to get bounced around.”
This is an especially important step for complex care cases like a cancer diagnosis, because oncologists are highly specialized in the cancers they treat—there are multiple kinds of breast cancer and many variables to take into account.
Once a doctor is found, Case Managers can also help coordinate care. “We can make appointments for members if they prefer,” says Wendi. “This member wanted to do it herself because she was very busy and had an active lifestyle. So it was easier for her to just schedule the appointments herself.”
Claims and approvals
Members meet with their doctor to make a treatment plan—procedures they’ll need, what sort of scans they’ll get, and what medications they’ll take. In this case, Wendi’s patient needed a bilateral mastectomy.
“It’s after the procedure that the insurance-related stuff comes up,” says Wendi. “We closely monitor our patients’ cases to confirm that everything is going through as it should and they’re getting the right approvals. We make sure things are taken care of in a timely manner so the member isn’t waiting weeks to get a response from their provider.”
Usually this responsibility falls on the patient or the patient’s family. But with Oscar, Wendi and the other Case Managers step in to help. “We stay in contact with the doctors’ offices to take the burden off of the members, so they don’t have the added stress of worrying about approvals,” Wendi explains.
Case managers work alongside Oscar’s Concierge Care Guides. “What we do goes hand in hand. If a member is getting care, they’re going to have claims and benefits questions,” says Wendi. “It’s nice because if we’re on the phone with a member and there’s a Care Guide available, we can just transfer them over without the member having to wait or sit on hold. It’s a better experience.”
"We stay in contact with the doctors’ offices to take the burden off of the members, so they don’t have the added stress of worrying about approvals."
Helping prepare
“A huge part of my job is educating members on their procedures—we help members understand what to expect before and after surgery,” says Wendi.
While patients get information from their own doctor and hospital, Case Managers also provide supplementary information packets. Members are given a list of external resources they can contact, and their Case Manager always follows up a phone call to see if they have any questions.
Emotional support
Everything leading up to the procedure is incredibly important, but once a patient returns home, the Case Manager’s role becomes crucial. “We take a holistic approach to care,” says Wendi. “So that takes into account how members are doing emotionally.”
“For cancer patients, it’s a whirlwind. They get the diagnosis and then it’s doctors, doctors, scans, etc,” Wendi explains. “Then they get surgery, and they’re home recovering, and that’s when it really hits them—everything that’s happened finally sinks in.”
Wendi makes sure that members are aware of the mental health support services available through Oscar’s partner, Optum (opens in new tab). “It’s super, super important to consider your mental health when you’re dealing with cancer. I want members to know about the behavioral health benefits available to them in case they need someone extra to talk to.”
It’s during this period that Case Managers are frequently on the phone with members. “They really lean on us during that time,”says Wendi. She and her patient formed a close bond. As the patient underwent a clinical trial for a new breast cancer therapy, Wendi helped her manage the side effects. “She formed a connection with me and hung onto that. Members establish trust with us—they know we’re looking out for them.”
"We take a holistic approach to care. We take into account how members are doing emotionally."
The healing process
This past August, Wendi’s patient had another surgery for a muscle issue related to the mastectomy. Wendi has already followed up with her and reports that she is healing well.
“I called a couple of days after the surgery to see how she was doing,” she says. “I let her know to watch for the signs and symptoms of infection, checked and made sure her pain level was ok and her drains were working all right. I also confirmed a follow-up appointment she had.”
During recovery, the member will check in with her doctors on a regular basis. As she continues to heal she’ll go back to being a regular Oscar member and will no longer need to have a Case Manager.
“She’s just about at that point now, where she’s moving on and doesn’t need me to monitor her anymore,” explains Wendi. “She actually said, ‘One of the worst things about getting better is that I have to lose you!’”
