[Podcast] Medicare: Care management tailored to your needs - Medicare Simplified

In this episode of Medicare Simplified In this episode of Medicare Simplified, we review how a plan with Align powered by Sanford Health Plan supports patients managing diabetes, blood pressure, other ongoing conditions






Mick Garry (host): Welcome to “Medicare Simplified,” a podcast by Sanford Health Plan that will help you make the most of your Medicare Advantage benefits. I'm your host, Mick Garry.

Living with chronic health conditions or experiencing complex medical situations can be challenging. Getting you the precise care you need, when you need it, are our care management professionals through Align, powered by Sanford Health Plan. Today we're joined by Barb Vandonslear, a director at Sanford Health Plan.

Let's start at the ground level here, Barb. What is care management?

Barb Vandonslear (guest): Well, our care management team provides case management services to our members, and that really is to help them improve their health and also better manage their health conditions. So we really want to focus on ensuring that our members understand the treatment plan that their doctor set up. That includes their medications and also things they can do to help manage their health.

We also provide a lot of education and support. This support can be through referrals within our team as well as for resources out in the community – entities like pharmacists and our social worker that we have on our team. So it's really about connecting to resources and then also just making sure that their care is coordinated and they're plugged into the right resources.

Mick Garry (host): Tell us how your team can assist our listeners.

Barb Vandonslear (guest): Our team is made up of intake coordinators, social workers, and then we also have case managers who are either focused on medical conditions or behavioral health conditions. They manage our programs, which can vary from somebody coming out of the hospital after a medical or behavioral health admission to someone with multiple health conditions or even complex conditions.

We also have specialty programs around kidney disease, transplant, cancer, and then also behavioral health. We really just walk through a series of questions with individuals who enroll in our programs so that we can really understand best where they currently are from a health status and where we can best provide support.

This could be through education and tools. So if somebody should be monitoring their blood pressure, do they have a blood pressure machine? That type of thing. We also have other programs that are available through the health plan for our insured members that are for diabetes. So diabetes management programs are also available. We want to make sure that they're plugged in and are aware of those resources.

And then if they're struggling in areas like transportation, food, housing, and even financially, we have social workers too who can help look for resources to help support them and their needs.

Mick Garry (host): Can you offer an example of somebody who you helped with a complex care situation?

Barb Vandonslear (guest): A lot of times we focus on individuals who are coming out of the hospital as part of our care transition program. And so if you can imagine somebody who has a chronic heart condition and they're in with pneumonia or any type of respiratory condition. It’s a situation that during the winter is pretty common. Maybe this person comes home and they’re on oxygen and maybe they don't have a lot of social support in the home and they're weak from being in the hospital so they're really at risk for falls. That can be very scary.

Our case manager would reach out to this individual and really talk through their discharge instructions given to them by the facility to make sure they understand what they should be doing. They would also make sure they have the medications that were prescribed.

Barb Vandonslear (guest): A lot of times what we'll see is their medications will change after coming out of the hospital. They have pills in the home, new pills that they've picked up at the pharmacy and they aren't sure what they need to take. We walk them through that and make sure any of the questions that they have are answered and they know what they're taking.

If there are a lot of questions, we then would potentially refer them to our pharmacist that we have on our team as well, just to help walk through the issues and resolve any questions that they have. This individual too probably could potentially be needing to monitor their blood pressure and also potentially weighing themselves daily. So we would make sure that they have a blood pressure machine and a scale in the home.

If they (don’t) have a scale or a blood pressure machine that would be something that we could assist in helping provide for them. And then we need to educate, too, so this is where we would talk about what is normal for readings for their blood pressure and what they should be seeing for weight changes day to day – as well as when to call the doctor. We want to support them also with tools to document this. We have tracking cards and different resources that we can provide to them as well. There are other things as well that we've seen too when they come out of the hospital. Maybe they're the caregiver for someone else in the home. They're the one who prepares the meals. So we do have options to help provide in-home meals as well. That would be something that we would offer to them and also set it up through a program that we have or even Meals on Wheels that's out in the community. We’re really trying to tap into any resources that we can find for the individual.

Mick Garry (host): Is this a one size fits all or is every plan personalized for our listeners?

Barb Vandonslear (guest): Everybody's situation is different and so is what is most important to them as far as their goals in improving their health. We really want to focus on what is important to our members and where they want to start. We look at what's most important to them first, and then we incorporate that into the plan and provide our recommendations or resources to support that. It really is customized to the individual because we know everybody's different.

Mick Garry (host): If people have questions at this point, what should they do?

Barb Vandonslear (guest): If you're an insured member, with Sanford Health Plan on the Align product, we would love to hear from you. You can reach us on our case management line, which is 888-315-0884. One of our intake coordinators answers the phone line and can answer any questions or enroll you in a program if you're interested.

Mick Garry (host): Thanks Barb for sharing your expert insights on care management. If you'd like to learn more about Medicare Advantage plan options from Sanford Health Plan, visit align.sanfordhealthplan.com or find more information in our episode show notes.


Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, or any other classification protected under the law. This information is not a complete list of benefits. Call (888) 605-9277 ( TTY: 711) for more information.