BHN Care Management Program team members
Only 12% of Americans have proficient health literacy skills, according to the National Assessment of Adult Literacy. Many adults may have difficulty completing routine health tasks like understanding a drug label or using a map to locate the closest health center. In recognition of Health Literacy Month, we highlight BHN's Care Management program and the important work they do in educating individuals and families, as well as connecting them to community resources. Through this education and referrals, they help people understand their health and healthcare needs, empowering them to make informed choices for maintaining a healthy lifestyle.
BHN's Care Management program serves people of all ages with chronic health problems, disabilities, or behavioral health needs. The program provides a team of professionals who work closely with individuals and families to understand their health conditions, access necessary services, and coordinate care across multiple providers. This team may include nurses, social workers, and care coordinators. By collaborating with individuals and families, care management aims to improve healthcare coordination, leading to better quality care, improved health outcomes, and an enhanced quality of life.
Molly McKnight, Senior Program Manager of BHN’s Care Management program, is a nurse with a background in behavioral health. She explains, "Care Management looks at a person holistically. Behavioral health, medical, and social determinants of health needs are considered. People may struggle with tasks like getting their insulin or arranging transportation to their appointments. Care management aims to comprehensively address and treat these needs.” The program's focus of health literacy is member-centered, helping clients identify their needs.
BHN's One Care care management program serves over 3,320 individuals and employs 23 staff members at Baystate's Mason Square and High Street locations. Carolyn Okrsaka, a nurse manager with One Care, has worked at Baystate’s High Street location since 2018. She loves building long-term relationships with clients. “There are things you can’t get from a chart review or discharge summary,” she says. “We help people access what they’re entitled to.”
One Care utilizes the instED program, which leverages highly trained paramedics to deliver urgent medical care services to members in the comfort of their own homes to prevent Emergency Department visits. This program has been successful in decreasing the number of hospitalizations. In the past 90 days, out of 121 visits, 13 resulted in being transferred to the ED, resulting in an 89% ED diversion rate. "We find that getting to know individuals on a long-term basis is more beneficial than the quick process of being in a hospital," says Kristi Brookman, One Care nurse supervisor. "This provides us with a longer period to assess health literacy level and to help bridge the gaps from where they are to where they need to be."
When discussing ways to support health literacy, Molly emphasizes, “You can refer individuals to us! We can work collaboratively with other groups. Our focus isn’t limited to behavioral health, we also address medical and social needs.” To learn more about BHN’s Care Management Programs or to make a referral, visit bhninc.org or call 413-301-WELL (9355).
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