VHAN Care Navigators Improve Patient’s Diabetes Management & Help Her Cope With Tragedy

VHAN’s Care Management team of registered nurses, Certified Diabetes Educators (CDE), social workers, pharmacists and Care Navigators work together every day to address the physical, mental, spiritual and social needs of patients. An opportunity to come to the aid of one of their own serves as a perfect illustration of the nimbleness and efficiency of VHAN’s Care Navigators and the power of cooperation to provide a better experience and more positive outcome for patients.

In this recent case, the patient, an employee with the Vanderbilt Health family, was initially admitted to the hospital with hyperglycemia. After being stabilized and sent home, she immediately suffered a tragic event that left her and her children without housing. The patient was now faced with the daunting tasks of finding food, clothing and shelter coupled with financial burdens, all while recovering from her hospital stay. 

Care Navigators to the Rescue
Access to VHAN’s Care Management team is a benefit of membership for VHAN providers. VHAN’s Care Navigators serve as extensions of a practice’s team, providing holistic support to at-risk patients between office visits and helping address patients’ social determinants of health, such as transportation issues, mental health challenges and more.

With this patient facing a perfect storm of health, personal and financial crises, VHAN’s Care Management team sprang into action, coordinating the necessary expertise and resources to get medical, emotional and financial support to the patient as quickly as possible. Vanderbilt’s Employee Assistance Program also stepped in to provide financial assistance, while social workers from Vanderbilt Heath and Aetna responded quickly to supply everyday essentials.

One of the most valuable assets of VHAN’s Care Management program is direct patient access. At their first outreach, Care Navigators give patients their direct contact number, ensuring they have a caring professional to talk to and consult with 24/7. For patients trying to make their way through a complex health care system—particularly while undergoing major life stress like the Vanderbilt employee—this simple act gives much needed comfort.

A Successful Collaboration
In this patient’s case, VHAN’s Care Navigators pulled together specialists from the social work, case management and pharmacy teams, along with a CDE, to support the patient in managing their health. Now that she has been set up with a continuous blood sugar monitor, the patient is making great strides in managing her diabetes. She is receiving financial assistance and counseling and reportedly has “a fantastic outlook on life.”

This case illustrates how Care Navigators are the vital connection point between patients, providers and caregivers. VHAN’s responsive and collaborative approach was particularly helpful in cases like this one where patients struggle to overcome multiple complex health conditions along with other barriers to care.

A Positive Outcome
The patient is now working on her diet, taking medications as directed, and developing a plan to reduce the cost and complexity of those medications. She is fully engaged with her Care Management team and is extremely grateful for all the help she has received. 

“You are like angels from heaven that have shown up when I needed it most,” she said of the Care Navigators. “You’ve given me an outlet to express myself and let go of my fears.”

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