New approach after major operations sees health insurance patients looked after at home.

The woman had just had a cancer-related mastectomy. She was sore and hated being in hospital. She wanted to go home.

She was not used to dealing with recovery from a major operation nor grappling with the complexities of the health system. She was, according to Cheryl Fenwick-Evans, a Wellness Coach for nib health insurance, a perfect example of why nib has introduced case management programmes.

It's a part of a health insurance move giving policyholders new dimensions to call on – either a wellness programme seeking to buffer them against future health problems, or case management which can help people like this woman – let's call her Linda – who needed something extra for a full recovery.

Fenwick-Evans, also a qualified nurse, was in touch with Linda after her mastectomy, talking on the phone for the two nights Linda was in hospital, preparing her for her discharge.

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"She hated hospital; she just wanted to go home," says Fenwick-Evans. "But her wound drain was going to need regular management and she wasn't comfortable managing it herself."

It was a fairly typical scenario: many people are so eager to leave hospital and recover at home that, provided health and recovery needs are being met, it can be beneficial for them to do so: "It benefits many of our members as they can return home sooner, allowing them to recover in the comfort of their own home, with family and community nearby.

"It also allows the medical team to assess how their recovery will be impacted by the home environment and personalise their treatment plan."

So nib arranged for a Registered Nurse to go to Linda's home and manage the wounds and drain – and the after-care did not stop there.

"It was clear she needed more to help her recover safely at home," says Fenwick-Evans.

"Over the next few days Linda had regular home care – helping her to wash, dress and assisting with meal preparations – while the drain remained. Her symptoms improved.

That was twice a day, tapering off as she began to improve. We had regular phone calls to ensure everything was improving and when the nurse had concerns about the drain, I was able to co-ordinate with the surgeon."

Linda was also helped by ensuring she knew when follow-up appointments were. Pre-approvals were arranged when she saw the oncologist. People dealing with cancer, particularly those who have never been much involved with the health system, often find it intimidating and overwhelming – and a steady hand of support is much appreciated, says Fenwick-Evans.

Small adaptations to Linda's home were also made; liaison with the DHB meant those changes occurred sooner.

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"It's a team approach and what we did for Linda is a key part of our cancer care programme. We want to be there from the start and through recovery to front things before they happen; arranging things like pre-approvals just takes so much off their minds while they are recovering."

The other facet of nib policies that can benefit patients are the population health initiatives. These are aimed at patients with health problems ranging from chronic back pain, osteo-arthritis, cancer, heart problems, diabetes, chronic back pain and even emotional wellness.

nib coaches like Cheryl work with small groups of patients, with the central theme of being the preventive warning sign at the top of the cliff directing people to safety – not just the proverbial ambulance at the bottom of the cliff.

"Wellness coaches are part of the wider role nib is bringing to health care," says Cheryl.

"We focus on wellbeing and take a holistic approach, assisting our members when they want help or addressing health needs we might have identified together.

"We want to help members live fuller, healthier lives, the best lives they can lead, by focusing on health prevention and promotion."

Most of the coaching is conducted over the phone, one-on-one, and health areas covered also include obesity, chronic obstructive pulmonary disease, mental health and more.

Justin Vaughan, nib's Group Executive, Benefits and Provider Relationships, says the case management programmes and wellness coaching originated in Australia where there was often great pressure on hospital beds.

"But there is the added incentive that most people, I believe, prefer to have care at home rather than stay in hospital. The case management and coaching programmes provide optimised health care and preventive health respectively.

"It is not always applicable – people's social circumstances, like living on their own, can make things more difficult. But it does also mean hospital beds are freed up.

"We do this for thousands of people in Australia; these are early days for these measures in New Zealand but it makes commercial sense for us and it seems to be win-win for our members as well."