Identifying and responding to patients’ social needs is an integral part of the work of VHAN’s Care Navigators. In a recent phone conversation with a VHAN RN Care Navigator, a 38-year-old female patient living in East Tennessee reported multiple social and financial barriers to her continuity of care. A kidney transplant recipient, she had recently lost her father to COVID-19, and she was having difficulty managing her health condition, finding work and paying bills. Read the full article to learn more about how VHAN’s Care Management team helped this patient during a difficult time.

During a recent checkup call with a 75-year-old male patient with a history of stroke, a VHAN RN Care Navigator talked to the patient’s wife, who spoke of feeling stressed and overwhelmed. After working full-time and serving for some time as the primary income provider, she was exhibiting classic signs of caregiver burnout—exhaustion combined with feelings of hopelessness and isolation. Read the full article to learn more about how VHAN’s Care Management team helped this caregiver navigate a difficult situation.

For every 10 people who visit a doctor, it’s estimated that seven are seeking care for behavioral health-related reasons, such as depression, anxiety, diabetes management, weight loss or substance abuse. VHAN’s Care Management team facilitates collaborative care that is designed to bridge the gap between physical and mental health care, delivering the right kind of care where and when it is needed.

Recently, VHAN Social Workers were able to create a coordinated plan for psychiatric care, anger management and medication management while providing a patient with the support and encouragement he needed to take proactive steps to manage his physical and mental health.

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. Recently, the team applied multidisciplinary efforts to help a patient heal from a hospital stay while simultaneously recovering from a personal tragedy—a fire that took her home and most of her belongings. Read the full article to learn more about how VHAN can help patients manage their health through the most difficult times.

VHAN’s Care Navigators help address the physical, mental, spiritual and social needs of patients. Watch a video to see the powerful story of how VHAN’s Care Management team helped Tina improve her mental health and better manage her physical symptoms.

The VHAN Care Management team serves as an important connection point between patients, providers and caregivers. This service is particularly helpful when patients are managing multiple complex conditions and additional barriers to care. Recently, several members of the care management team stepped in to help a VHAN patient who was struggling to stay out of the emergency department.

In 2020, VHAN focused on 11 key aims to drive quality performance and improve patient care. Our new Impact Report outlines how the network performed across these key aims, including several personal stories that detail how VHAN providers have made a difference in patients’ lives.

VHAN Care Management team members serve as advocates for patients in many aspects of their health care journey. A success story profiling Care Navigator Martha Merry, BS, RN, and a patient with cancer illustrates the team’s impact.

Working directly with our member hospital systems and practices, VHAN aims to improve the transition process and improve continuity of care, thus reducing adverse events and readmissions.