Care Plans - Process Overview (CHW/ICA)

Care Plans are how your supporting physician gains insight into your work. When shared with the patient, they help them understand the power of your advocacy work.

Below is an in-depth look at the type of content required when creating a Care Plan.

For a look at the technical aspects of Care Plans, please see the following article:

• Care Plans - Technical Steps (CHW/ICA)
• Note that Care Plans should be submitted within 7 days following an intro call

Come Prepared

To best prepare, read the treating physician's notes BEFORE meeting with each patient. As soon as a visit is booked, you can view any patient's specific care plan template alongside the Solace Physician’s encounter notes. And don't forget that the time you spend reviewing Physician Notes and preparing for your visit is reimbursable.

During your intro call with the patient, provide your full attention, take notes, and connect. Following the call, you'll create a personalized Care Plan for that patient using a Solace-provided template.

In each Care Plan, you’ll set the goals of your work with the patient and create a roadmap for accomplishing those goals. After you craft and submit a Care Plan, a Solace Physician will review it and either give it a thumbs-up ("Approved") or provide feedback on revisions.

Quick Overview - FAQ

• When should I work on the Care Plan for my new patient?
  
  • Before the call: Review the physician's encounter notes and familiarize yourself with the Care Plan fields in advance to make the most of your intro call time together
  • Following the completion of your intro call with the patient
  • Schedule yourself some time after your intro calls for Care Plan development and submission

• How long does a Care Plan take to complete?
  • Expect to spend 45 to 60 minutes for a thorough Care Plan
  • You will be documenting in the Care Plan the assorted details and courses of action discussed during the intro call
  • Each patient's situation is unique, so this is an estimate only. Some cases are more complex and will take longer to complete than others

• When can I begin working on my patient's behalf?
  • Immediately! Consent is obtained during the clinician intake, so as soon as you meet with your new patient, you may begin working together
  • If the reviewing physician returns your Care Plan and requires additional content, you are still safe to proceed with your patient in the meantime, but please make any suggested updates as soon as possible to the plan

Creating a Care Plan

Keep track of the time you spend prepping for your intro call and writing the Care Plan— you’ll need to submit that time via Timesheets. On average, advocates spend 45 to 60 minutes writing each Care Plan. Care plans have three key sections that you will complete:

• Patient Information
• Care Objectives
• Plan of Care
• Review & Submit

Patient Information

You'll answer questions about what brought the patient to Solace, their current medical situation, and any family or social dynamics impacting their health or access to healthcare.

Care Objectives

Here, you'll describe the patient's current care team, any salient information from their medical history, and any barriers preventing them from accessing care.

The most effective Care Objectives are those that can be measured. Solace Physicians may check in occasionally to see how your work with the patient is progressing against these goals.

Some Care Objective Examples:

• Increasing patient compliance with prescribed treatment plans (e.g., taking medications, attending follow-up appointments, making lifestyle modifications).
• Improving measurable indicators of health related to the patient’s primary diagnosis (e.g., lowering cholesterol levels or improving markers of liver function)
• Eliminating barriers preventing the patient from accessing care (e.g., overcoming obstacles such as lack of transportation or challenges interacting directly with medical providers)

Plan of Care

You'll include information about any advocacy or care management services the patient receives or has previously received outside of Solace. This section also covers the patient's goals, the treating physician's recommendations, and your plan of action. 

To see the treating physician's notes, click the "Solace Physician's Notes" button on the left-hand side of each patient's Care Plan.

Review & Submit

Each care plan you submit will be reviewed by a Solace Physician. Do your best to be methodical as you write your Care Plans. If a Care Plan doesn't quite hit the mark, it will be returned to you for revision. If this happens, you can view the Physician’s notes and resubmit the care plan.

• NOTE that you may continue working on behalf of your patient even if your Care Plan is returned for additional information.

As always, thank you for being a part of the Solace family and for all the work you do on behalf of your patients.

Still have questions? Feel free to email us at [e-mail] or give us a call at [phone]. We're happy to help!