44 Personal Care Guide Management Quantum Health utilizes a primary nurse model for chronic condition as well as acute condition management. This enhanced approach provides one nurse to address clinical needs for all chronic and acute issues. The Personal Care Guide (PCG) nurse will consult with the covered member, their family (if requested), the attending physician, and other members of the covered person’s treatment team to assist in facilitating/implementing proactive plans of care. The Personal Care Guide nurse can assist with benefits, incidental health care issues, becoming healthier, finding resources or an unexpected healthcare journey. During outreach, the Personal Care Guide will touch on the covered member's treatment and perform a physical assessment, perform a medication reconciliation to ensure there are no duplications or interactions, perform a depression screening with subsequent referrals to EAP or in-network providers, as well as focus on the physical and emotional needs of the covered member. The Personal Care Guide will look at the covered member’s psychosocial needs and social determinants of health. In addition to the depression screening, they will evaluate the covered member’s financial issues, knowledge deficits, as well as any cultural barriers that may exist. Conversations with the covered member could occur at least monthly, if not more frequently, and continue until the covered member’s health goals and needs are met. The primary Personal Care Guide nurse will align with the covered member and be the single point of contact for them, and their family and caregivers, and providers. The primary Personal Care Guide nurse will: • Provide comprehensive benefit education/utilization support • Drive PCP designation and steerage to Network Providers • Encourage provider involvement • Perform pre-admission, pre-discharge, and post-discharge engagement • Coordinate with utilization review team for discharge planning needs • Identify gaps in care and alleviate clinical, financial, and humanistic barriers • Coordinate second opinions, drive utilization to other third-party vendor tools, and introduce community resources • Perform behavioral health screening • The primary nurse model has three foundational drivers for the changes: • Humanistic: to help members with acute and chronic needs by assigning a single nurse to the covered member and their family as well as a heightened attention to psychosocial issues that can negatively affect health, quality of life and financial outcomes. • Clinical: identify and prioritize members in need of clinical outreach. Improve adherence to quality measures for preventive health and management of chronic conditions. • Financial: identify and outreach to members at risk for future high costs while encouraging preventive care and chronic condition management to improve health and reduce costs.