Surrounding Patients with Support
The Care Management team connects patients to resources while removing barriers to health care.
Managing a chronic health condition or a serious medical event can come with a lot of challenges, from insurance coverage issues and discharge planning to medication management and anxiety about what’s going to happen next. But when a health crisis or diagnosis strikes, Torrance Memorial Medical Center patients don’t have to navigate these challenges alone.
Whether a patient needs social work services, assistance with discharge planning or help with insurance coverage, the hospital’s Care Management team is there to provide everything they need to cope with their diagnosis.
“We’re problem-solvers, and patient advocacy is our No. 1 priority,” says Lindsey Stone, RN, director of care management at Torrance Memorial. “We serve every unit in the hospital, and our goal is to ensure each patient gets the right level of care at the right time and the right services to support their overall well-being.”
Led by Stone, the Care Management team is organized into three divisions, each with unique responsibilities: case management, clinical social work and utilization management. “Together our team works to balance clinical quality with the patient, physician, nurse, and organizational expectations and goals so each patient receives optimized care,” says Stone.
Next Steps in Patient Care
The case management team, led by case management manager Giles Ordinario, RN, assists patients with discharge planning after their hospital stay. “For some patients, discharge planning is as simple as providing them with a walker, scheduling physical therapy appointments and sending them home,” says Ordinario. “But for others it can be complex — especially if they have limited family support, insurance concerns or need a higher level of care but would prefer to return to their own home instead of a facility.”
Ordinario and his team work with medical partners, including transitional care and rehabilitation providers, home health, medical equipment companies and nursing homes, to ensure patients can seamlessly move to the next level of care.
Providing Psychosocial Support
When a patient’s care team identifies a need for additional support, the clinical social work team, led by clinical social work manager Tracey Green, LCSW, will perform a comprehensive psychosocial assessment to determine what the patient needs to help them successfully manage their health.
“Our goal is to optimize each patient’s psychosocial and medical functioning while minimizing stress,” says Green. “After assessing each patient’s needs, we identify gaps in support, resources and services and figure out how to close them.”
Green says her team considers many factors during the patient assessment, including the patient’s home environment, social and family situation, emotional and mental functioning, ability to cope, spiritual needs, and access to necessities such as transportation, food, clothing and shelter.
Torrance Memorial clinical social workers also provide crisis intervention services, serving as mandated reporters and assisting patients who are victims of abuse or assault. They work closely with community organizations to connect patients with services such as mental health counseling, substance use treatment, childcare, food banks and shelters.
“We’re masters of resources,” says Green. “We meet the patient and family where they are in a nonjudgmental way, providing education and facilitating communication and collaboration with their treatment team. We also connect them with community-based services to remove barriers to receiving care and complying with treatment recommendations.”
Navigating Insurance and Treatment
The utilization management team, led by Mary Espinoza, RN, is responsible for supporting patients by obtaining insurance authorization, navigating compliance with Medicare, Medi-Cal and commercial payer regulations and contracts, and sharing opportunities to use appropriate resources for the care patients need.
“We review patient admissions and work with providers to make sure each patient is placed in the proper status to ensure insurance payment and prevent denials,” says Espinoza. “If we receive an insurance denial, we work with our team of physician advisors to determine whether we should appeal.”
Espinoza and her team also collaborate with insurance and internal case managers on discharge planning, following patients as they progress through the continuum of care and helping “paint a picture” for the insurance company that streamlines coverage decisions and claim approvals. After discharge, the team works closely with the billing office to manage denials and review claims to make sure they are compliant with insurance regulations.
“We work behind the scenes to make sure pre-authorizations are completed, patients are placed in the correct status and insurance payments are received,” says Espinoza. “We make sure patients understand their health insurance coverage so they can use it appropriately for their health needs.”
Supporting Providers and Patients
In addition to supporting patients, the Care Management team is also a valuable resource for providers. “Our team gets things done, and we support our providers by helping remove patient care barriers so they can focus on providing the best possible medical treatment,” says Stone.
The team also works closely with Torrance Memorial physician advisors Tracy Bercu, MD, Roy Fu, MD, and Ernest Lee, MD, to ensure each patient receives supportive care that aligns with their treatment goals and complies with internal and external best practices, policies and regulations. They also support the Care Management teams as liaisons with the medical staff community.
“We work closely with care management to ensure our patients have a smooth transition through their hospital stay and beyond and have the resources they need,” says Dr. Bercu. “The care management team is vital to our mission to provide patients with the best care possible.”
However, the real key to the Care Management team’s success is collaboration. “Having a life-threatening health event or managing a chronic medical condition can be terrifying for patients and their families — especially if they don’t have access to the resources they need to cope,” says Heather Shay, RN, vice president of clinical quality and accreditation. “The entire Care Management team works hand in hand with the patient, family and medical team to provide comprehensive support, addressing the full spectrum of personalized patient needs and ensuring each patient gets the support, compassion and care they deserve.”
Connecting Our Community to Essential Resources
At Torrance Memorial we’re proud to partner with our affiliate Cedars-Sinai to offer a comprehensive tool designed to connect individuals and families in the South Bay with nonprofits, government agencies and community programs providing critical support needed to live a stable, secure and fulfilling life.
If you or someone you know is struggling with things like not having enough food, needing health care, finding affordable housing or other challenges, the Find Help resource hub makes it simple to find the support you need. Torrance Memorial cares about making a real difference in your life and the lives of those in our community. Together we can build a stronger, healthier South Bay and bridge the gap to equality and opportunity—one connection at a time.
