IAMHP

BlueCross BlueShield Member Story

Thu, 02 Apr 2026 20:02:51 GMT

New Member Gets A Fresh Start

Earlier this year, Kelly, a new member, was admitted to a behavioral health hospital. Kelly had experienced prior hospitalizations, but this was the first time getting care through Blue Cross Community Health Plans (BCCHP).

Kelly, who identifies as non-binary and uses the pronouns she and her, shared during past hospital admissions, she saw the care coordinator from BCCHP helping others and wondered when someone would help her. As the care coordinator approached, she smiled and said, “It’s finally my turn.”

At the time of her admission, Kelly was homeless and needed stable housing to support her long-term recovery. Other challenges included no phone or way to stay connected with her providers, and difficulty getting medications once discharged from the hospital.

Kelly’s situation required rapid coordination across care teams and community partners to ensure a safe and stable transition. Within 24 hours, the care coordinator arranged immediate housing support with a community organization that secured an apartment for her.

Bridging the pathway to continuous care and engagement, Kelly was given a new cell phone to keep the lines of communication open with her health care providers and support team. She was also paired with a care coordinator who specializes in gender-affirming care to get the support and care she needs throughout her health care journey.

Kelly made a smooth transition from the hospital to her new home. However, she faced a barrier getting three prescribed medications. Once notified, the care coordinator identified the prior authorization issue, contacted the discharge provider and resolved the problem within an hour. She was then able to get all medications without delay.

BlueCross BlueShield Member Story

Thu, 02 Apr 2026 20:00:29 GMT

Doula Provides Member With Educational And Emotional Support

Blue Cross Community Health Plans (BCCHP) member, Alice, wanted a doula to help guide her and provide emotional support during her pregnancy journey. Fortunately, she was able to enroll in a doula program offered through BCCHP to get the education and support she needed during and after her pregnancy.

Throughout her prenatal experience, Alice engaged in educational sessions with her doula, learned what to expect during labor, how to advocate for herself, and how to approach birth with confidence.

On Dec. 13, 2025, Alice delivered her baby with her doula by her side. The doula provided continuous emotional support, helped her apply the techniques they had practiced, and ensured she felt informed and empowered during the entire labor process.

After delivery, Alice expressed deep gratitude for the support she received. She shared she was very pleased with her birth experience and credited her doula’s education and hands-on assistance as key elements that helped her feel prepared and confident.

This success story highlights the powerful impact of integrating doula services into maternal care. The doula kept the BCCHP team informed by sharing valuable member feedback, reinforcing the collaborative effort behind her care. Through the partnership, Alice experienced a safe, supported, and informed birth, demonstrating how access to doula care can elevate outcomes - emotionally, physically, and mentally - for expecting parents. It is a testament to the effectiveness of coordinated programs that place members at the center of their care journey.

Humana Member Story

Wed, 01 Apr 2026 19:35:45 GMT

Stepping In When It Matters Most

J.S. is a 71-year-old male with an aging waiver. Member receives 142.50 hours per month of homemaker services. Functionally, the member is primarily bedbound and requires assistance with all activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as personal care, meal preparation, housekeeping, laundry, errands, and routine health management. His health conditions include congestive heart failure, hypertension, high cholesterol, asthma, Type 2 diabetes, chronic pain, osteoarthritis, chronic diarrhea, gastritis, and incontinence.

The member recently faced a serious situation. He had been without insulin for over a week, causing his blood sugar to rise to 486. J.S. expressed that he felt worried, overwhelmed, and unsure of what to do. The member was able to contact his Care Coordinator.

At that moment, our Care Coordinator stepped in as a true advocate for his wellbeing. Her efforts included:

• Escalating the issue urgently to ensure the insulin refill request was prioritized

• Maintaining continuous follow up and direct communication with the provider’s office

• Working persistently until the prescription refill was approved and sent to the member’s pharmacy

• Providing emotional reassurance so the member did not feel alone during the crisis

• Ensuring appropriate follow-up visits were scheduled.

• Following up to ensure continued medication compliance.

Because of her persistence, the member avoided what could have become a diabetic emergency. During a follow up call, the member expressed deep appreciation, saying: “Thank you… I didn’t know what I would do without you all.” His words reflect just how meaningful consistent, compassionate care coordination can be - especially for members navigating complex medical conditions with limited resources or support.

CountyCare Member Story

Tue, 31 Mar 2026 18:57:02 GMT

CountyCare Helps Premature Member And Her Family

Jordyn* is a CountyCare member who was born at 28 weeks at a local Chicago hospital. A fighter from the start, she overcame a heart defect but continued to struggle with swallowing, which required the insertion of a feeding tube. Her family initially reached out to their CountyCare care coordinator for nursing support, but when Jordyn’s parents lost their home, the support they required became much more acute.

Sarah*, their CountyCare care coordinator, developed a plan and connected them with local resources and organizations to help find temporary housing and assistance with SNAP and other benefits. CountyCare continued to support Jordyn’s parents with medical care, supplies, and transportation services while they worked toward securing stable, permanent housing.

With the help of their care team and various community resources, a few weeks later they were able to find a permanent apartment and were thrilled to move in and finally have a stable home for Jordyn and her two siblings. Today, Jordyn is a happy toddler who loves singing, dancing, blowing bubbles and watching Elmo. Her family continues to cheer her on as she reaches new milestones.

*Names and identifying details have been changed to protect anonymity.

Aetna Member Story

Thu, 26 Feb 2026 18:34:52 GMT

A Fresh Start Through Steady Support

Kevin*, an Aetna Better Health of Illinois member, was determined to maintain his sobriety and rebuild his life after completing residential treatment and transitioning into sober. While committed to his recovery, he faced several challenges, including limited access to primary care, dental services, transportation and ongoing support resources. Without these essential connections, maintaining stability felt overwhelming.

Maria*, a behavioral health case manager, worked closely with Kevin to understand his needs and develop a plan for long-term success. She helped connect him to a primary care provider (PCP) and dental services, ensuring he received the medical care he had been postponing. With Maria’s guidance, Kevin completed his dental treatment and established consistent care with his PCP. He also received referrals to dermatology and physical therapy to further support his health.

Recognizing the importance of emotional and community support in recovery, Maria connected Kevin with Affect Therapeutics. Through this partnership, he found encouragement and accountability as he continued working toward his sobriety goals. The additional support strengthened Kevin’s confidence and reinforced his commitment to recovery.

As Kevin’s stability improved, he was able to return to work and begin earning income. Although this initially affected his Medicaid eligibility, Maria supported him through the reapplication process when his income fluctuated. Once coverage was reinstated, Kevin was able to re-enroll in case management and continue receiving the services he relied on.

With consistent support and guidance, Kevin has maintained his sobriety since discharge and remains actively engaged in his care. He continues working with Affect Therapeutics and accessing community resources that help him stay focused on his health and future.

Reflecting on his journey, Kevin shared his gratitude for the support he received, expressing how instrumental it was in helping him rebuild his life and make informed decisions about his health.

*Member name changed to protect privacy

Aetna Member Story

Thu, 26 Feb 2026 18:32:52 GMT

Restoring Stability Through Rapid Support

After managing his diabetes successfully for nearly two years, David* suddenly found himself facing a major setback when insurance issues caused him to lose access to his prescribed medication. Without his usual treatment, maintaining his health became increasingly difficult and his blood sugar levels required significantly higher doses of insulin to remain stable.

David, who had previously relied on Mounjaro to manage his condition, had tried several alternative medications in the past, including options that resulted in serious health complications. As his condition worsened, he began requiring high daily doses of insulin, placing both his health and quality of life at risk.

Sarah*, a registered nurse case manager, quickly stepped in to support David during this critical time. She engaged him in intensive case management and immediately reached out to the pharmacy and prescribing provider to address the barriers to medication. Understanding the urgency of the situation, Sarah coordinated closely with all parties involved to ensure the necessary approvals were obtained as quickly as possible.

Through her persistence and advocacy, the medication approval process was expedited, and within 48 hours, David regained access to his treatment. Sarah followed up to confirm delivery and ensure he could safely resume his medication without further delays.

With his treatment restored, David’s insulin needs decreased significantly, and he was once again able to maintain better control of his diabetes. He continued progressing toward his weight loss and overall health goals, regaining confidence in his ability to manage his condition.

Reflecting on the experience, David expressed deep appreciation for the support he received, sharing how the timely intervention made a meaningful difference in his life and helped prevent further complications.

*Member name changed to protect privacy

Aetna Member Story

Thu, 26 Feb 2026 18:29:55 GMT

Rebuilding Stability Through Persistent Care

Michael* struggled to stay connected to medical care after a serious accident and ongoing health challenges. Unstable housing, unreliable phone service and limited support made it difficult for him to manage his chronic conditions, leading to repeated hospitalizations and setbacks.

Michael, a member who was also coping with depression and alcohol use, felt overwhelmed by his situation and unsure how to move forward. Without consistent access to care, his physical and emotional health continued to decline.

Laura*, a registered nurse case manager, worked persistently to engage Michael and reconnect him with essential services. Alongside the care team, she helped coordinate medical appointments, identify safe housing with family support and establish reliable communication methods.

The team also supported medication adherence, arranged transportation and provided education to help Michael better understand and manage his health. With consistent guidance and encouragement, he began attending appointments regularly and following his care plan.

Today, Michael lives in a stable home environment, remains engaged in case management, and reports significant improvements in his physical, mental and emotional well-being. Through persistent outreach and coordinated support, he has regained confidence and independence.

*Member name changed to protect privacy

Aetna Member Story

Thu, 26 Feb 2026 18:28:11 GMT

A Little Support Goes A Long Way

James*, who suffers from multiple co-morbidities, was referred to care management for additional care coordination and personalized support.

During outreach, James shared interest in strengthening his connection with a primary care provider closer to home and expressed a preference for an African American provider. He also requested assistance coordinating dental, vision and dermatology services to support his overall health.

Kathy*, A registered nurse case manager actively listened to James’ goals and quickly coordinated services to support his preferences. Kathy provided information for three African American primary care providers located near his home, helping him make an informed decision about his care. Kathy also connected James with several in-network vision, dental and dermatology providers to address his immediate needs.

Through personalized support and coordinated care, James was able to establish connections with providers aligned with his preferences and health goals. The experience enhanced his confidence in managing his care and ensured timely access to essential services.

*Member name changed to protect privacy

Meridian Member Story

Tue, 06 Jan 2026 00:59:02 GMT

Ongoing Support Helps Sarah Make Meaningful

Progress In Her Mental Health Journey

Meridian member Sarah*, an 18‑year‑old college theatre major, manages several mental health conditions, including attention‑deficit/hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), and major depressive disorder. She joined Meridian’s R.E.A.C.H. program, which helps young members with depression in developing self-management plans for their mental health conditions by pairing resources and skill-building activities with traditional therapy. Although Sarah was passionate about school and performance, she found herself struggling with daily tasks. When she completed her initial Patient Health Questionnaire‑9 (PHQ‑9), she scored an 18—indicating moderately severe depression and difficulty across nearly every area assessed.

Sarah began working with her Meridian care manager, Catharine (RN), who took the time to understand how deeply Sarah’s symptoms were affecting her overall well‑being. Sarah shared that she was experiencing intense mood swings, fatigue, poor appetite, and trouble focusing, all of which were interfering with her health and her studies. She was seeing a therapist weekly and a psychiatrist monthly but still needed help bringing structure and self‑management skills into her day‑to‑day life.

Together, Catharine and Sarah developed goals for an individualized care plan, including implementing strategies learned in treatment such as identifying her triggers and using existing coping skills more effectively. Also, addressing her desire to quit smoking. With her care manager’s ongoing support and consistent check‑ins, Sarah started to recognize the patterns in her moods and found healthier ways to navigate stressful moments.

Two months later during a follow‑up assessment, Sarah completed her third PHQ‑9. This time, she scored an impressive 4, showing significant improvement and demonstrating the hard work she had put into her own progress. She proudly shared that she had stopped smoking, felt healthier and more energetic, and—perhaps most exciting—had landed a vital role in a play she auditioned for.

Today, Sarah remains active in the R.E.A.C.H. program to maintain her improved outcomes and care. With her Meridian care manager by her side, she continues working toward her individualized care plan goals and building the tools she needs to stay healthy and continue thriving.

*Member name was changed for privacy reasons

Molina Member Story

Tue, 30 Dec 2025 23:52:02 GMT

Achieving Maternal Health Goals Through Comprehensive Support

A pregnant Molina member with high blood pressure and persistent headaches was identified as high-risk and referred for additional support. Initially, outreach efforts were unsuccessful due to scheduling challenges, missed appointments, and competing responsibilities as a caregiver. Through persistent efforts, a maternal health educator completed a face-to-face visit, resulting in a thorough assessment of health and social needs. The member lacked prenatal care, vitamins, and essential baby supplies, and had

not completed critical testing.

In response, the care team rapidly coordinated services, including scheduling both in-person and virtual appointments with an OB provider. The member received immediate telehealth consultations, prenatal education, and enrollment in a pregnancy support program. Assistance extended beyond healthcare to securing Goodwill vouchers, help with a WIC application, and connecting with local organizations for necessary baby items.hank you for helping me and my daughter.”

With ongoing support from the care manager and educator, the member completed all recommended labs, received essential medications and supplies, and attended follow-up appointments. Blood pressure monitoring and medication adherence became part of her routine. Ultimately, the member successfully delivered her baby and received thorough post-partum and well-baby care education. This collaborative, caring approach empowered the member to overcome barriers and achieve positive health outcomes for herself and her child.

Molina Member Story

Tue, 30 Dec 2025 23:50:52 GMT

Keeping A Family Safely Housed During Crisis

A 64-year-old woman facing homelessness and severe anxiety found herself at a crossroads after losing her job. With her disabled daughter, who relies on a service dog for seizure support, she was living in a hotel room, rapidly exhausting savings and county social service resources. Unable to stay with family or access shelters due to the service dog, her situation grew increasingly dire. She also encountered complications in securing her early retirement benefits due to missing residence paperwork.

Her Molina case manager acted swiftly, initiating referrals for housing and employment, and connecting her to vital resources through community programs. Daily check-ins and collaboration with senior services helped identify additional support avenues. An attorney was engaged to address paperwork issues, and arrangements were made for her healthcare needs, including establishing a treatment plan for anxiety and facilitating weekly telehealth counseling.

These coordinated efforts resulted in extended hotel vouchers, allowing the member and her daughter to remain safely housed. She secured employment and is actively applying for permanent housing with assistance from senior services. The member’s anxiety is now managed with the help of her physician and ongoing counseling. Expressing gratitude, she shared, “Thank you for helping me and my daughter.”

Molina Member Story

Tue, 30 Dec 2025 23:48:42 GMT

Supporting Complex Mental And Physical Health

A 51-year-old female member living with multiple health challenges, including bipolar disorder, asthma, urinary incontinence, and hypertension, faced significant barriers in getting care. The member enrolled in case management to help manage her asthma and address gaps in specialist care for her complex conditions. The member was having difficulty communicating her needs to providers, and felt unheard and unsure of how to advocate for herself. She also required durable medical equipment (DME), such as a blood pressure monitor, incontinence supplies, and a nebulizer, but lacked support in obtaining these essentials.

With the help of her case manager, the member took comprehensive health assessments, received education information about which specialists could best address her diagnoses. The case manager arranged appointments with primary care, urology, psychiatry, mental health counseling, and DME suppliers. Telehealth options for behavioral health counseling were introduced, and assistance was given to secure needed medications and vaccinations. The member received vital DME supplies and started a new bipolar medication regimen.

As a result, the member gained confidence in discussing her conditions and advocating for her care. She reported feeling much better mentally and appreciated the support in connecting with providers and resources. Ultimately, she graduated from case management, having established a foundation for ongoing self-advocacy and engagement in her health journey.

BlueCross BlueShield Member Story

Tue, 30 Dec 2025 00:04:54 GMT

Men’s Health Matters: A Community Success Story

BCBSIL’s Community Engagement team recently teamed up with the Men’s Ministry at New Faith Baptist Church for their annual Men’s Health Summit—an event dedicated to shining a light on prostate and colorectal cancer, as well as mental health in the African American community. The theme, “Men’s Health Matters,” set the tone for a day focused on education, early detection, and access to care.

Glen Brooks, who leads our Men’s Health Program, spoke on behalf of BCBSIL and shared the importance of preventive screenings, especially for men ages 45 to 75. He helped break down the barriers around chronic illnesses like prostate and colon cancer by making sure attendees knew what resources were available to them—and that quality care is within reach.

In addition to Glen’s presentation, our team was on site engaging directly with attendees, answering questions, and distributing educational materials, cancer screening info, and BCBSIL-branded giveaways. In total, we connected with over 125 men, giving them tools to take charge of their health.

The feedback we received was overwhelmingly positive. Many attendees expressed that they felt more informed, supported, and motivated to take preventive steps in their own health journeys. This collaboration is a great example of how our Men’s Health & Wellness Program helps improve access to care and spread awareness in communities that need it most.

Thanks to this event, more men now feel empowered to seek early screenings and live healthier lives.

CountyCare Member Story

Wed, 17 Dec 2025 22:46:51 GMT

CountyCare Helps Member With A Neurological Disorder

Will* is a 57-year-old CountyCare member who receives in-home visits from a care coordinator to help manage his care.

During a visit, Will’s CountyCare care coordinator noticed an issue with his foot and suggested he go to the emergency department to get it checked. While Will appreciated the suggestion, he was not willing to go to the hospital at that time. Will’s care coordinator said that she would check up on Will to make sure his foot didn’t get worse.

The seasoned care coordinator ended up convincing Will to allow him to help secure an appointment and transportation to his primary care provider (PCP). The care coordinator reassured him that transportation would not cost him anything, and it would be available to him before and after the appointment. In the end, Will was sent to the emergency department directly from his PCP appointment and endured emergency surgery to address the issue with his foot.

Will shared his appreciation for his care coordinator and was extremely thankful that due to her persistence he resolved what turned out to be a serious health issue quickly before it turned into an even larger problem.

*Names and identifying details have been changed to protect anonymity.

Humana Member Story

Fri, 10 Oct 2025 22:04:30 GMT

Building A Safer Future With The Right Support System

J.M. is a resident of Rockford, IL, previously living with her aunt (who served as her Personal Assistant [PA]) and cousin in a ranch-style home. Due to her functional limitations and history of dizziness, she was approved for 87 hours per month of PA services for required assistance with bathing, grooming, household chores, laundry, meal preparation, shopping, medication management, and transportation. She is compliant with her medication regimen and sees her Primary Care Provider (PCP) every three months for physical and behavioral health management. J.M. maintains a high-protein, low-gluten, low-calorie diet and owns a small dog.

In January, J.M. reported increased symptoms of anxiety and depression and described her mood as “flat,” expressing intent to initiate behavioral therapy. By April, J.M. experienced significant discomfort living with her relatives and reported that her PA (aunt) was committing verbal, emotional, and financial abuse. Due to the stress of her home life and transportation issues, J.M. faced barriers to attending her medical appointments.

Once aware of the situation, J.M.’s care coordinator escalated her risk level to high. Following a crisis incident on April 29 where J.M. was the victim of verbal abuse and property damage, the care coordinator contacted Adult Protective Services (APS). Law enforcement was involved, and J.M. shared she felt unsafe.

J.M. terminated the PA relationship in May and transitioned to agency-provided homemaker services as APS began assisting with her housing search. In June, J.M. secured an extended order of protection against her former PA, valid through August.

On August 18, 2025, J.M. moved into a new apartment where she resides independently, receiving homemaker support via an agency. Her well-being has improved significantly since relocation and she is actively engaged in her care management, maintaining regular contact with her PCP and adhering to dietary guidelines. By having her care coordinator connect her to the support she needed, J.M. now reports feeling safe, comfortable and optimistic about her future.

BlueCross BlueShield Member Story

Mon, 29 Sep 2025 23:59:12 GMT

Overcoming Barriers In A New Country With Care Coordination

When Isabella arrived in the U.S., everything felt overwhelming. She was new to the country, had no support outside of her immediate family, and her husband had recently been in a car accident. She had little income, limited transportation, and a language barrier that made it difficult to navigate the U.S. healthcare system. On top of that, she was preparing for the arrival of her baby but had no crib or car seat and could not afford them. Due to a recent infection, as well as tuberculosis diagnosis, she needed medication but couldn’t pick it up due to lack of reliable transportation. She was also dealing with being billed incorrectly for her baby’s doctor visits, adding more stress.

Isabella was connected with a Care Coordinator through BCBSIL who immediately arranged a translator on the phone so she could share her needs in Russian. Together, they reviewed her postpartum care plan. The Care Coordinator connected Isabella with ModivCare for transportation to and from appointments and the pharmacy, and even arranged to have her antibiotics delivered to her home. They also referred her to Brave Health so she could begin receiving care virtually. Her Care Coordinator also went over how Medicaid works in Illinois and explained different social services she was eligible for.

Isabella was referred to Woman, Infants, and Children (WIC) so she could receive formula, as she was advised by her doctor to formula feed. WIC also provided breast pump in case she was cleared to breastfeed. To relieve financial strain, Special Beginnings provided her with a cribette, and connected to the Lurie Buckle Up program for a car seat. Finally, her Care Coordinator called the clinic directly to correct the billing issue so she no longer had to pay out of pocket for her baby’s well visits.

Thanks to this support, she felt reassured, equipped, and grateful. She was able to care for her baby safely while adjusting to life in a new country.

CountyCare Member Story

Mon, 29 Sep 2025 17:08:19 GMT

CountyCare Helps Member With A Neurological Disorder

Tom* is a 30-year-old CountyCare member who has a neurological disorder and is partially blind. Tom lives with his grandmother, Mary, who is his primary caregiver. During a conversation with Tom’s CountyCare care coordinator, Mary mentioned her desire to secure new housing to allow her and Tom better living conditions.

While Tom and Mary already had sufficient housing, their care coordinator went the extra mile by conducting research to investigate viable options to upgrade their living situation. The care coordinator shared information with Mary about the Chicago Housing Authority’s (CHA) Down Payment Assistance program and signed her up for an orientation session. After attending the orientation, Mary and Tom were able to get started on the process of buying a home. They applied for the program and waited anxiously for their application status from CHA.

Mary was able to secure new housing through the assistance program and contacted Tom’s care coordinator to tell him the good news! Mary thanked him for telling her about the program. He was thrilled that his research could play a small role in their non-medical victory.

*Names and identifying details have been changed to protect anonymity.

BlueCross BlueShield Member Story

Mon, 29 Sep 2025 00:24:14 GMT

Supporting A Mom Through Pregnancy Nutrition Needs

Samia* is a 32-year-old pregnant mom who has been living with type 1 diabetes. She was struggling to manage her nutritional needs during pregnancy. On top of her medical challenges, she had recently lost her job and was worried about affording specialized nutritional shakes her provider recommended. Her Care Coordinator referred her to the VHP Living 365 program for pregnancy and postpartum.

After her initial nutrition and health assessment, VHP determined that her goals were to improve her dietary habits during pregnancy and prepare for a safe delivery, while balancing a busy schedule and the demands of raising two young children.

Together, they reviewed her benefits and confirmed that her plan would cover the nutritional supplements her doctor prescribed. The team supported Samia with culturally relevant nutrition counseling, behavioral goal setting, and access to healthy food delivery through the Sweet Potato Patch program, removing barriers to healthy eating during a critical time. The Care Coordinator worked directly with Sweet Potato Patch and her provider’s office to make sure all the paperwork was in order, removing that stress from Samia’s plate.

Within a short time, she was approved for the nutritional shakes. Samia shared how relieved she felt knowing she wouldn’t have to choose between her health and her budget. She said the support made her feel confident that she could focus on her pregnancy and diabetes management without the added financial burden. Thanks to early referral from BCBSIL, Samia experienced a healthy delivery and a smooth postpartum recovery, despite a history of complications. She improved her eating habits, resumed physical activity, and gained confidence in managing her health.

Through nutrition counseling, meal delivery via Sweet Potato Patch, and consistent follow-up, Samia stayed engaged in her care. This consistent engagement helped her build healthier habits, stay consistent, and feel more confident in caring for herself and her baby.

Humana Member Story

Mon, 07 Jul 2025 16:27:28 GMT

Rebuilding Trust And Independence

Through Compassionate Care Coordination

History: 54 yr old member had been unable to contact since June 2024

Barriers: We reached Ms. T in February 2025, and shared that she is currently morbidly obese (approx. 500 lbs). Ms. T added, “my apartment has become my island, I haven't left it in 3 years, and I never leave this chair except to use the bathroom or microwave food. I saw my doctor about a year ago, and the doctor was not very happy with me and my weight. I felt (fat) shamed and I never went back. I can only walk a few steps with a walker, and I can hear my knees crushing and cracking from my weight."

Ms. T has vitiligo on her hands and face, with her face being most severe. Ms. T stated this added further to her shame when leaving the house. The assigned care coordinator, Sue, empathized and connected with the member first. Ms. T felt comfortable in asking Sue she had ever seen the show Hoarders and self-identified with that. Ms. T’s friend Mary was with her during the call and noted she had helped clean Ms. T’s whole apartment to the best of her ability.

Ms. T shared her biggest concerns were getting help at home with ADL's and seeing a psychiatrist for depression. She stated, “no one has visibility on what I look like, people only see my arm and hear my voice as I collect food at the apartment door.” Ms. T added, “my phone is my only method of communication with family, and they all live out of state.” She also reported she is afraid to fall due to broken discs, painful knees and right side that is swollen, and painful.

She shared additional hygiene issues because she can no longer shower by herself. Ms. T reported that her only friend Mary is a certified nurse’s aide and helps with getting up and prepping healthy meals, but requested that she use, "all the help I can get in the home". Ms. T shared she is depressed and has been agoraphobic now for 3 years. She had a psychiatrist, but did not like him and had stopped going.

Interventions: Our care coordinator, Sue, praised Ms. T for opening up and sharing her situation, assuring her that there is no shame in sharing her story. Sue continued to provide reassurance that together with our social work team, we can provide additional resources to support her.

Sue verified with Ms. T that the house is currently clean and clutter-free with the assistance of friend Mary, allowing Ms. T to freely move around as needed without the risk of falls. Sue offered to refer Ms. T to work with a peer, Nurse Care Manager Anita, to assess needs, follow up more frequently, and offer face-to-face assessment. Sue educated Ms. T on additional resources and assistance around medical appointments and transportation. Sue educated Ms. T on our partner Carelon and the importance of initiating a consultation for a psychiatrist, to which she agreed. Sue collaborated with our social worker Evelyn following the call, who outreached Ms. T and completed the social worker’s Needs Survey. Evelyn then referred her to the Department of Rehabilitation for in-home support. Ms. T verified her contact information and was assisted by Evelyn on the process for applying for in-home services.

Outcomes: Sue was able to build rapport and re-engage with Ms. T. With the help of our social worker, Evelyn, Ms. T has initiated the process for in-home waiver services. Ms. T has received a list of psychiatrists from the Carelon consultation and has been reassigned to a nurse care manager who is better suited to work with her based on her current needs. With addressing Ms. T’s top two priorities first, she agreed to a follow-up call by her new nurse care manager, Anita, who was able to complete health risk assessment and further assist Ms. T with additional resources and support.

Humana Member Story

Mon, 07 Jul 2025 16:21:27 GMT

Supporting A Non-English-Speaking

Senior With Complex Health Needs

Medical/Behavioral History: High cholesterol, Hypertension, Diabetes, Hypothyroid, Osteoarthritis, GERD, Chronic Kidney Disease, Overactive Bladder

History: Ms. L. is a 66-year-old female who speaks the Urdu language and requires the assistance of an interpreter on calls. She became engaged with her care coordinator Amy in November of 2024. During her initial assessment Ms. L discussed her diabetes and stated she did not check her blood glucose at home. She also stated she believed her Primary Care Provider was going to order a continuous glucose monitor but was not sure and did not have any updates from them. She was also working with her provider on obtaining diabetic shoes.

Barriers: This member does not speak English, was newly effective with the Integrated Medicare-Medicare plan, and did not understand the health system well enough to navigate the coordination of her care needs. In addition, she maintained the same Primary Care Provider, but with the plan change required some additional follow-ups with referrals started prior to her new coverage.

Interventions: After their initial call, the care coordinator Amy, began working on assisting the member with her stated needs. In December, Amy followed up with the PCP office, who advised they sent the referral for a continuous glucose monitoring system back in August. Amy advised the office that with the plan change in October, the referrals will need to be sent again.

On the next follow up call with Ms. L in February, she advised that she had completed her diabetic shoe fitting and was recently told it would be a few more weeks until they are ready. Amy verified that an authorization for the shoes was approved in January. The member mentioned she did not have a working blood pressure cuff to take her blood pressure at home. Amy placed a referral to a DME company to provide Ms. L a blood pressure machine for hypertension management. The member also requested assistance with getting refills on her medications. One of the member’s diabetes medications did not have a refill and Amy offered to discuss this with her PCP office. Amy outreached the primary care office staff who advised the member needs to come in for their 3-month evaluation in person, as her last visit with virtual. Amy followed up with the member to advise of the need for an in-person appointment which was scheduled for March 4, 2025. Due to concern of lapse in her diabetes medication, the office advised they would send an urgent message to the doctor. The PCP did submit a refill to prevent the member from running out of medication prior to the scheduled appointment.

In early March, Amy followed up with the Ms. L. She reported that she did attend her scheduled PCP appointment, and the PCP did not feel a CGM was necessary anymore, but did prescribe diabetic testing supplies as the recommendation for blood sugar management. Ms. L advised that she received a call that her new diabetic shoes were ready and asked for transportation. Amy assisted Ms. L with setting up her transportation for the appointment on 3/6/25 to pick up her new diabetic shoes.

Outcome: The Care Coordinator Amy has worked to build a great rapport with Ms. L in a short 4-month time span and has made great progress in her health goals. With the Care Coordinator’s assistance Ms. L has been able to obtain the necessary supplies, equipment, medications, and knowledge to better manage her conditions.

The member has obtained her diabetic shoes as well as blood glucose testing supplies. She has been able to obtain her medications without any gaps in usage. Additionally, her A1C labs have shown improvement from 6.2% down to 6% during this time.

CountyCare Member Story

Tue, 01 Jul 2025 16:31:28 GMT

CountyCare Helps Member With Autism

Ashley* is a 4-year-old CountyCare member living with autism. Ashley is sensitive to food textures making it difficult for her to eat. During an appointment with her primary care provider (PCP) they discussed concerns regarding Ashley’s development. A treatment discussed was adding PediaSure, a nutrient-dense and caloric-filled drink, to Ashley’s diet.

Over the next several months, Ashley’s mom was thrilled that she took so well to PediaSure but was concerned with the ongoing costs as it was one of the few things Ashley was able to tolerate. She shared her financial concerns with her CountyCare care coordinator who checked to see if PediaSure was a covered benefit. It was confirmed that since PediaSure was medically necessary, it could be covered if there was a prescription from her PCP.

Ashley’s mom reports that she obtained the prescription and is thankful for the financial relief and monthly shipments of PediaSure - more importantly she is thrilled to see her daughter thriving.

*Names and identifying details have been changed to protect anonymity.

BlueCross BlueShield Member Story

Mon, 30 Jun 2025 16:38:45 GMT

Men's Helath Matters: A Community Success Story

Thanks to this event, more men now feel empowered to seek early screenings and live healthier lives.

BlueCross BlueShield Member Story

Mon, 30 Jun 2025 16:36:23 GMT

Helping Taneka Find Hope With Specialized Care

Taneka, A 31-year-old member living in DuPage County had been managing a rare neurological condition called Mitochondrial Disorder since she was a teenager. Although she had a personal assistant through the Department of Rehabilitation Services and support from her family, she had not seen a neurologist familiar with her condition since her original pediatric specialist. For over 13 years, her family had struggled to find a provider who understood how to treat her specific diagnosis. Most doctors she saw focused only on treating her related conditions and avoided addressing the disorder itself.

While supporting another member with Muscular Dystrophy, a Case Management Specialist realized that Mitochondrial Disorders fall within the same clinical category. That discovery sparked new hope. The specialist began making calls to several organizations, including the Muscular Dystrophy Association, the Mitochondrial Disorder Support Association, and the University of Illinois Muscular Dystrophy Clinic.

After thorough outreach, the Case Management Specialist found a neurologist at the UIC Neurology Clinic who specializes in Mitochondrial Disorders. They worked with the member’s primary care provider to secure the necessary referral and arranged transportation for Taneka, her mother, and her service dog to make the visit possible. They also supported Taneka’s mother, who serves as her power of attorney, in navigating the appointment scheduling process.

Now, for the first time in over a decade, Taneka and her family are feeling hopeful. They are excited to meet a provider who understands her condition and looking forward to having a care plan tailored to her needs.

BlueCross BlueShield Member Story

Mon, 30 Jun 2025 16:33:51 GMT

DME Support For A Member With Autism

Tom is a 17-year-old member in Cook County who has Autism and multiple medical needs. He was recently enrolled in the Autism Care Coordination Specialty Program. His mother, who is also his primary caregiver and power of attorney, shared that she had been paying out-of-pocket for his specialized nutritional shakes and incontinence supplies for years. Due to juggling his appointments and daily care, she didn’t have the time or energy to search for alternatives.

The BCBSIL Case Management Specialist stepped in and worked closely with both Tom’s mother and various DME support teams to track down vendors that could meet his specific needs, including finding the right size for incontinence supplies that weren’t readily available through the main suppliers. They also made sure any requests went through the correct providers.

The BCBSIL team also explained that their OTC benefits could cover wipes, which was another ongoing expense the family had been handling on their own.

Just recently, the family got the good news that the nutritional shakes were approved. Tom’s mom was so relieved to be saving nearly $100 a month. She shared how grateful she was and said she finally felt confident that they could get the help they needed moving forward. Now, her son has the supplies he needs to stay safe and well cared for at home.

Aetna Member Story

Tue, 03 Jun 2025 21:41:52 GMT

Bridging Smiles For Emma

Emma*, a 4-year-old experiencing chronic dental pain, was in urgent need of oral surgery under general anesthesia due to the complexity of the required procedures. However, no in-network providers within 120 miles could accommodate her. Her family and DentaQuest’s provider search had reached a standstill.

ACM Ashley Boyles initiated an out-of-network search with DentaQuest and escalated the case to leadership. Although a provider was found an hour away, Andrea continued advocating for a more convenient and familiar option due to Emma’s young age. She identified a local dental office that had treated Emma previously and submitted the information to DentaQuest, who successfully engaged the provider in a single case agreement (SCA).

During planning, it became clear that a separate SCA was also required for anesthesia services. RN Case Manager Carla Mendoza collaborated with utilization management, contracting, and the DentaQuest team to finalize agreements with both the dental and anesthesiology providers.

The SCAs were approved, and Emma was scheduled for oral surgery with access to general anesthesia - providing much-needed relief and care close to home.

*Member name changed to protect privacy

Aetna Member Story

Tue, 03 Jun 2025 21:38:28 GMT

A Life-Saving Call For Michelle

ICM received an urgent report from a HUB ACM that during an outreach call, Michelle* - who had no prior behavioral health history but a record of uncontrolled type 1 diabetes - sounded incoherent and was unable to provide her location. Michelle also had no stable address on file due to ongoing housing insecurity.

The team needed to identify Michelle’s location immediately and send emergency services to ensure her safety.

The ICM team sprang into action. Gina attempted to call Michelle back without success, while Froilan searched the member file for any prior addresses. Simultaneously, Gina contacted Michelle’s emergency contact and Latoya continued active outreach. Latoya successfully reached Michelle and confirmed her address, conferencing in Gina to stay on the line. As Michelle’s condition was deteriorating, Froilan contacted EMS while Latoya and Gina kept her calm until help arrived.

EMS transported Michelle to the ER, where she was treated for diabetic ketoacidosis - a life-threatening emergency. The following day, Latoya re-established case management with Michelle, who expressed deep gratitude and agreed to work on managing her diabetes. Michelle later said, “Latoya and her team saved my life.”

*Member name changed to protect privacy

Aetna Member Story

Tue, 03 Jun 2025 21:36:55 GMT

Reversing Diabetes - Daniel’s Journey

Daniel*, a healthcare worker who educates patients about diabetes, was unexpectedly diagnosed with the condition himself in December 2024 with an A1c of 14. The diagnosis was overwhelming - Daniel lacked a primary care provider, access to medical tools and struggled to apply his professional knowledge to his personal health.

Case Manager Jessica Hartmann stepped in with compassionate guidance. She helped Daniel securean in-network PCP and coordinated closely with the provider’s office to ensure he had a glucose monitor, medications and tailored diabetic education. Jessica maintained regular communication to support Daniel emotionally and logistically, ensuring his access to ongoing care and resources.

Within five months, Daniel’s A1c dropped from 14 to 5.4 - no longer in the diabetic range. He developed a strong relationship with his PCP, significantly improved his diet, and lost weight. Daniel is now energized to continue his wellness journey and serves as a real-life example of the power of proactive care and determination.

*Member name changed to protect privacy

Molina Member Story

Tue, 03 Jun 2025 21:00:14 GMT

Meet Lynette

Lynette is a 62-year-old- woman from central Illinois. Lynette was diagnosed with Chiari Malformation and a brain injury that impacted neuromuscular function. Lynette was scheduled for brain surgery. Lynette also faced depression, nerve problems, muscle weakness and frequent headaches. These conditions were causing difficulty in Lynette’s daily life. Lynette lives alone and also has poor vision, which makes her a fall risk. Lynette reached out to the Molina case management team to get help.

Getting Help

Molina case management helped Lynette by providing education on the Illinois Department of Aging application process. Since Lynette was having brain surgery – a homemaker would be required to aid in her recovery. Lynette’s waiver application was received and processed. Lynette’s needs were assessed and her case manager helped through the waiver process. Lynette’s waiver request was approved and the team developed a comprhensive care plan around her daily needs, depression, vision issues and headaches.

Now

Lynette is awaiting her brain surgery. Lynette’s case manager worked with a DME agency to get her a shower chair and set up local therapy appointments to assist with behavioral health needs. Lynette’s waiver services were approved, and she utilizes homemaker services to meet her daily needs and improve her chronic conditions. Lynette is able to stay in her home because of the addition of durable medical equipment at home. Lynette is grateful to be her home and to have help with her needs. “I am so grateful this was taken care of right away,” Lynette said. “You don’t even know how much this means to me. I was so scared to go to a nursing home.”

Molina Member Story

Mon, 24 Mar 2025 21:21:33 GMT

Meet Olivia

Olivia is a 50-year-old woman from Vermillion County. Olivia was having a hard time communicating with her case manager. She needed help with getting dental care and needed dentures. The issue was affecting her daily life. She was having a hard time eating and maintaining proper nutrition. She also reported difficulty getting food and transportation.

Getting Help

Olivia’s Molina case manager stayed persistent in contacting her. Her case manager contacted its dental vendor to inquire about dentures. The case manager connected her with a local dentist to help with the process. Furthermore, the case manager connected Olivia with some local food pantries and other resources.

Now

Olivia followed through with her dentist and received her dentures. She reports its easier to chew now. Olivia has been using Molina’s transportation vendor to get to and from appointments. Olivia continues to improve. Olivia recently called her case manager to thank them for all the help she received.

Molina Member Story

Mon, 24 Mar 2025 20:57:28 GMT

Meet Tommy

Tommy is a 51-year-old man living in Cook County. Tommy was faced with a life-threatening situation when he experienced sudden cardiac arrest. After the event, Tommy was diagnosed with multiple health conditions including diabetes, obesity, and hypertension. Tommy also had an infection in his mouth due to tooth decay which was preventing him from having necessary heart surgery. Tommy’s condition was further complicated by anoxic brain injury, which had led to verbal and cognitive dysfunction. Because of this, Tommy’s family was worried they would be unable to care for him at home and began considering long-term placement as its only option.

Getting Help

A Molina case manager began working closely with the hospital to help with discharge planning and coordinating care. The case manager worked with hospital staff and obtained Tommy’s Power of Attorney documentation and explained his health benefits and case management services. The Molina case manager helped Tommy receive dental care – clearing the dental infection – which allowed him to get his triple bypass heart surgery. Tommy’s case manager provided support each day, helped arrange discharge appointments, secured home health services as well as durable medical equipment and medications. Tommy’s case manager also helped with applications for SSDI Benefits, a LINK card, and DRS assistance. Tommy worked with his case manager to get transportation to and from his medical and dental appointments.

Now

Tommy has regained his strength and has returned to his home with in-home health services. Tommy never had to go to a long-term facility. Tommy’s sister moved in his home with him to help provide oversight and safety. Tommy’s diabetes and blood pressure have stabilized. He has now lost over 100 pounds and no longer needs a wheelchair. Tommy continues to go to therapy, which has increased his cognitive ability and his mobility. Tommy continued to progress. Tommy became independent in daily activities. He and his sister decided that he doesn’t need waiver services anymore. Tommy continues to seek the medical care her needs. “I never knew an insurance company would help me so much,” Tommy said. “Thank for you being a caring case manager.”

Molina Member Story

Mon, 24 Mar 2025 20:55:51 GMT

Meet Danny

Danny is a 27-year-old man from central Illinois. Danny has diagnoses of schizophrenia, bipolar disorder, depression, sleep disorder, and borderline personality disorder. Danny also has a history of substance abuse and incarceration which has been difficult for him. Danny lives with his parents and grandfather. Danny provided caregiver assistance but struggled with his mental health and wasn’t working with behavioral health providers. Danny was having a hard time obtaining a social security card and identification because of his recent release from jail. He found his psychiatrist to be judgmental. He felt unsafe in their care and was worried about relapsing into substance use because of stress.

Getting Help

Danny began working with a Molina case manager. The case manager talked with Danny about his needs and provided a list of new psychiatrists and psychologists for counseling services. Danny’s case manager helped him set up appointments, connect with some local AA meetings, and educated him on the process for obtaining a new ID and social security card.

Now

Danny is now established with a new psychiatrist and psychologist and maintains his sobriety with the help of his local AA meetings. He obtained the documents he needed, including his court order, birth certificate, medical bills, disability letter, and W2 forms to obtain his new identification documents. He now has a new ID and social security card. Danny bought a car after working with his case manager to access funds from a former job. He uses it to help his parents and grandfather get to appointments. Danny feels more confident in managing his health needs. He continues to maintain his sobriety and stay positive about his future.

Molina Member Story

Mon, 24 Mar 2025 20:52:48 GMT

Meet Elias

Elias is a 39-year-old man from Cook County. Elias was in a car accident that left him paralyzed from the neck down. He had a lot of challenges in his life. Elias was relocating from Springfield to Chicago and needed help obtaining services. He needed a new primary care psychic and dentist; he needed medical supplies, and home health services, and he needed to make his home accessible.

Getting Help

Elias worked with his Molina case manager. They collaborated with agencies to get DME supplies and home health services. Elias and his case manager found a new primary care physician and new dentist. At home, Elias needed a lift system installed in his home, but the home’s electrical system wasn’t powerful enough to accommodate the system. The City of Chicago worked with Elias to provide a grant system to be installed but could not upgrade the electrical system as part of the program.

Elias’ Molina case manager helped him utilize a waiver home modification benefit to receive an upgrade to his home’s electrical system. The Molina case manager helped enroll an electrician as a Medicaid service provider. The project was completed with help from Molina’s case management team, the Molina Provider Network team and the Department of Rehabilitation Services. Elias’ home now had an upgraded electrical system that could handle the lift he needed.

Now

Elias’ home lift was installed successfully and he utilizes it to be more independent at home. Elias thanked the case manager for their knowledge, professionalism and hard work.

CountyCare Member Story

Tue, 04 Mar 2025 21:25:39 GMT

CountyCare And Community Partners Help Member With Redetermination

Mike* is a CountyCare member who is currently receiving treatment at a local children’s hospital.

A hospital nurse coordinator was arranging transportation for Mike for an important upcoming appointment when she encountered an unexpected roadblock: Mike had lost his CountyCare coverage.

Recognizing the urgency, she quickly contacted Mike’s CountyCare care coordinator to explain the situation. Collectively, they determined that Mike’s redetermination paperwork was received a day late, but that he still had coverage through the end of the month allowing them to schedule the necessary transportation. In addition, they provided guidance to Mike’s parents that they needed to go to their local Department of Human Services (DHS) office to expedite new paperwork.

Mike’s parents wasted no time taking the necessary steps to complete the proper redetermination paperwork for Mike to stay with CountyCare. The team’s swift response and collaboration ensured that Mike wouldn’t miss his critical appointment – and that his Medicaid coverage would stay with CountyCare until he was up for redetermination.

*Names and identifying details have been changed to protect anonymity.

Aetna Member Story

Fri, 28 Feb 2025 21:32:34 GMT

A Member’s Journey To Peace Of Mind

Medicaid member, Laura*, who requires dialysis three times a week was unable to secure a ride to her doctor, as she was incorrectly marked ineligible in the ModivCare system. Laura’s son had to take her to her appointments at 5:30 AM, causing significant stress for both. An Aetna Better Health® of Illinois case manager (CM) worked with the transportation liaison, who found an incorrect code in Laura’s file that prevented her from accessing transportation benefits. Once the code was corrected, Laura was successfully scheduled for roundtrip transportation to her dialysis appointments.

When Laura faced an issue where she was being dropped off too early, leaving her waiting outside in the cold, the CM stepped in.

The CM escalated the concern to a ModivCare supervisor, who coordinated with the driver to adjust the pickup and drop-off times. After follow-ups, Laura confirmed that her transportation was running smoothly. As a result, her quality of life has improved, and she no longer worries about how she will get to her dialysis treatments. She now has a standing transportation order that renews monthly, giving her peace of mind and independence in managing her appointments. Laura expressed satisfaction with the care coordination and follow-up provided by her CM.

*Member name changed to protect privacy

Aetna Member Story

Fri, 28 Feb 2025 21:31:04 GMT

Balancing Work And Treatment

Tom*, is an Aetna Better Health® of Illinois member who receives four-hour infusions Monday through Friday. This created a major challenge when Tom secured a full-time job. Unable to continue his infusions during regular hours, Tom sought an alternative that would allow him to keep his job while receiving the necessary treatment. The care coordinator researched Tom’s infusions, consulted with a team lead nurse, and explored alternative treatment locations with flexible hours.

After conducting extensive outreach through provider networks and online searches, the care coordinator found a provider who accepted Tom’s insurance and offered Saturday infusion hours. She connected with the infusion provider and Tom’s oncologist/allergist to ensure a smooth transition. As a result, Tom successfully maintained his full-time job while continuing his critical treatment. In a follow-up conversation in January 2025, Tom expressed his gratitude, stating he was extremely happy with the outcome and calling the care coordinator the “MVP” for making it all possible.

*Member name changed to protect privacy

Aetna Member Story

Fri, 28 Feb 2025 21:29:11 GMT

A Holisitc Approach To Mental And Physical Health

John is an Aetna Better Health® of Illinois member who was diagnosed with schizophrenia and severe malnourishment-related conditions, John had been unhoused for five years and was frequently hospitalized due to his mental and physical health instability.

Resistant to mental health treatment, including medication management, John’s condition continued to deteriorate, leading to an extended hospital stay. To support him, his Aetna case manager (CM) conducted weekly outreach to build a trusting relationship and made a referral to Brave Health, where he engaged in an intake appointment. The CM also provided nutritional supplements, arranged transportation through ModivCare for medical visits, and offered education on his condition and medication options. Recognizing his resistance to treatment, the CM also made a connection with Collaborative Bridges, whose rep visited him in the hospital and helped establish a support system.

During John’s hospitalization, the CM worked closely with the hospital psychiatrist and social worker to advocate for a long-acting injectable (LAI) medication, which John received before discharge. The CM also coordinated with ACCESS Healthcare to ensure a follow-up outpatient appointment for continued LAI treatment. As a result, John is now living with his mother and engaging with his CM from Collaborative Bridges. He has attended a post-discharge appointment with his primary care provider and has a scheduled follow-up for his monthly injection, marking a significant step toward stability and improved health.

*Member name changed to protect privacy

CountyCare Member Story

Thu, 20 Feb 2025 21:23:08 GMT

CountyCare Helps Member Overcome Health Care And SDOH Challenges

Jose* is a Spanish-speaking 66-year-old who joined CountyCare through the Health Benefits for Immigrant Seniors (HBIS) program. He lives with impaired vision, has heart issues, and was recently diagnosed as pre-diabetic.

The CountyCare care management team contacted Jose, and determined he would benefit from assistance in navigating the health care system, securing housing and managing his health conditions with the help of a translator. Not only did the care management team assist in scheduling the necessary doctor’s appointments, but they also made sure Jose understood how to reschedule or cancel if needed. This simple, yet crucial step, gave the member confidence knowing he could manage his health care needs more independently in the future.

By coordinating care with Jose’s providers, the care management team ensured that his treatments for high blood pressure and being pre-diabetic were consistently monitored and updated as needed.

Finally, the team assisted Jose and his family with applying for housing through the Chicago Housing Authority to secure safe, stable and affordable housing.

Once the care coordination team addressed the language barrier, Jose is now comfortable contacting his care coordinator with questions and support. Jose expressed gratitude at being able to attend and manage appointments and receive care for his medical conditions.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Wed, 13 Nov 2024 02:23:57 GMT

CountyCare Helps Member With Upcoming Surgery

Stephanie* is a 25-year-old CountyCare member who had a recent emergency room (ER) visit during which she was prescribed medications for an upcoming surgery. During a routine ER visit follow-up call, the CountyCare Care Coordinator conducted a medication reconciliation and soon realized the member did not recall being prescribed medications.

The Care Coordinator found out that Stephanie was scheduled to have surgery in the coming month and that the prescribed medications must be taken prior to the surgery. The Care Coordinator contacted the doctor’s office to confirm the medications on file and any other information the member might need.

The Care Coordinator took the time to explain to Stephanie the importance of taking her preoperative medications. Thanks to the Care Coordinator following up with Stephanie after her ER visit, Stephanie was able to take her preoperative medications to ensure the necessary surgery could take place. This is just one example of how a phone call can make a world of difference in the lives of our members.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Wed, 13 Nov 2024 02:22:21 GMT

CountyCare Helps A New Mom

Natalie* is a 30-year-old CountyCare member who gave birth to a premature baby boy when she was 32 weeks pregnant. Her baby spent time in the NICU due to a few complications including trouble with feeding. Due to the baby’s extended stay in the NICU, Natalie was not able to work and was at risk of losing her apartment. Natalie shared her situation and concerns that she was at risk of eviction with her CountyCare Care Coordinator. Natalie was worried that she would not have a place to bring her baby home.

Her Care Coordinator sprang into action and referred Natalie to Legal Aid Chicago and signed her up to receive Foodsmart benefits that include nutritional support and money for groceries. Her Care Coordinator worked with Natalie to make sure that once the baby was able to leave the hospital, they would be able to follow up with all the appointments for her and her baby.

With the help of Legal Aid Chicago and other eviction resources, Natalie and her landlord came to an agreement for her to stay in the apartment while she looked for a new place to live. Thanks to the support Natalie received from her Care Coordinator on her housing issues, she is happy to report that she secured a part-time job and is on track with the rent at her new apartment.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Wed, 13 Nov 2024 02:19:43 GMT

CountyCare Helps Member With Foodsmart

Anthony* is a CountyCare member who was born with craniofacial abnormalities. He has been with the Division of Specialized Care for Children (DSCC) for nearly a decade and has gone through various surgeries and requires a vigorous treatment plan due to his condition. His family is currently going through financial hardship and reached out to their Care Coordinator because they needed help with securing food.

Anthony’s dad called their DSCC Care Coordinator to explain that while the cost of groceries has increased, their budget has not, and they were struggling to feed the family. Having previous experience with the Foodsmart reward, the family inquired if Foodsmart was still an option for them.

Their Care Coordinator was able to quickly place a Foodsmart order for the family to receive access to emergency meals. Within hours, the family received a call saying that their food was on the way. The Care Coordinator was thrilled to be able to connect them to a service to secure food and take away one worry for a family trying to care for a child with special needs.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Wed, 13 Nov 2024 02:17:34 GMT

CountyCare Helps Member With Alcohol Use Disorder

Rob* is a 52-year-old CountyCare member with multiple chronic conditions who is unemployed and lives with family. He has been diagnosed with mental health issues, diabetes, and alcohol use disorder. Rob has neglected his health in the past years leading to a worsening of his conditions.

Rob’s CountyCare Care Coordinator met with him in person at his local clinic. This in-person meeting built a great foundation for a trusting relationship. During the weeks that followed, the Care Coordinator was able to help schedule appointments to assist in managing his chronic conditions, refer him to specialists, and provide diabetes program information including diet adherence and the importance of monitoring blood sugars.

With continuous communication and support along the way, the Care Coordinator monitored progress and saw improvements in Rob’s health.

*Names and identifying details have been changed to protect anonymity.

Molina Member Story

Tue, 12 Nov 2024 02:35:41 GMT

Meet Jericho

Jericho is a 71-year-old man from Central Illinois. He was recently discharged from a long-term care stay facility. While there, Jericho had one of his legs amputated, and after arriving home, he was having difficulty with activities of daily living.

Molina Steps In

Molina case management contacted Jericho and scheduled a home visit. When the case manager arrived, they found Jericho had fallen and was alone. The case manager called for emergency services and remained with Jericho until he was transported for evaluation.

The Response

Jericho was treated at the hospital and was discharged. The Molina case managed met with him after discharge and confirmed an emergency health response system was installed. The Molina case manager also connected Jericho with resources and ensured he received his prosthetists and worked with his caregiver to help support his activities of daily living.

Now

Jericho has been working with his therapist and has acclimated to his prosthesis. He hasn’t fallen anymore and says he is more independent, and his quality of life has improved.

Meridian Member Story

Tue, 05 Nov 2024 02:44:38 GMT

Unhoused Mother And Son Receive Important Assistance To Achieve Housing

In March 2024, Jennifer, a Meridian Medicaid Plan member, connected with Lourdes, Community Resource Coordinator, after determining the state of the member’s living status. Jennifer and her adult son had a history of challenges regarding housing, utilities, and health issues, including chronic pain and injury. Given her unhoused status and disability, she was referred to multiple assistance programs through the help of her coordinator for support to their health-related social needs. Jennifer was initially referred to have hand surgery to improve her limited mobility, which made it difficult for her to stay at a shelter because post-surgery recovery did not allow her to take care of herself. Lourdes connected her to a local organization that assisted in connecting Jennifer to the transportation and housing resources she needed. One month later, Jennifer provided her community resource coordinator, Lourdes with an update. The member shared that while she was able to attend her housing appointments, she was lacking the required documents to secure an apartment unit.

Lourdes swiftly worked alongside local organizations to obtain the necessary information needed for Jennifer’s housing interview. This helped Jennifer secure low-income housing. After Jennifer was approved for an apartment, she found that she lacked the funds to get started. Lourdes contacted multiple services for assistance and secured funding for Jennifer to pay her deposit, the first month’s rent, and an outstanding electricity bill.

Jennifer continues to live in safe and stable housing along with support to pay for her utilities. Jennifer thanks Lourdes for all the health-related and health services and support she has received from Meridian, especially during her housing and financial hardships.

Aetna Member Story

Wed, 30 Oct 2024 01:37:32 GMT

From Homeless To Hopeful

At 23 years old, David* has complex behavioral and physical health needs, including a diagnosis of schizophrenia and medical conditions caused by malnourishment. He had been living in a tent for the past five years, with frequent hospitalizations for both physical and mental health issues. Due to limited resources and significant resistance to support, David found it challenging to accept behavioral and physical health interventions.

A care manager at Aetna Better Health of Illinois, Stefany*, reached out to David at least once a week to build a trusting, therapeutic relationship. Before his most recent hospitalization, Stefany referred David to Brave Health, where he completed an intake appointment. Recognizing his nutritional needs, she also arranged for nutritional supplement drinks to support his health. And she helped schedule Modivcare rides to ensure David could attend his medical appointments. They worked together to address his resistance to therapeutic support, with Stefany providing education about his mental health condition and the importance of managing his medications.

Stefany also introduced David to Collaborative Bridges, a network of three agencies that supports mental health needs on Chicago’s West side. She obtained David’s permission to make a referral. When he was hospitalized, Collaborative Bridges was notified and agreed to visit David there, building a relationship and offering support. Through this connection, David began engaging with C4—a program that provides a caseworker to help him navigate resources, such as completing his SSI paperwork. They provided home visits and are working to connect David with resources to promote consistent treatment engagement and reduce future hospitalizations.

Since his discharge, David has moved in with his mother and continues working with his caseworker from Collaborative Bridges. He has attended a follow-up appointment with his primary care provider, is taking his medicine and is now living a healthier and more stable life.

*Member name changed to protect privacy

Aetna Member Story

Wed, 30 Oct 2024 01:32:11 GMT

A Helping Hand In Difficult Time

Blake* is an Aetna Better Health® of Illinois member with a progressive neurological diagnosis. His mother was concerned about his recent weight loss. She thought Blake may need parenteral nutrition but wasn’t sure about using a feeding tube. She also worried that the weight loss might indicate Blake’s health condition was progressing.

Karla*, an Aetna care manager, learned from Blake’s mother that he liked Boost, but the cost made it difficult for her to continue purchasing it. Karla worked closely with Blake’s parents and his health care specialists to find a solution. They were able to obtain oral nutritional supplements that Blake was able to take. Karla also worked with his parents and health care specialist’s office to place him on a waiting list for a primary care provider who would help consolidate his care into a cohesive team — making his appointments more manageable for his parents.

This allowed Blake to continue receiving care from his specialists, and to obtain nutritional supplements covered by Aetna. Blake experienced a healthy weight gain — going from 60 to 80 pounds — and has now graduated from care management. Blake’s family expressed gratitude to Karla, saying they would miss her assistance, which had been incredibly helpful throughout the process.

*Member name changed to protect privacy

Aetna Member Story

Wed, 30 Oct 2024 01:30:03 GMT

Communication Is Key

In August 2024, Rodney* became eligible for the Pathways to Success program to support his behavioral health. His Aetna Better Health® of Illinois care manager, Anna, reached out to his mother to begin the process. But Rodney’s mother had questions. She had been told during a recent health visit that other insurance benefits were showing up on Rodney’s file and she needed to get the issue resolved to order Rodney’s medicines.

Anna was able to confirm Rodney’s Aetna® insurance coverage with the state. She worked with the appropriate contacts to remove the incorrect insurance information from his file. Anna let Rodney and his mother know that they could now obtain his medicines and services at their preferred location using his Aetna benefits. She also called the pharmacy to confirm that Rodney’s medications would be processed through Aetna. As an additional step, Anna contacted Rodney’s health care provider to inform them of his correct insurance information.

Rodney received his necessary medication, and his mother expressed her gratitude to Anna and other Aetna staff for their helpful support.

*Member name changed to protect privacy

Aetna Member Story

Wed, 30 Oct 2024 01:24:56 GMT

Easier Breathing

Louis* is an Aetna Better Health® of Illinois members who was in the hospital due to an asthma exacerbation. When his parents spoke with the care manager, Terry*, they explained that the tubing for their son’s nebulizer was broken, and they needed a new machine. Terry reached out to the medical equipment provider to order a replacement, but the company required an order from the primary care provider (PCP) to initiate the process.

Terry made multiple calls to the member’s PCP office about the issue. After nearly a month of persistent follow ups, she received the required order and sent it to the medical supplier. Due to Terry’s efforts, Louis received a new nebulizer machine. Since then, he has not returned to the emergency department.reached out to see how she was doing.

*Member name changed to protect privacy

Aetna Member Story

Sat, 31 Aug 2024 00:18:24 GMT

Supporting A High-Risk Pregnancy

Melissa*, a registered nurse care manager at Aetna Better Health® of Illinois, received a referral for a member who was 29 weeks pregnant. Kathy* was experiencing her first pregnancy but was facing complications related to epilepsy/seizure disorder, hyperemesis, baby growth issues, and significant weight loss.

Kathy is a single parent who couldn’t work due to her health. She had lost 40 pounds since the beginning of her pregnancy. The baby's father was involved but provided minimal financial support. Kathy didn’t have reliable transportation and was not able to obtain essential baby supplies due to her financial situation.

Melissa knew that Kathy was feeling overwhelmed by her health and financial challenges She provided Kathy with information on transportation benefits and community resources for baby supplies. Melissa also reviewed the value-added benefits Kathy could receive as an Aetna Better Health member, including a car seat and diaper bag. Melissa helped verify Kathy’s eligibility, resulting in the approval for a car seat and diaper bag. Kathy expressed her gratitude for the assistance. During the next follow-up, Kathy confirmed receiving both items and had also obtained other supplies for her baby through the resources Melissa shared.

Kathy delivered a healthy baby boy, and both she and the baby are doing well. Kathy continues to be engaged in case management, with Melissa providing ongoing follow-up.

*Member name changed to protect privacy

Aetna Member Story

Sat, 31 Aug 2024 00:17:35 GMT

Guiding A Member To Assistance

Mary*, a care manager with Aetna Better Health® of Illinois, connected with Jack* in June of 2024 for care management services. After reviewing Jack’s health conditions, social determinants of health (SDOH), and financial situation, Mary offered resources for electricity and gas assistance through LIHEAP. She also referred him to food assistance tailored to his health needs, completing a referral through GA Foods. Jack needed some durable medical equipment (DME) supplies, and Mary encouraged him to reach out to his primary care physician (PCP).

During a follow-up one month later, Jack happily reported to Mary that he’d been approved for assistance with utility bills and had already received a food delivery. He had contacted his doctor’s office about the DME supplies and was awaiting a call.

*Member name changed to protect privacy

Aetna Member Story

Sat, 31 Aug 2024 00:16:29 GMT

Angel In Disguise

Olivia*, a registered nurse care manager with Aetna Better Health® of Illinois has been working with Angela* for more than one year. Their relationship started after Angela was hospitalized and received a new diagnosis. When Angela was discharged from the hospital, Olivia reached out to see how she was doing.

Angela’s daughter was her caregiver and was a little overwhelmed. After speaking to Angela’s daughter and learning about her current needs, Olivia got to work. She contacted Angela’s primary care physician (PCP) to confirm her follow-up appointments. She made calls to ensure the order for durable medical equipment (DME) had been placed and that Angela received the supplies. Olivia worked with Angela’s family to get power-of-attorney documents on file with Aetna. She also provided information about the health plan’s benefits for over-the-counter products and made sure a referral for palliative care was received.

Angela’s family felt supported and cared for; they were able to develop a trusting relationship with Olivia. They were pleased with the numerous resources that were shared. In fact, they sent the following email to the health plan:

“On behalf of my mother, I would like to share some recognition for Ms. Olivia. Olivia had been my mom’s coordinator since one of her recent hospitalizations late last year. I will be honest — I was initially frustrated and annoyed when I saw Aetna on the caller ID. I wondered, “What could they possibly want? Don’t they know all her info? I’m dealing with enough as it is.” Needless to say, only God would know how much Ms. Olivia’s comforting and compassionate voice would calm me, and eventually be recognized as a true and genuine resource.

Ms. Olivia has been so pleasant and helpful in my mom’s recent diagnosis. She is patient and thorough. If she tells me she will call me back at a set time, she calls. If she needs to research something and get back to me, she follows up as promised. She’s compassionate and caring, and it shows in how she assisted me. In a world where patrons and clients often share so much negative feedback, and what went wrong matters, I feel equally obligated to tell you all the things she does right. I hope this email goes as high in the organization as it could, because it’s the work like this that leaders need to see."

*Member name changed to protect privacy

Aetna Member Story

Sat, 31 Aug 2024 00:02:09 GMT

Breaking Barriers

Jenn*, a care manager with Aetna Better Health® of Illinois was made aware that Liliana*, a member’s mother, had been waiting on the results of an autism screening since January 2024. Liliana hadn’t called the screening facility because she doesn’t speak English. Jenn called the facility to request an update. She learned that the evaluation results had been sent — but to the wrong provider, and the facility had not contacted Liliana to provide an update.

Jenn contacted Liliana to confirm her child’s PCP. She then called their office to confirm the member was their patient and got their fax number. Jenn got back in touch with the screening facility to provide the correct fax number. She also asked them to call Liliana. When she learned the center didn’t have a staff member who could speak Spanish, she asked that they use an interpreter when they reached out to Liliana. Jenn called Liliana to share an update and let her know that she would be receiving a call from the screening facility. 

Liliana has an appointment to review the results of the autism screening with her child’s provider who will evaluate the results to diagnose the child and provide treatment.

*Member name changed to protect privacy

Humana Member Story

Tue, 09 Jul 2024 14:00:17 GMT

A Path To Independence

History

J.A was initially unable to be contacted until one of our nurses, Jennifer, was able to reach him following a hospital admission. J.A. is from Puerto Rico and speaks Spanish. Further challenges for J.A. are low literacy as he let us know that he never learned to read or write. J.A. is difficult to understand on the phone as he is usually very tired from hemodialysis or from completing his daily activities. He has bilateral below-the-knee amputations, anxiety, depression, diabetes, end-stage renal disease, dialysis, liver cirrhosis, possible liver Cancer, pacemaker for arrhythmia, as well as being an oxygen-dependent asthmatic. J.A. also lived with his sister and wanted to find a place of his own as they had not been getting along.

Barrier

Poor historian, low literacy, mobility difficulties, transportation, knowledge deficit in medications and medical conditions, lack of knowledge regarding his plan benefits and resources. He also fatigues easily which can make it difficult to address identified gaps.

Interventions

After the first contact with the J.A., Jennifer began working on his numerous needs. She had post-discharge meals sent and provided verbal and written dietary information to him. She continued working with the J.A. over the next several weeks, speaking to him often which identified further needs and worked to close those gaps. One of the big priority interventions was referring to our social worker for services for in-home assistance and housing needs. J.A. prioritized seeking his own housing at that time and also wanted to defer his LTSS application. Over the next several months, Jennifer and the social workers worked to close his numerous health gaps by placing referrals, making phone calls, assisting in scheduling appointments, and providing written information. Due to J.A.s barriers, the team completed numerous calls per month as well as coordination with the team and other providers to meet his needs. At times, J.A. would defer an intervention and opt to wait until his sister could be present or would request a callback. Sometimes J.A. would be tired from completing his ADLS or attending dialysis and would not want to engage on the phone. To overcome these barriers, the team persistently followed up with J.A. to support his needs. We also transitioned J. A. to a Spanish-speaking social worker and Spanish-speaking Care Coordinator.

Outcome

Since our initial contact with J.A. several months ago, he has successfully moved into his own apartment and has had an in-person visit which showed a clean, appropriate, safe environment. He also has received portable oxygen, a blood pressure monitor, and a blood glucose monitor. We have ensured that he has transportation to all appointments and regularly scheduled transportation to dialysis via MTM. We also assisted in successfully transitioning his prescriptions to Humana’s CenterWell pharmacy so that he could receive his medications through the mail.

On his most recent contact in May, he decided that now is the right time to pursue applying for LTSS services and has begun that application process and is awaiting approval. Our team continues to support J.A. until he has these much-needed services in place. This story highlights the numerous challenges he faced and the amazing teamwork that went into overcoming his many barriers and closing these gaps.

Humana Member Story

Tue, 09 Jul 2024 13:57:13 GMT

From Crisis To Community

History

PM is a 35yr old woman who has been enrolled for approximately 8 months. She has a medical and behavioral health history of Alcohol Abuse, Bipolar Disorder, with psychotic features, Conduct Disorder, Asthma, Tobacco use, Unspecified Abnormalities of gait/mobility and Weakness, history of domestic abuse. P.M. was admitted to nursing home to a behavioral health crisis that led to a motor vehicle accident. P. M’s POA/mother reported she attempted to drive alone to California while experiencing auditory hallucinations causing a one car accident. She sustained injuries to her leg and back causing weakness and unsteady gait.

She was brought back to Chicago to receive care including physical and occupational therapy to regain mobility and strength and subsequently her and her supports decided that long term care was the best option for care due to member needing assistance with both physical and behavioral health assistance. Her mother who was also her POA over Healthcare admitted her to Long Term care so she could be stabilized on her medications as she received much needed therapies.

Barriers

P.M. verbalized that she was ready and willing to return into the community but needed some considerable support from her formal and informal supports. P.M. struggled with remaining adherent to her medications when residing in the community. P.M. has a history of being in a domestically abusive relationship which caused a decline in her mental health. She was distant with her family for an extended period until she was admitted to long term care. For P.M. to have a smooth transition into the community she needed to be connected to behavioral health care provider to be monitored and stabilized on her medications. She also needed additional supports with Activities of Daily living and instrumental activities of daily living due to her mobility issues and weakness. P. M. Also verbalized some difficulty navigating public transportation and reported that she is forgetful and needed some assistance with getting to appointments.

Interventions

P.M enrolled into the community Transitions Initiative Program in January 2024. Her LTSS Care coordinator worked with P.M and her supports to ensure that her transition into the community was smooth and that member had the appropriate services in place. CC referred her for a Person’s with Disability waiver through the Department of Rehabilitative services (DRS). P.M. has strong support system through her mother who also assisted her with removing herself from a domestic violent situation. The CC also worked with P.M. and her mother to secure a psychiatrist within the community as well as a PCP. She was also assessed for outpatient therapy services and Community Support Team services through Thresholds.

Outcome

P.M transitioned into the community in early April 2024. She was approved for waiver services later that month. She is now receiving outpatient therapy services and attends scheduled psychiatrist appointments through Thresholds. P.M.’s sister applied to become her Personal Assistant through the Person’s with Disability waiver and will be able to provide her with assistance with ADL’s and IADL’s within the home.

She is now learning to live independently in the community and learning how to make small meals and grocery shop. She can communicate her feelings and understand the importance of adherence to her medications. She has a behavioral health crisis plan which she has worked on with her outpatient therapist to ensure she is able to respond appropriately during a crisis. P.M has remained stable since her discharge into the community and continues to receive daily visits from her mother who is her natural support.

Molina Member Story

Thu, 20 Jun 2024 00:50:16 GMT

Meet Helen

Helen is a 68-year-old woman from Peoria with morbid obesity and a skin condition. She was referred to Molina case management because she was having a hard time meeting her daily needs and had barriers to accessing specialty care. Helen had limited mobility and a walker and felt self-conscious about her appearance. She did not have any regular providers to treat her conditions.

Getting Help

A Molina case manager began working with Helen to educate her on her benefits. The case manager coordinated with Helen’s primary care physician to make her home more accessible and get needed medical equipment. The case manager helped her schedule appointments with specialty providers and advocated for her to receive a power scooter and a physical therapy evaluation.

Now

Within 90 days Helen received a mobile scooter and was set up with physical therapy and in-home support. She was able to move around her apartment and go to appointments more easily. Helen continued to engage with her care team and improve her health. She feels more confident and satisfied with her life. Helen is grateful to her Molina case manager for her help, compassion, and professionalism. Helen reports the help she’s received has changed her life and given her hope for the future.

Molina Member Story

Thu, 20 Jun 2024 00:46:51 GMT

Meet Jacob

Jacob is a 52-year-old man from DuPage County who has a history of high emergency department utilization and frequent inpatient visits. Jacob has several medical diagnoses including heart failure, anemia, diabetes, hypertension, coronary artery disease, high cholesterol, and history of strokes. Jacob also has some behavioral health issues that led to him not engaging with his providers or taking his medications properly.

Getting Help

Jacob was referred to the Molina case management program. Jacob and his case manager met to talk through his history and challenges. Jacob stated that his primary care physician was not helpful and did not listen to him. Jacob’s case manager helped him find a new PCP and made sure the doctor had his medical history. Jacob’s case manager attended his appointments via teleconference and helped him express his healthcare needs. The PCP developed a treatment plan to address all his health needs. Jacob and his case manager continued to meet and talked about the importance of taking his medications and discussing treatment with his providers. Jacob did lab work and was linked with specialty providers for podiatry, ophthalmology, endocrinology, and cardiology, and received CT scans. Jacob’s case manager continued to help him set up transportation for his appointments and made reminder calls. His case manager helped manage his progress and provided ongoing support.

Now

Jacob no longer utilizes the emergency room as his primary source of healthcare. He continues to attend all of his appointments and has positive relationships with his care teams. Jacob states that his new PCP has been quick to address his concerns and prescribe medication refills. Jacob continues to take all his medications and stays engaged. Jacob reports better numbers for his diabetes based on his treatment plan. Jacob has incorporated a healthier diet with suggestions from his medical team. Jacob continues to work with his case manager to navigate his health. He stated that he trusts his case manager.

Molina Member Story

Thu, 20 Jun 2024 00:44:39 GMT

Meet Charlie

Charlie is a 45-year-old woman from Cook County who was referred to the Molina case management program because of high emergency room utilization. Charlie was dealing with complications and pain in her hips and back. Charlie has a history of alcoholism. At her appointments, Charlie did not want to talk about her history of alcoholism, only about her back and hip pain.

Getting Help

Charlie’s case manager tried their best to build a good relationship with her. The case manager kept performing outreach, even when Charlie was not responsive to assistance. Charlie’s case manager helped set up appointments for her hips and her back pain. Charlie’s case manager focused on promoting healthy living behaviors. As part of their discussions, Charlie’s Molina case manager would encourage behavioral health counseling and substance use programs as resources. Charlie didn’t take offense but wouldn’t engage or address the topics.

Now

After several months of working through Charlie’s physical needs – she began to open up. Charlie was ready to seek counseling and rehabilitation for her alcohol use. Charlie’s case manager helped her make an appointment for her to go to inpatient rehabilitation for substance use. Once rehabilitation was completed, Charlie’s case manager helped her find aftercare counseling and local alcoholics anonymous meetings. Charlie joined a sobriety program and completed a 30-day residential treatment program. Charlie continues to work on her sobriety. She is more engaged in her health, she attends her medical appointments and has an appointment to have hip surgery. Charlie continues to engage with her case manager and remains hopeful about her future.

Aetna Member Story

Mon, 03 Jun 2024 16:37:16 GMT

Coordinating Behavioral Health Care For A Young Member

Blake* is 12 years old and was recently admitted to a hospital for behavioral health concerns. When he was released from the hospital, Blake needed to have a follow-up visit. His primary care provider deferred to a psychiatrist to adjust Blake’s medication, but there was a 2-3 month wait before he could see a specialist. Unfortunately, Blake seemed to have no options other than to wait.

Realizing Blake needed care sooner rather than later, an Aetna Better Health® of Illinois care manager reached out to a mental health care provider that offered therapy and medication management for ages 13 and older. The care manager asked if an exception could be possible since Blake’s 13th birthday was coming up later this year. The provider agreed to this plan and Blake was cleared to receive psychiatry services. The provider has already reached out to start Blake’s care.

*Member name changed to protect privacy

Aetna Member Story

Mon, 03 Jun 2024 16:34:10 GMT

Taking Care Of Family Needs

Jennifer* is a mom to three children. Carol*, a care manager with Aetna Better Health® of Illinois, recently reached out to connect with the family. She learned that one of the young people had started riding a bike and had lost some weight. As a result, his clothing didn’t fit anymore.

Carol told Jennifer about the clothing voucher available to Aetna members as a value-added benefit. Members in grades K through 12 (ages 5 through 18) can get a voucher for clothing through select online retailers when they complete a health risk screening, have an annual wellness visit, and are up to date on all immunizations.

Carol sent the info to Jennifer so she could obtain clothes for her son to match his new weight.

*Member name changed to protect privacy

Aetna Member Story

Mon, 03 Jun 2024 16:30:26 GMT

A Care Team In Action

Markel* is a 15-year-old member who had been hospitalized since late March for psychiatric care. His grandmother was his guardian but didn’t feel equipped to care for Markel’s needs. The teen’s liaison at the Illinois Department of Children and Family Services connected with Markel’s grandmother and developed an Interdisciplinary Care Team to discuss his care. Markel’s primary care provider, psychiatrist, and a community-based behavioral health organization worked with his grandmother to discuss a plan for care after his hospital stay.

After two months in the hospital, Markel was able to go home. His grandmother now feels supported and optimistic.

*Member name changed to protect privacy

Aetna Member Story

Mon, 03 Jun 2024 15:33:23 GMT

Support During Pregnancy And Beyond

Yasmine* was 28 weeks pregnant. She had a history of anxiety and depression, had previously used drugs, and was a smoker. She suffered abuse as a child, domestic violence in a previous relationship, and the loss of an infant from SIDS.

Aetna Better Health® of Illinois care manager Joy* reached out to Yasmine in March for intensive care management. Joy learned that Yasmine didn’t have a stable food supply so needed behavioral health counseling and medication management. She also had some dental care needs.

Joy first placed a referral for Yasmine with a behavioral health provider who could support counseling and management of her medication. She also arranged for food delivery to supplement the SNAP and WIC benefits Yasmine was receiving. Joy gave Yasmine a list of dental providers in her health plan’s network and provided resources on quitting smoking. She also shared educational materials about pregnancy, infant care, and safe sleep.

Yasmine now has a monthly follow-up with the Maternity Matters team and her behavioral health care manager. To get ready for her baby, she has received a car seat through the value-added benefits offered by Aetna, as well as a breast pump. She’s also connected to community resources to support her and her child.

*Member name changed to protect privacy

Meridian Member Story

support@iamhpteam.org (Misty Turnbull) — Thu, 09 May 2024 14:57:07 GMT

New Mom Receives Critical Pre- And Postpartum Care

In August 2023, Leyila, a Meridian Medicaid plan member, was receiving care coordination for a high-risk pregnancy. She had a history of gestational diabetes and neurological issues, including epilepsy. Given her diabetes diagnosis, she was referred to Meridian’s Start Smart for Your Baby program for support throughout her pregnancy. A Spanish-language interpreter assisted in communicating between Leyila and Keena, her Meridian care manager.

After Leyila gave birth to twin girls, Keena learned that Leyila had developed postpartum preeclampsia. As a result, Leyila had to stay in the hospital for seven days. Keena also discovered Leyila did not have a follow-up appointment scheduled after her delivery and she had not received follow-up treatment for her epilepsy. Leyila was initially referred to a neurologist, but she went into labor on the day of her scheduled appointment.

Keena helped schedule all of Leyila’s necessary follow-up appointments to address her complex postpartum healthcare needs. She was also able to contact a provider with Leyila’s history, who referred her to another provider to better support her. With her care manager’s help, Leyila was then able to receive the postpartum follow-up care she needed one week after she left the hospital.

In addition, Keena found a neurologist for Leyila to see for her epilepsy.

One month later, Leyila provided her care manager with an update. The member shared that while she was able to attend the postpartum appointment, she was lacking transportation to attend the neurology appointment. Keena swiftly scheduled transportation and resources, and helped Leyila schedule a new neurology appointment within six weeks.

Leyila continues to see a neurologist and she has had follow-up CT scans as recommended by her provider.

Leyila thanks Keena for all the healthcare services and support she has received from Meridian, during and after her pregnancy.

BlueCross BlueShield Member Story

support@iamhpteam.org (Misty Turnbull) — Thu, 09 May 2024 14:46:32 GMT

Providing A Helpful And Fast Support To An Expectant Mother

Already full of frustration and worry, BCCHP member, Maria, was diagnosed with a high-risk pregnancy by her provider. From the beginning of her pregnancy, Maria ran into various social barriers in partially due to her need for a Spanish translator. Following the high-risk pregnancy assessment, a Spanish speaking BCCHP Care Coordinator (CC) was assigned to make outreach. The CC contacted Maria and immediately recognized that her high stress levels were primarily caused by her social barriers. Her CC gathered all the outstanding problems Maria was facing and connected her with a combination of resources through CSS referrals, CC intervention and education, and added translation services to ease the process. Maria’s CC helped her identify her strengths and areas where improvements could be made as she prepared for her baby. All her social barriers were addressed within 24 hours, and she expressed extreme relief upon hearing of the resolutions and thanked her team for their efforts. With this help, Maria was able to complete her pregnancy without unnecessary added stress that could have impacted her already high-risk pregnancy.

CountyCare Member Story

Fri, 03 May 2024 15:44:41 GMT

CountyCare Helps Member Living In A Shelter

Kelly* is a 52-year-old CountyCare member who was homeless and living in a women’s shelter. Kelly was motivated to find her own place as soon as possible after an incident at the shelter put her at risk.

Kelly’s CountyCare care coordinator jumped into action once she heard about Kelly’s situation and helped coordinate services for Kelly. Working together, they were able to work with the shelter to secure housing for Kelly. Along with an apartment, the shelter was able to provide six months of rent payments. Her care coordinator also helped Kelly get assistance finding household items and furniture to get her set up in her new home.

Kelly expresses thanks to her care coordinator for helping her during a tough time while she anxiouslywaits for some of her household items to arrive.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Fri, 03 May 2024 15:40:04 GMT

CountyCare Goes Above And Beyond For Members

Henry* is a 61-year-old CountyCare member who struggles with homelessness. Henry reached out to CountyCare regarding his situation and spoke with his assigned care coordinator.

Henry received the chance to fill out a Chicago Housing Authority (CHA) application but with limited access to a computer he was struggling to complete the form.

The application was due on President’s Day and many places where he could access a computer before were going to be closed. He explained his predicament to his CountyCare care coordinator.

His care coordinator went above and beyond for Henry, meeting him at a local restaurant to help him complete his application the Sunday before President’s Day. Henry was thankful for the critical assistance from CountyCare that will allow him to take a major step in improving his life.

*Names and identifying details have been changed to protect anonymity.

CountyCare Member Story

Fri, 03 May 2024 15:26:49 GMT

CountyCare Helps Member With Alzheimer’s

Jose* is an 80-year-old CountyCare member living with Alzheimer’s and other chronic health conditions including diabetes. Jose requires full support for his activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and is taken care of by his wife and three daughters. They all live in the same house and work in shifts to take care of Jose.

During an on-site annual assessment, Jose’s CountyCare care coordinator witnessed disturbing behavior between Jose’s children that she believed could affect his care. As an advocate for Jose’s well-being, the care coordinator called the proper authorities which led to an investigation by the Illinois Department on Aging (IDOA). As a result of the investigation, changes were made to Jose’s home situation to ensure his safety.

The CountyCare care coordinator and her manager continue to follow up with the family to make sure Jose is safe, being taken care of properly, and to reinforce the importance of wellness checks and open communication with the care coordination team.

*Names and identifying details have been changed to protect anonymity.

Humana Member Story

Fri, 03 May 2024 15:15:31 GMT

Community Well Member Success Story

History - G.S. lives alone. When initially contacted for engagement G.S. declined participation in care management stating that he was already connected with a provider and “didn’t need the extra help”. During our AAP HEDIS Campaign, MD at Home was able to schedule a visit with G.S. the last week of November to complete an Annual Wellness visit. MD At Home then provided their detailed assessment to the assigned care coordinator (Brandon).

Barrier - G.S. had previously declined care management so the care coordinator had little to no information related to G.S.’s needs or chronic conditions.

Interventions - Brandon, G.S.’s care coordinator, received and reviewed the assessment from the MD At Home Wellness Visit. Brandon then took this opportunity to reach out to G.S. to re-engage him in active care management. Brandon was able to reach G.S. and used the information that MD at Home provided to help guide his conversation. Brandon was able to complete the Health Risk Assessment and developed care goals focusing on G.S.’s hypertension and community resource needs. He engaged the team’s social worker for community resources to assist with food and utilities. He also was able to order the member a blood pressure monitor. Brandon provided G.S. with transportation information, Over the Counter catalog information, Advance Directives form/information, and a dental provider list. Brandon discussed changing his PCP to MD at Home as G.S. reported that he doesn’t have a car and needs to take take 3 different buses to get to his current provider. GS thought this was a good idea and Brandon spoke with customer service to make this change.

A few days later while the social worker (Anne) was speaking with G.S., he mentioned to that he had some concerning symptoms the night before that involved hiccups, sweating, dizziness, and weakness and had some questions. Anne was immediately able to connect G.S. to Brandon, his care coordinator. G.S. mentioned that he had contacted MD at Home to report the symptoms and they were going to have a clinician come visit him tomorrow. Brandon reviewed with G.S. our 24 hour nurse line and encouraged the member to call 911 before his MD visit if he had any of the symptoms return that he had the previous night (hiccups, sweating, dizziness and weakness).

MD at Home notified us a few days later that the member had been admitted to the hospital with a history of 2 syncopal episodes which led to a subdural hemorrhage with incidental findings of RSV and COVID. They also provided the care coordinator with the Emergency department information. When we were notified that G.S. was discharged from the hospital, our post discharge nurse outreached him and was able to complete our post discharge assessment, notify MD at Home of the discharge, and confirmed that the G.S. had an appointment scheduled for MD at Home to see the member at home.

Outcome - MD at Home and Brandon have been in close contact regarding G.S. They have been coordinating follow ups with specialists, ensuring that he has transportation to the specialist and CT scan. Brandon has worked with G.S. to locate a neurovascular neurologist that was in network. Brandon was also able to set up home delivery of G.S.’s prescriptions to take the burden off of G.S. having to pick them up. G.S. spoke with Anne the social worker recently and stated that he has been feeling better every day since he has gotten out of the hospital. He knows that he needs to watch what he eats, avoiding salty foods and additional salt. He recognizes that his BP goes up when he has more salt in his diet so he has been eating things with less salt and also trying to drink more water. He said he has already seen the benefit of this small change. G.S. also said that he has the food he needed and was working with his landlord to complete needed repairs for his gas. Brandon and MD at Home remain in close contact regarding G.S. as he continues in these early days of follow up with his specialists, his new PCP (MD at Home), and his care coordinator. With the collaborated efforts of G.S. new PCP and our Care Coordinator, G.S. remains in active care management.

Molina Member Story

support@iamhpteam.org (Misty Turnbull) — Mon, 01 Apr 2024 16:19:38 GMT

Mobile Care For Trinity

Trinity is a 33-year-old African American mother from Central Illinois who was newly admitted to a local shelter with nine children. Trinity was 16 weeks pregnant when she was admitted and hadn’t had any prenatal care. Trinity didn’t have support, transportation, or access to health services. Two of her children had been to the ER in the past week. Molina’s Mobile Health Unit held a clinic day at the shelter. Trinity and her children visited the unit. She was able to get her prenatal assessment and was diagnosed with extremely high blood pressure. Her pregnancy was categorized as “high risk” due to her history of premature delivery. The provider on the Molina Mobile Unit prescribed her blood pressure medication and scheduled a follow-up appointment with her. All nine of her children received well-child exams. Two of them made appointments for follow-up care. Trinity was appreciative that her family received preventative care.

The mobile unit also gave the family hygiene items including diapers and wipes. The mobile unit visited the shelter multiple times. Trinity was able to see a provider four times throughout her pregnancy. Her blood pressure was checked, and she was supported through Molina’s case management. Trinity scheduled her c-section. She and her family are looking into moving into a four-bedroom home that is within walking distance from the shelter. Trinity plans to utilize the resources from the shelter. Trinity continues to work with the Molina team to manage her health. “You showed up in my life at the perfect time,” Trinity said. “You have helped me so much and I don’t feel alone.”

Molina Member Story

support@iamhpteam.org (Misty Turnbull) — Mon, 01 Apr 2024 16:16:32 GMT

Introducing Lisa

Lisa is a 24-year-old woman from Peoria County who was 20 weeks pregnant. She had a high-risk pregnancy because she had preeclampsia, preterm delivery, and type II diabetes in her medical history. Lisa, who speaks Spanish, said that she got different and conflicting advice from her two different providers. Lisa’s primary care physician told her to use a glucometer every day to check her blood sugar. Lisa went to an obstetrician who said she didn’t need to test every day. This made Lisa confused, and she tested rarely.

Getting Assistance

Lisa joined case management and met with her case manager who spoke Spanish. Her case manager got in touch with the obstetrician for more information. The case manager found out that there was no staff who spoke Spanish on the day of Lisa’s visit, which probably caused the misunderstanding. Lisa’s case manager made another appointment where Lisa could get the information she needed in Spanish. Lisa’s case manager also gave her information on insulin use, blood sugar testing, understanding diabetes levels, preeclampsia, preterm labor, postpartum education, and case management contacts to help her progress.

Now

Lisa has worked with her case manager and care team to improve her knowledge and management of her diabetes. She has now been following her medications and doing her blood sugar testing. Lisa reported her blood sugar levels during her pregnancy and after delivery. Lisa’s son was born healthy, without complications. She keeps scheduling follow-up appointments. Both Lisa and her son are doing well. Lisa stays in touch with her case manager, and is more in charge of her care, materials and talking with her providers in Spanish.

Aetna Member Story

support@iamhpteam.org (Misty Turnbull) — Fri, 22 Mar 2024 05:50:08 GMT

Supporting Members Through A Challenging Pregnancy

Nataly* was 29 weeks pregnant when Aetna Better Health® of Illinois received a referral for care management. Nataly’s pregnancy had been complicated by a diagnosis of epilepsy/seizure disorder and hyperemesis.

This was Nataly’s first pregnancy. She wasn’t employed due to her health and the baby’s father was involved but provided very limited financial support. Nataly’s hyperemesis was severe; she had lost 40 pounds since getting pregnant and her baby was having trouble growing. She was feeling very overwhelmed due to her health and limited financial resources.

The Aetna® care manager told Nataly about her health plan’s transportation benefits. She also reviewed the value-added benefits that Nataly could receive — including a car seat and diaper bag — if she completed the qualifying activities. The care manager also provided Nataly with community resources for additional baby supplies.

Upon learning that Nataly was overwhelmed by the process, her care manager offered to call Member Services to assist with requesting a car seat. During the call, Member Services verified that Nataly qualified to receive a car seat and diaper bag. The request was placed, and Nataly was grateful for the care manager’s support.

During their next conversation, Nataly told her care manager that she had received the car seat and diaper bag. She had also connected with the recommended community resources and was able to get the other baby items she needed.

Nataly thanked her care manager, stating she felt so much better since getting a car seat and baby supplies. She expressed appreciation for the help and support during her pregnancy.

Nataly has since delivered a healthy baby boy. Both she and her baby are doing well. She is still engaged in case management and her care manager continues following her progress.

*Member name changed to protect privacy

Aetna Member Story

support@iamhpteam.org (Misty Turnbull) — Fri, 22 Mar 2024 05:36:50 GMT

Managing Behavioral Health During Pregnancy

Erica*, an Aetna Better Health® of Illinois member, was 28 weeks pregnant when she reached out to the health plan for intensive care management. Erica had been dealing with anxiety, depression and post-traumatic stress disorder. She also had a prior history of substance abuse and was currently smoking.

Erica’s history includes being abused as a child and experiencing domestic violence in a previous relationship. She had lost her first child from SIDS at two months old. Erica didn’t have access to a secure food supply. She needed dental care and was in urgent need of behavioral health counseling and medication management.

A behavioral case manager from Aetna® coordinated counseling, mediation management and food assistance (SNAP and WIC) for Erica. The case manager also gave Erica a list of dental providers and resources to stop smoking. Erica was also connected with our Maternity Matters team and she received education about pregnancy, along with resources on caring for an infant and safe sleep.

Erica has now monthly follow ups with the Maternity Matters team and her case managers. Her medical needs have been addressed and she has received dental care. The care manager arranged for Erica to receive a car sear, breast pump, meal delivery services and connected her to community resources for continued support.

*Member name changed to protect privacy

Aetna Member Story

Fri, 01 Mar 2024 16:38:28 GMT

Calming The Overwhelming

Sam*, a community health worker with Aetna Better Health® of Illinois had a great home visit with Kathy*, a newly eligible member and her two children, who are also members.

During the home visit, Kathy expressed that she gets anxious when calling providers to schedule appointments. When she tried to schedule a new appointment with a local behavioral health provider, Kathy couldn’t connect to the right prompt to schedule the appointment and eventually gave up.

While at Kathy’s home, Sam was able to connect with the clinic and assisted with getting a behavioral health appointment scheduled for both Kathy and her two children. Sam completed the initial assessments and enrolled Kathy and her two children in the care management program.

Kathy expressed her appreciation for Sam’s assistance and was relieved that the appointments were scheduled.

*Names changed to protect privacy

Aetna Member Story

Fri, 01 Mar 2024 16:36:12 GMT

A New Lease On Life

Aetna Better Health® of Illinois member David* had recently been discharged from a rehabilitation facility when our community health worker, Susan*, got in touch. David was recovering from a serious motorcycle accident. He had been airlifted to a hospital due to his injuries and had to learn to walk again.

David is still receiving physical therapy to improve his mobility and is working to get his health and wellness back on track. Susan learned that David needed incontinence and cleaning supplies.

Susan completed the screening assessments with David. She made him aware of the health plan’s monthly over-the-counter (OTC) benefit, as well as the gym membership. She also made sure he sure he had the 24-hour nurse line. Finally, Susan helped David download the ModivCare app, so he would have access to transportation to his doctor visits.

The next day, Susan dropped off some cleaning supplies for David. He was extremely grateful for the support.

*Names changed to protect privacy

Aetna Member Story

joy.duling@gmail.com (Admin User) — Fri, 01 Mar 2024 16:34:05 GMT

Help Is A Call Away

Dora*, a care manager with Aetna Better Health® of Illinois, reached out for a yearly check-in with a member’s family. While completing risk assessments with the mother, Gaby*, Dora recognized that the family needed some resources.

Gaby shared that her husband had abruptly left and that she wasn’t currently working because she was caring for her child who has special needs. Gaby needed additional support.

Dora offered several resources to assist the family, including transportation and legal support. She called to schedule a PCP appointment and a visit with a dental provider who works with children who have special needs. Dora also arranged for the health plan’s food delivery program and provided information for respite services so Gaby could take a break from caregiving when needed.

Dora was able to complete the risk assessments and helped Gaby with scheduling a therapy appointment.

Gaby agreed to enroll in care management for both her and her child. Dora checked back to be sure that the family had received their food delivery. Gaby shared that she is happy with the care management services she is receiving and expressed gratitude for the assistance Dora provided.

*Names changed to protect privacy

Meridian Member Story

Fri, 23 Feb 2024 15:13:27 GMT

How Larry Lives Brighter

Larry, a Meridian member, sits down with Jeni, his care coordinator, to discuss how the program helps him set—and reach—his health goals. View at https://youtu.be/pHRpuPqRuP8?si=Utk_kNgrVROR5kPX .

What is Care Coordination?

Our Care Coordination program helps members connect to the care they need. All members are eligible to join this program. If you have certain health conditions, you may be enrolled automatically.

After you join, you will be assigned a care coordinator. This person is a partner on your health journey. Your care coordinator will help you get the care and resources you need. You can also get help arranging your care services.

For more information, visit https://www.ilmeridian.com/discover.html

CountyCare Member Story

Wed, 14 Feb 2024 16:07:00 GMT

CountyCare Helps Member with Sickle Cell Anemia

Taylor* is a 7-year-old CountyCare member who was born prematurely, battles sickle cell anemia and has severe asthma. Managing his pain often means frequent visits to the emergency room and multiple specialist appointments causing a significant amount of stress for his mother, Ella*.

Ella met with a CountyCare care manger to review Taylor’s current treatment plan. Her care manager helped coordinate appointments between Taylor’s specialists and secured transportation to all the appointments. They also reviewed possible pain triggers and how they could work to avoid them, and identified certain weather conditions that tend to make Taylor’s asthma worse.

Ella updates Taylor’s care manager monthly and the frequency of their emergency room visits has declined. Ella recognizes Taylor’s conditions can be difficult to manage but will continue to make adaptations to Taylor’s care plan with the support of her care manager – and has welcomed the care manager’s suggestion of joining a parental support group.

* Names and identifying details have been changed to protect anonymity

CountyCare Member Story

Wed, 14 Feb 2024 16:04:56 GMT

CountyCare Helps Member With Housing Issues

Patricia* is a 50-year-old CountyCare member who was experiencing housing instability and struggles with managing her mental health. These stressors caused additional financial issues and led her to neglect her health (e.g., getting her medications, buying groceries, etc.).

During a checkup, Patricia shared her situation with her CountyCare care manager, Lily*. Because of her strong contacts with community organizations, Lily contacted the Chicago Housing Authority to discuss Patricia’s situation. She also contacted a representative for the Rental Assistance Program on Patricia’s behalf to help assist her in securing a security deposit.

Lily’s coordination between Cook County Health System and the Chicago Housing Authority to address Patricia’s housing needs made it possible for Patricia to focus on things like securing her medications and groceries, and scheduling future health appointments.

* Names and identifying details have been changed to protect anonymity

CountyCare Member Story

Wed, 14 Feb 2024 14:39:26 GMT

CountyCare Helps Member With Mental And Behavioral Health Issues

Xavier* is a 16-year-old CountyCare member who struggles with his behavioral health and has been

diagnosed with post-traumatic stress disorder. Xavier experienced a traumatic event that has lingering

effects on him and his family.

Xavier was originally referred to a care coordinator at an integrated health home. The care coordinator

then referred his case to his CountyCare care manager, Lily*. Lily learned that Xavier was having trouble

securing transportation to school and had not seen a primary care physician or a behavioral health

specialist in over three years. Lily sprang into action and completed a health risk screening for Xavier and

developed a care plan based on his needs.

Thanks to Lily, Xavier was able to visit his primary care physician and see a behavioral specialist. Lily

made sure to follow up with both providers to keep Xavier on track. His behavioral specialist and Lily

also contacted the school to help Xavier and his family with any issues he was having – and secured a

bus card for Xavier to get to and from school.

* Names and identifying details have been changed to protect anonymity

Humana Member Story

Thu, 02 Nov 2023 15:50:15 GMT

Humana Care Management (Non-Waivered)

History: Mr. N. is a 64-year-old male that has been with Humana (off then back on) since April 2018. When he was originally engaged, he was depressed, in a lot of pain due to severe osteoarthritis. He was caring for his disabled mother and feeling helpless about his situation. He was not receiving any type of medical intervention and was reluctant to participate in telephonic care management.

Barriers: The member was overwhelmed he was in a lot of pain and did not believe any type of medical intervention would help. He knew he needed a shoulder and hip replacement but feared the surgery would take him out of commission for too long, fearing he would not be able to care of his mother. The member also doubted that the intervention would make any difference and assumed he would always have to live with the pain.

Interventions: Member was open about participating in our interdisciplinary care team by being linked to our social work department to discuss community resources and behavioral health access. The member started counseling and through care planning little by little started working on his health conditions. He first completed the shoulder surgery, which made such a huge impact on his pain and ability to perform activities of daily living. This gave him the trust and confidence to follow through with a hip replacement. This surgery resulted in a longer recovery and the member ended up in an assisted living facility. The facility did not accept his plan, so he was enrolled in a different one. Member wanted to come back to Humana because of his experience with care management. He got his own place and worked with our social work department to secure LTSS services for home maker services while recovering.

Outcome: The member continued to work with his health providers and made it his goal to phase out the need for home health services. The member made this his goal because he wanted to return to community well, so he could work with his original care coach that he always remained in contact with. The member is thriving. He is fully engaged in care management and his health care goals. He was recently diagnosed with cancer but feels confident that he has the resources, supports with care management and is hopeful about his ability to overcome this new health challenge. The member shares his experience with the program with his family and friends. He reports that two of his sisters have enrolled with the plan. Care management allows for a level of continuity of care that transcends time and situations facing our members. Some members are still participating in the program since its inception in 2014 and for many of us they’re more like family.

Humana Member Story

Thu, 02 Nov 2023 15:42:38 GMT

Humana IL LTSS Community Transitions

(Member Initials): H. D.

(IL MMAI Waiver and LTC Program) IL MMAI LTC

History

H.D is a 75-year-old AA male who was residing in a Long-Term Care Facility (LTC). He was initially admitted due to a motor vehicle accident causing him to have a fractured femur. H.D was living out in the community; his accident caused significant issues for his ability to care for himself independently and which caused him to go into custodial. He required total assistance with all ADL’s and IADL’s. H.D began physical therapy within the facility and regain some mobility and was able to ambulate with a rolling walker. He started to express to this care coordinator that he wants to return to the community to live independently once again. He wanted his own apartment but did not know how to begin the process of transitioning out of a facility.

Barriers

H.D met with the IL LTSS Community Transitions Care coordinator who assessed him for appropriateness for transition into the community and discussed some of the barriers that may delay the process such as housing limitations and ensuring he had the appropriate level of support to make it a safe transition into the community.

H.D reported he had limited support and that he has one relative that he communicates with and no other supports. He reports he was staying with family and friends prior to going into Long Term care and would need assistance with finding accessible housing. He expressed his desire to live independently but acknowledged that he would benefit from medication management and assistance with meals.

Interventions

Member became a part of the Colbert Program to transition back into the community. Member was educated on the benefits that the program offers. Member stated that this program was heaven sent and was very grateful for being a part of the program. CC and member collaborated to research different facilities to see which one would suit the member’s needs. Member was provided health education post discharge.

CC referred member for the Supportive Living Program waiver and coordinated with a Supportive Living Facility (SLF) and H.D. to ensure that he would be able to receive the care that he needed but also have autonomy to come and go as he wants.

Cc worked with the Long-Term Care facility to obtain documents needed for member’s transition. Although H.D has improved from his accident he continues to need assistance. Care Coordinator discussed the Supportive Living Program which is a waiver program that allows members to live independently with some minimal support from professionals. He would have 24hour supervision from medical and social service staff and would have access to medication management as well as meals.

Outcome

H.D was able to successfully transition to Green Oaks of Park Forest Supportive Living Facility in September. The Supportive Living Facility will be able to support member with medication management as well as providing meals to member. He now has his own studio apartment which was furnished with a bed and a recliner seat with funds from the Community Transitions Initiatives program. He will be seen by a nurse daily and will receive medication reminders daily. H.D can independently check his own blood pressure and has a blood pressure cuff in his apartment and will be seen by a PCP monthly.

H.D can independently request transportation with Pace and has access to using MTM as needed. There will be staff at the SLF that will be there to assist with the ADL and IADL needs.

CC followed up with member to ensure he is transitioning well; and he reported he is very happy and grateful to be in his own apartment. H.D reported the staff at the SLF are very helpful and he is enjoying the meals that are provided daily. He reported that he will be participating in the activities within the facility and is happy to be in an environment where he is able to thrive. H.D reported that he is enjoying meeting new people and couldn’t be more grateful to be living independently.

CountyCare Member Story

Thu, 02 Nov 2023 15:12:19 GMT

CountyCare Helps Member with Substance Use Disorder and Diabetes

Tom* is a 39-year-old CountyCare member who struggles with substance abuse and has diabetes, among other chronic health issues. His diabetes was uncontrolled causing Tom to regularly use the emergency room instead of going to his primary care provider (PCP) for care. He expressed to his care coordinator that he has a hard time managing his medications and treatments due to his multiple health issues.

His care coordinator developed a care plan to help address his needs. First, his care coordinator educated him on different scenarios for when to see his PCP, visit an urgent care location or if an emergency room visit was necessary. The care coordinator also provided Tom with comprehensive diabetes education and signed him up for a managing your diabetes class and referred him to a substance use program.

Tom was able to enroll in a substance use treatment program and has been sober for over a year. Thanks to his care coordinator’s help, he successfully manages his diabetes while keeping his use of the emergency room to a minimum – and reports feeling better overall.

* Name and identifying details have been changed to protect anonymity

CountyCare Member Story

support@iamhpteam.org (Misty Turnbull) — Thu, 02 Nov 2023 15:11:09 GMT

CountyCare Helps Youth Member with an Eating Disorder

Laura* is a teenage CountyCare member with an eating disorder and a history of suicide attempts. During the past three months she has experienced rapid, dangerous, intentional weight loss resulting in an emergency room visit.

Laura was transferred to multiple hospitals and facilities to receive treatment. Her care coordinator worked closely with the hospitals and facilities to coordinate her appointments and care plan. Laura’s care coordinator also worked with her school to help to accommodate her needs by providing a safe space for her to eat lunch while continuing her treatment.

* Name and identifying details have been changed to protect anonymity

CountyCare Member Story

Thu, 02 Nov 2023 15:09:32 GMT

CountyCare Helps Member With Mobility Issues

Denise* is a 59-year-old CountyCare member who has severe mobility issues yet lives alone in a studio apartment with no elevator. Denise requires assistance with all her activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Due to her condition, she cannot walk for more than a couple minutes. She also requires someone to drive her to doctor’s appointments and shopping trips. Denise was resistant to accepting care and support.

Her care coordinator identified the need for Denise to have a Polish-speaking home care aide to help the resistance Denise expressed and educated her on the benefits of receiving home care by explaining the home care aide’s role and how it would enhance her quality of life. Thanks to her care coordinator, Denise has received support with ADLs and IADLs and also feels comfortable receiving care from her new home care aide.

* Name and identifying details have been changed to protect anonymity

Aetna Member Story

Tue, 31 Oct 2023 15:58:45 GMT

New Hope For A Member In Need

Steven*, a member of Aetna Better Health® of Illinois, called the health plan expressing serious frustrations about his health and his need for health care. He told the call center team member that his health was failing him all at once. Steven had been scheduled for cataract surgery a month earlier, only to learn when he went to the appointment that the provider was not in network and wouldn’t perform the procedure. Steven couldn’t reach his assigned PCP and didn’t see any specialists. He was overwhelmed by the process of trying to find the health care he needed.

Because Steven was expressing harmful thoughts, a behavioral health care manager was assigned to speak with him. Toni* was able to deescalate the situation, assuring Steven she would help connect him with the providers he needed. Steven expressed relief that someone was listening and providing information that made sense.

Toni enrolled Steven in care management. She called his assigned PCP and scheduled an appointment for Steven. She scheduled a next-day visit at a CVS® Minute Clinic so Steven’s blood pressure could be checked. Finally, Toni scheduled an appointment with an ophthalmologist.

After each appointment, Toni followed up with Steven. He was very satisfied with his PCP visit, getting a full exam, a prescription for blood pressure medication and referrals for other care. He was scheduled to have the cataract surgery he needs.

Steven was extremely grateful for Toni’s help, stating “for the first time in a long time, I have hope.”

*Names changed to protect privacy

Aetna Member Story

Tue, 31 Oct 2023 15:56:16 GMT

Turning Frustration Into Progress

Chris* is an Aetna Better Health® of Illinois member who was assigned to care management. He refused to engage in care management planning and assessments with his care manager, Melanie*. She was able to determine that Chris needed to see a dentist and ophthalmologist but didn’t have the information he needed. He was frustrated and asked for Melanie’s help.

Melanie advised Chris that he needed to select a primary care physician (PCP), who could refer him to an ophthalmologist. Chris refused to speak further and insisted that Melanie email the resources to him. Melanie compiled a list of dental providers, ophthalmologists and PCPs in Chris’ zip code. She called each one to make sure they were in network and emailed the list to Chris. But Chris called and was unhappy. He insisted that she do another provider search.

Melanie placed Chris on hold and called an ophthalmologist office he had selected. The staff stated the need for a PCP referral. Melanie then reached out to a network primary care provider to get an appointment for Chris. The provider’s office contacted Chris, enrolled him in their system, assigned a PCP, and scheduled an appointment — even getting him in for an earlier visit.

Working through Chris’ frustration, Melanie was able to help achieve a positive outcome. With the collaboration of the network provider, he was able to see his new PCP and get a referral to an ophthalmologist.

*Names changed to protect privacy

Aetna Member Story

Tue, 31 Oct 2023 15:54:54 GMT

Value-Based Teamwork

Angie*, a care coordinator with Aetna Better Health® of Illinois, enrolled Tommy* into the plan’s care coordination program in September. He has several chronic health conditions and had been discharged from a nursing home four months earlier. Tommy hadn’t seen a doctor since that time and wasn’t able to get his medications because he didn’t have a photo ID. A family member was working to get Tommy’s state identification, but the lack of a photo ID created a challenge.

Tommy’s case was deemed high acuity and referred to an RN care manager. Before handing off the case, Angie and her manager contacted the nursing home to determine if his photo ID or social security card was on file, but they weren’t. They asked if the face sheet included a photo and learned it did. Angie’s manager reached out to one of the health plan’s value-based providers to determine if Tommy could be established as a new patient with the face sheet as identification.

The provider agreed to see Tommy for an initial visit while work continued to work on getting his state identification. He got an appointment scheduled and was able to have his medications refilled. Now, his Medicaid ID reflects the name of his new provider while he awaits his state identification.

*Names changed to protect privacy

Molina Member Story

Mon, 30 Oct 2023 16:04:37 GMT

Disease Management Program For Sickle Cell Anemia

Meet Max

Max is a 29-year-old man from DuPage County who is in the disease management program for Sickle Cell Anemia. He was feeling more pain with his ongoing condition and needed pain medication to help her manage his health. The pharmacy did not have his pain medication due to supply shortage.

Getting Help

The provider contacted Molina’s disease management program and told Molina that they were unable to locate a pharmacy nearby that had the correct dosage as listed in Max’s prior authorization. They were able to find the medication in another dose. The provider was reluctant to create a second prior authorization request for Max which would override the original dosage for a temporary order. This would mean that a third prior authorization request would be needed to change the medication back to its original dose.

Now

Molina worked with the provider to explain the challenges and situation and advocated for Max to be able to get pain medication he needed. The pharmacy prior authorization requests were overridden. Max obtained the necessary medication to manage his sickle cell without returning to the hospital. Max continues to work with his case manager, provider, and care team to manage his condition. Max is thankful for Molina’s intervention to help him keep his medicine in his time of need.

Molina Member Story

Mon, 30 Oct 2023 16:02:37 GMT

Long Term Care Recovery

Meet Cassidy

Cassidy is a 28-year-old woman from Madison County who was involved in a serious car accident in August 2022. Cassidy was admitted to inpatient and stabilized, however, after a long stay she was admitted to a long-term care facility in a vegetative state, on a ventilator, and was

unable to participate in rehab.

Getting Help

Cassidy was assessed by a Molina long-term care manager. Cassidy was dependent on the LTC staff for all of her daily needs. Cassidy’s grandmother wanted her to be moved to her house but was feeling overwhelmed by her care needs. Cassidy’s grandmother and her Molina

manager began to discuss what was needed to transition her. Cassidy was hospitalized as a result of an infection and later was discharged to an acute rehab hospital. Cassidy’s family and her case manager connected her with speech, occupational, and physical therapies. Cassidy’s

grandmother came to the facility and began learned how to care for her. The team worked to ready her home and secure needed medical equipment and transportation services for her upcoming care appointments.

Now

Cassidy went to her appointments and began responding to care. She was transitioned off the ventilator. Cassidy begun responding to yes or no questions by moving her head. Cassidy’s Molina case manager worked with the LTAC and ordered her a special wheelchair. Cassidy was

eventually transitioned to her grandmother’s house. Cassidy’s grandmother is now her caretaker. This is being supplement through waiver services. Cassidy, her grandmother, and their Molina case manager stay in contact to address any health, care, or home issues. Cassidy continues to engage in therapy to improve her life. Her family has expressed how grateful the services and supports they receive and the continued support of Cassidy’s recovery.

Aetna Member Story

Thu, 26 Oct 2023 01:17:32 GMT

Aetna's Care Coordination Team Renews Hope For An Isolated Member

Thirty-three-year-old Parker Smith had lost hope. Parker suffers from bipolar disorder and Leigh’s disease, a very rare autoimmune condition. A side effect of the disease are severe headaches, which Parker complains of often. He lives at home with his mother, just the two of them.

He described his relationship with his mother as them having raised each other because his mother didn’t know much about his conditions, nor did he, but they both learned together throughout the years.

Along with his physical conditions, Parker suffered from symptoms of depression that stemmed from feelings of isolation and loneliness. His mother works outside of the home and was often gone for most of the day, leaving Parker alone at home, with no one to talk to and no means of transportation.

He said the only person he saw consistently outside of his mother was the mail woman whom he had developed a friendly relationship with. Parker expressed to his mother many times that he needed to meet more people because the constant isolation he was experiencing made him feel hopeless about the future.

Unfortunately, a habit he developed was threatening to kill or harm his mother. In the beginning, Parker’s mother would ignore his threats, however, after some time, she started to notice some of his advances becoming more serious in nature, so fearing for his safety, she called and had him hospitalized.

During his hospital stay, Parker engaged frequently with Aetna’s care coordination team, and they were able to learn more about him, his needs and what was going on at home. At 33 years-old, Parker felt like he didn’t have many friends, and he just wanted to meet new people that he could talk to.

During his stay in the hospital, Parker worked closely with behavioral staff at Aetna. They helped him to see how his behavior could deter people from wanting to interact with him. As a result, Parker became more aware of himself and subsequently became very active in groups, attending them regularly.

He said he found the social interaction component of his inpatient care something that he had been missing for a long time. Parker began forming friendly relationships with other patients and staff and even got to a point where he was able to lead some of the group discussions.

Since one of Parker’s main issues was that he often felt sad and alone, the behavioral health staff on the Aetna team made sure to remain consistent in outreaching him via phone calls so that he knew when he could expect their calls.

The care coordination team made sure to include him while discussing discharge plans and connected him with doctors and specialists in the community that could see him post discharge to help manage his Leigh's disease, including addressing the severe headaches he was experiencing.

Aetna’s care coordination team also:

Ensured transportation was provided to and from his appointments.
Connected him with a facility that would offer him a day program where he could participate and give back to the community.
(He was able to attend three days a week which helped to address his feelings of isolation while his mother was away at work).
Worked on getting him setup with home health services so that if something were to happen at home and he couldn’t get to a provider, one could come to him.

“The work that we do touches lives, but it’s really nice when you get a chance to see how transformational it is, and in this case, I really felt that way,” said Philip Montgomery, Care Coordinator at Aetna Better Health.

*Names changed to protect privacy

Aetna Member Story

Thu, 26 Oct 2023 01:12:20 GMT

Aetna Helps Stroke Patient Get Her Life Back On Track

Jenny had experienced a stroke and took several falls that required surgery to mend broken bones. When she joined Aetna Better Health®

of Illinois in March, Jenny had been struggling with these health setbacks and was self-medicating with alcohol. It was clear to our team

that she needed immediate support and services.

The Aetna team was able to complete the onboarding process in four days. Our staff worked with Waiver Operations to determine what

services were available to assist. They learned Jenny was eligible for services in her home to help make her daily life easier. Tara, a member

of our Waiver Services team, reached out to let Jenny know what resources were available.

Eight days after she joined the plan, Help at Home started providing services in Jenny’s home. A caregiver helped with meal preparation,

laundry and personal care activities to make Jenny’s daily life easier. Each day when Tara called Jenny to get updates and encourage her, she

heard progress. Tara said, “Jenny showed continual improvement and an increasing level of independence. She became less reliant on alcohol

and expressed increased satisfaction and happiness.”

In less than three months, Jenny shared with Tara that she was doing everything on her own. She even hoped to return to her career in health

care. She felt so good, in fact, that she no longer needed in-home support. She told Tara, “I don’t want to tie up services that I don’t need,

especially if there is someone out there that could benefit from them like I have.”

*Names changed to protect privacy

Aetna Member Story

Thu, 26 Oct 2023 01:09:35 GMT

Aetna Helps Family Navigate An Adolescent Behavioral Health Crisis

Matthew is an adolescent Aetna Better Health® of Illinois member who has severe behavioral needs, resulting in him being violent and aggressive in the home. Matthew had been placed in a residential house. However, he was sent back to his family home when there was no availability at a higher-level of care facility.

He was at home for seven months during which he, and his family, struggled immensely. During this period, Matthew caused significant damage to the house, caused his parents to miss time from work and spent multiple days in the hospital. His parents tried to get an inpatient hospital placement but could not find a facility that they felt could handle his level of aggression.

Matthew’s parents were connected to Ben, an Aetna behavioral health care manager. Ben worked tirelessly to coordinate with all stakeholders

(school district, county-level behavioral health support, post-adoption services, the Family Support Program and the Illinois Department of

Children and Family Services) in Matthew’s care to ensure there was a plan and that all stakeholders carried out their roles.

After working closely with these stakeholders and Matthew’s family, Ben was able to secure a placement at a residential facility that could

address Matthew’s needs. Matthew is now safe in the residential facility and his family is safe at home as well. He now has a chance to get the

intensive help that he needs and has the possibility to shape his future in a positive way. His parents say Ben was empathetic, focused and never gave up on helping them, stating, “Ben and his team literally saved our family.”

Aetna Member Story

Wed, 25 Oct 2023 22:04:58 GMT

Aetna’s Care Coordination Team Helps Family Beat the Clock and Avoid Hospitalization

"As a nurse, I used to think that insurance companies were only out for themselves, but today I’d like to present a story that gives me my real why, my why I wake up and love going to work every day and how impactful my team is,” said Lisa-Jasmin Ford, Clinical Manager at Aetna Better Health.

Last year brought with it many challenges. Along with a nationwide pandemic, Illinois grappled with severe storms. Aetna Better Health Member, Linda Velazquez, called Aetna in a panic the day after one of these severe storms. Linda’s daughter Vanessa, also an Aetna member, was born with a very rare and complex genetic disorder, which results in profound weakness, chronic lung issues and malnutrition.

Linda was in a panic because she had lost power in her home which directly affected Vanessa’s medical needs. Vanessa had extreme failure to thrive, a form of malnutrition, and suffered from many nutritional imbalances and had to be fed through a stomach tube. Without continuous and proper nutrition, Vanessa was at a high and immediate risk of developing a seizure condition which could potentially become fatal. The battery for the stomach pump used to feed her only had a lifespan of a few hours without being plugged into a power source.

Aetna’s care coordination team:

Outreached ComEd and was able to escalate the case for faster restoration.
Signed Linda up for text alerts so she could track when the power would be back on.
Established a safety plan checklist with Linda so she could safely travel to a family member's home while her power was being restored.

With the help of the care coordination team, Linda and Vanessa were able to beat the clock and safely settle into her aunt's house. Her feeding was uninterrupted, she suffered no life-threatening seizures, and she was able to return home and sleep in her own bed that night once the power was restored.

“Aetna believes in prevention, we work with all different agencies and treatment teams to ensure the safety and best health outcomes for our members - We are prevention,” said Ford.

Aetna Member Story

Wed, 25 Oct 2023 21:49:01 GMT

Aetna’s Care Coordination Team Goes Above and Beyond for Member and Her Family

Sometimes, care coordination means thinking outside of the box when it comes to achieving the best health outcomes for members. Aetna Better Health knows this all too well. That’s why their care coordination team went beyond benefits and outside the typical network of care to provide the highest level of attention for the Henderson family and their newborn baby, Grace.

Grace was born on Feb 22, 2021, at 37 weeks and remained in the hospital for four days. After a subsequent hospital stay, she was diagnosed with crater willi syndrome at one month of age, which causes muscle weakness in all bodily systems, and in Grace’s case, obstructive sleep apnea. Grace was also initially fed through a tube in her stomach.

Grace and her family are from a small, rural town in Illinois, and they have to travel two hours to get to Grace’s specialty providers. This, of course, poses many challenges for Grace and her family.

Knowing this, Aetna’s care coordination team made sure to equip her family with all the tools, education, and resources they needed to help Grace thrive.

Aetna’s care coordination team facilitated:

Connecting the family with specialty providers including a nutritionist, endocrinologist, pediatrician, pulmonary specialist, physical therapist, and occupational therapist.
Ensured home health services were coordinated to help the family receive care closer to home.
Made sure the family received ongoing education regarding Grace’s care, including CPR training.
Connected the family with behavioral health providers and resources.
Coordinated transportation services, going above and beyond the 90 miles stipulation to bring Grace home from the hospital.
Provided safety planning and community resources for diapers and supplies to offset costs for the family.
Ensured her necessary medical equipment was supplied through community partners.

Additionally, all first responders in the town, on their own time, traveled to the specialty hospital where Grace received care to get trained on what to do if the power were ever to go out and Grace needed to be transported to the hospital.

Since coming home from the hospital in March, Grace has not been readmitted. The family reports that she is currently swallowing, which was something she previously struggled with due to her condition. She’s also gotten stronger with physical therapy, was able to have her stomach tube removed, is now eating solid foods, and is starting to gain weight.

Grace’s mother said thanks to Aetna Better Health, she feels more confident in being able to care for Grace’s special needs and the challenges they face as a family. Having a child with special needs can add stress to an already busy family. Having a care coordinator that was compassionate but was also able to relate, having toddler aged children herself, helped to put the family at ease.

“My goal is to continue to instill confidence in the parents and help them face any challenges they may have behaviorally, medically, socially and familiarly in the future, and decrease chances they may need to go back to the emergency room, which would put Grace at risk of infections,” said Cheryl Wyatt, Registered Nurse at Aetna Better Health.

Member Story - A Man Struggles To Find Solid Ground

Wed, 25 Oct 2023 21:46:47 GMT

A Man Struggles To Find Solid Ground

While attempting to retake control of mental health following a history of substance abuse, one man’s journey on his road to recovery has

overcome numerous obstacles. Barriers to achieving health and wellness are different for every individual.

In the past, Jacob Williams, has self-medicated his schizophrenia with alcohol, which has led to various health problems due in part to risky behavioral health patterns. Now that he has achieved one year of sobriety, Jacob a 45-year-old Illinois resident, still had many challenges that hindered his mental health success.

Once assigned to care coordination for behavioral health needs, an assessment revealed a major factor to Jacob’s success was a precarious and inconsistent housing situation going between his parents and hotels. To find more stability, Jacob considered the idea of entering into a long-term care facility where he’d have access to join the “Moving On Program.”

Instead, through the assistance of a care coordinator, Jacob was connected to a community support team where he was introduced to a community Chaplain.

With the development of natural supports within his community, an action plan was put in place to secure a stable living situation for Jacob. Through the efforts of the community support team case manager, care coordination, and the Chaplin, Jacob was assisted with the application for subsidized housing.

Molina Member Story

Wed, 25 Oct 2023 21:45:12 GMT

Molina’s Care Coordination Team Helps Member on the Brink of Homelessness

A 61-year-old African American man from central Illinois was on the brink of homelessness. Challenged with intellectual disabilities, housing instability and a lack of support system, Michael Smith was forced to move out of state to live with his niece in Texas.

This posed a huge risk for him since all his doctors were in Illinois, and he subsequently lost all waiver services and most of his independence and autonomy because his homemaker was also Illinois-based.

Molina’s care coordination team was able to:

Identify and address his social determinant of health needs.
Secure housing for him through community partnerships.
Help him furnish his new home.
Educate and connect him with resources available to him.
Reinstate his home and community based waiver services.

Michael is now back in a clean and safe home in Illinois, active in his community including attending church regularly, and enjoys taking advantage of the food pantry that’s located in his building.

When Michael moved to Texas, he moved out of desperation, because he needed housing. If Molina’s care coordination team hadn’t stepped in, Michael would have been at a high risk of becoming homeless, which would have created another set of barriers for him.

Aetna Member Story

Wed, 25 Oct 2023 21:21:48 GMT

Insights From A Care Manager: The Power Of A Home Visit

I recently had a home visit with a member — a home visit at last! Because of COVID-19, my role as a Community Health Worker (CHW) went from field-based and in person to working from home and talking to members by phone. I missed meeting with members and couldn’t wait to connect in person.

MEET ANNA

Anna* has multiple complex health issues. She recently had a double mastectomy and was recovering from COVID-19. She was with a different managed care plan, and when she re-enrolled with Aetna Better Health® of Illinois, her assigned PCP wasn’t taking new patients. Anna sees specialists in our network, but couldn’t find a new PCP.

Anna and I met on her front porch - our visit lasted for three hours. Anna told me her health care journey had been long, hard, and exhausting. She shared that she sometimes feels no one really cares about her health struggles. She talked about her mother's battle with cancer and her grief after her mother passed. i learned about her husband and family.

Anna said how good it felt to talk and be heard. And I couldn't be more grateful to be back in the field. The face-to-face experience can't be matched by phone or video.

I'm still working with Anna to find a PCP who's a good fit. And I'll continue to follow up with her for as long as it takes. i want to help Anna get positive health outcomes that improve her quality of life.

Molina Member Story

Wed, 25 Oct 2023 21:09:46 GMT

Molina's Persistence Leads To Member's Sobriety

Katie is a 55-year-old woman from Kane County who has a history of alcohol dependence, alcohol peripheral, BPD, PTSD, Hernia and Gallstones. Katie was recently referred for case management services after an inpatient stay. Her case manager initially tried to contact her post-discharge but was unable to reach her after multiple attempts. Katie was referred to case management services again after another hospitalization for alcohol abuse.

This time, Katie’s case manager’s continued outreach led to successful contact. They began talking and Katie began engaging with her case management supports. Her case manager even assisted Katie in enrolling into a 28-day recovery program. Katie and her case manager continue to work together. Katie’s case manager links her with services and supports to help her recover. Katie now has a primary care provider, a dentist and a gynecologist on her care team to support her health.

Katie and her case manager re-enrolled her in SNAP benefits to help her get access to food. Katie also recently saw a specialist for gallbladder

surgery—Post-surgery her case manager and care team helped her as she recovered. Katie keeps her appointments now. Katie reports active

engagement in her sobriety support and goes to weekly Alcoholics Anonymous meetings. Katie has now been sober 7 months. She is appreciative and thankful for her care team and Molina case manager.

Molina Member Story

Wed, 25 Oct 2023 21:07:33 GMT

Molina's Specialty In Care Gains Trust Of member And Puts His Health Back On Track

John is a 45-year-old man who lives with hypertension, asthma, TIA, diabetes and ESRD. John has a history of discharging himself from hospitals against his team’s medical advice. John has a history of nonadherence to prescribed medications and not going to follow-up appointments. John is not established with any primary care or specialty providers. John was referred to Molina case management during an inpatient stay for TIA, cardiac event and seizure like activity. John was prescribed insulin during his stay and received hemodialysis.

John worked with his case manager, who has a specialty in diabetes management. The case manager engaged with hospital staff, John’s daughter, and the support team to help support John’s recovery. The case manager provided John with support and education on disease management, as well as a discharge plan to help meet his needs. John was discharged and needed 24-hour supervision. John’s case manager continued to provide support services post discharge.

The case manager arranged for support, scheduled follow-up appointments, transportation, provided education on disease management, medication management and was referred for HCBS waiver support. The case manager also helped John get a cell phone and blood pressure cuff. Now, John sees his nephrologist regularly and gets regular blood work. John uses Molina’s transportation services to get to and from his appointments. John no longer requires dialysis and is medication adherent. He does not require insulin and tracks his blood pressure daily. John has returned to work as a high-school janitor and lives independently.

Aetna Member Story

Wed, 25 Oct 2023 21:04:41 GMT

Aetna Establishes Onsite Partnership At Mount Sinai Hospital

Aetna Better Health® of Illinois partnered with Mount Sinai Hospital to establish an onsite link to Aetna’s utilization management and care coordination services. Based on Chicago’s west side, Mount Sinai Hospital is one of the largest private safety net hospital systems in Illinois and is a critical partner for Aetna and our members.

The innovative arrangement between Aetna and Mount Sinai Hospital is designed to better assist our members during and after stays for both physical and behavioral health. An onsite Aetna representative engages members by providing health plan benefits, education, assessments and warm transfers to care coordinators. Additionally, they can link members to the appropriate follow-up care after discharge — with an emphasis on behavioral health discharge planning support.

Since the start of this partnership, Aetna members who are patients at Mount Sinai Hospital have been connected to Aetna case managers who provide confirmed follow-up appointments and engagement in interdisciplinary care teams. This has resulted in shorter hospital stays for our members.

*Names changed to protect privacy

CountyCare Member Story

Wed, 25 Oct 2023 21:03:54 GMT

'CountyCare Is The Best,' Member Says After Losing Health Insurance Due To Personal Tragedies

Diagnosed with rheumatoid arthritis, Rhonda Smith, a resident of Streamwood, has been a CountyCare member since 2019. After losing her son in a car accident in 2019, she was completely traumatized and grieving to the point where she could not perform at work. Ironically, Rhonda worked in the emergency department at Roseland Hospital, where she has seen trauma cases up close and personal and patients in critical condition, but she never thought she was going to be so close to a trauma case that will change her life forever. And that was only the beginning.

Two months after her son passed away, Rhonda lost her mom to a massive stroke, a month later, she lost her fiancé to a heart attack and just in February of 2020, her dad passed away from COVID-19.

With a heavy heart and trying to heal from these major personal losses, she realized she could not concentrate at work. She quit her job and with that, lost her health insurance.

Luckily, a coworker from her former employer, Roseland Hospital, arranged for her to have CountyCare. As a member of the health plan, Rhonda has access to key specialists within CountyCare’s network who are helping her move forward, both in life and with her medical conditions. She has seen a hand specialist, psychiatrist and chiropractic. All along she kept hearing from these health care professionals, “Your insurance got you here.” Her initial public aid insurance did not give her access to these specialists.

Just recently, she also spoke with her CountyCare care coordinator for the first time, who will work by her side to ensure she continues to stay on track as part of her wellness journey.

And that’s not all, Rhonda has also enjoyed her OTC Rewards Card, one of the many benefits she gets when a member completes certain health care services and medical appointments. “I have used the card when I had no money,” says Rhonda. “It has truly helped me a lot.” Her advice to others, “Use the services that are provided to you. If you have a problem, call CountyCare or your care coordinator. They really help you,” says Rhonda. “CountyCare is the best, it has been the best for me.”

Aetna Member Story

Wed, 25 Oct 2023 21:02:21 GMT

Collaboration Between Utilization Management (UM) And Care Management (CM)

Mary, an Aetna Better Health® of Illinois member, was admitted to Substance Abuse Residential Treatment at Cornell Interventions in October 2021 due to daily heroin and cocaine abuse. A below-knee left her wheelchair bound, and a recent diagnosis of Multiple Sclerosis requires close observation and monthly infusions. Mary has an extensive history of attempted sobriety through treatment, with five years of sober time from 2009 to 2013. She also had five attempts of RTC treatment in 2020, along with medical admissions due to necrotic wounds on her arms from IV heroin use.

During her residential treatment, the team recommended specialized aftercare due to Mary’s medical diagnoses. The Behavioral Health Utilization Management team reached out to Aetna Better Health of Illinois Care Mangers Olga and Marlene for help with placement options. Together, they helped get Mary placed at The Boulevard, a medical respite option in Chicago that specializes in both physical and behavioral health support.

*Names changed to protect privacy

Aetna Member Story

Wed, 25 Oct 2023 20:58:47 GMT

Aetna Provides Support For A Busy Mom

Julia is a busy mom of a big family. She stopped by the Aetna® table at a recent Laundry & Literacy Day event for some information. Betsy, an

outreach coordinator with the Aetna Better Health® of Illinois team, was there to help. Julia shared that she hadn’t seen a Primary Care Provider

(PCP) in over two years and told Betsy she was thinking of changing plans.

Betsy and Julia went over the health, dental and vision care benefits available to her and her kids — all 100 percent covered with an innetwork

provider. Betsy made sure Julia knew about all the extras like the free student data plan, free school clothes and after-school care, free gym memberships, and more. Julia was grateful for the support and excited to start taking advantage of all their benefits. “There’s nothing better than connecting with the members we serve,” Betsy shared. “I’m grateful that I was able to help Julia learn about all that our plan has to offer.”

*Names changed to protect privacy

Molina Member Story

Wed, 25 Oct 2023 20:44:22 GMT

Member Regains His Independence Thanks To Molina's Care Coordination Team

Dwayne is a 58-year-old man who has been living in a long-term care facility in Cook County for two years. Before living at the LTC, Dwayne

lived with a friend but because of hip pain and difficulty with mobility he was admitted to the LTC. Dwayne wanted to live in accessible

housing in the community and was assessed and referred to HFS’ CTI program by a Molina transition specialist.

Dwayne began working with his Molina transition specialist, case manager and facility staff on his recovery goals. He was provided supports and service while his specialist and community connector looked into accessible housing for him. Molina staff worked with him to ensure he obtained a bridge subsidy voucher from HACC so he would only be required to pay 30 percent of his income towards rent. They confirmed his housing was accessible and that all utilities were in place.

The Molina connector accessed Dwayne’s transition funds and helped him purchase 30 days’ worth of food, pay his security deposit, get furniture and household goods, and needed medical equipment. Dwayne began working with his primary care physician to develop a care plan, find an orthopedic and approach his pain management.

Dwayne has been living in his new home for the last two months. He has ongoing support through both his Molina case manager and onsite case

management. Dwayne continues to follow his care plan and work with his providers.

Dwayne has had no inpatient stays or emergency room visits since discharge. Dwayne continues to use his coping skills and support team to help him through difficult situations. Dwayne has reported he is very happy and grateful that he is able to live in the community, with privacy, independence and autonomy.

Molina Member Story

Wed, 25 Oct 2023 20:41:29 GMT

Molina's Care Coordination Team Helps Reunite Member With Her Husband

A 45-year-old Illinois woman was separated from her husband while on the state’s fee-for-service program. An Adult Protected Services report

flagged Roberta Wilson’s case due to what was reported as neglect of care in the home for her husband’s failure to pay the electricity bill.

Roberta had a history of stroke, seizures, diabetes, hypertension, respiratory failure, and depression, and as such, required electricity for

the use of equipment that helped her to manage these conditions.

After a hospitalization stay, Roberta was placed in a long-term care facility where she remained for four months, despite voicing her desire to want to return home. One of her parents was made her temporary guardian to help facilitate her care.

In January 2021, Roberta was connected with Molina and upon an initial assessment, Molina’s care coordination team discovered the APS report

stemmed from an unmet social determinant of health need. It appeared as if her husband had been neglecting her care by not paying the

electricity bill, however, Molina’s care coordination team uncovered the family was facing financial hardship and having difficulty paying their

bills routinely.

Roberta expressed to Molina’s care coordination team that she wanted to move back home with her husband and reacclimate to the community. The team then developed a transition plan with the long-term care facility, her husband, and her temporary guardian to move her back home.

The care coordination team facilitated:

Having her waiver services reinstated.
Implementing a medication plan.
Ensuring all her utilities were up-to-date and paid routinely.
Assisting the couple to apply for LIHEAP for assistance with energy costs and payment.
Outlining an ongoing plan of care.
Connecting her with home and community-based waiver services.
Supplying a hoyer lift, hospital bed, wheelchair, bedside commode, blood pressure cuff, pulse oximeter and other medical supplies to help manage her various conditions.
Setting her up with a primary care physician and a neurologist to ensure completion of follow up appointments.

Roberta was connected with Molina and their care coordination team in January 2021 and was able to return home and reacclimate to the

community in March 2021.

Since then, she’s had only one inpatient stay, which was a result of a wrong dose for one of her medications that was identified and corrected

right away. She’s had no further ER visits or inpatient stays and has been successfully living back at home with her husband. Roberta and

her family are very happy with the services they’re receiving and her level of independence and autonomy back in the community.

Unfortunately, situations where a member is in an LTC facility and desires to move back home are fairly common. Molina’s team says whenever they complete an assessment with members who are in long-term care facilities, they always inquire about their desire of a higher level of independence in a least restrictive environment.

A member like this may have remained in a long-term care facility, the Molina team said, without inquiry into her desires and assessment of her

and her support system. Her guardian may not have been aware of services available to them, such as the home and community-based waiver services, that allowed her to go home with the additional support she needed.

Care coordinators are crucial in helping members and their families navigate what can feel like a very complex system by educating them about available resources and taking the initiative to connect them to agencies that can further assist.

“This is an example of someone getting caught up in the system because of the APS report, because of not knowing that there are resources available to help with the very thing that forced her out of her home, and split her up from her husband,” said Kris Classen, Vice President of Healthcare Services at Molina Healthcare.

“And then she joined Molina and we were able to intervene and help.”

Humana Member Story

Wed, 25 Oct 2023 20:36:41 GMT

Humana's Attention To Details Provides Better Quality Of Life For Member

June, a Humana member in her mid-40s, lives with a series of chronic conditions that affect her physical and mental health. She underwent a

surgical procedure for weight loss several years ago, and she was able to perform most of her daily living activities with minimal assistance from

her spouse after the surgery. Standing for extended periods of time was still difficult after her surgery, so Humana arranged to have meals

delivered to her home.

Last year, June’s mental health became unstable, and she and her spouse moved to a specialized mental health rehabilitation facility for access to group therapy and psychiatric care. After about six months of intensive mental healthcare, June wanted to become more independent and began looking for an apartment. She worked with a Humana transition coordinator to help her transition into the community and to complete a health risk assessment to identify her needs.

The care coordinator found some gaps in June’s abilities and arranged for a local homemaker service to assist with meal prep, laundry, housework and shopping. Because June walks with an unsteady gait, the care coordinator also authorized a personal emergency response (PERS) unit in case she fell. June’s mobility issues also brought up safety issues in the bathroom, and the care coordinator helped June get a shower chair, shower grab bars, a shower sprayer and bathroom grab bars, along with a cane, walker and other durable medical equipment for her new home. The care coordinator noted that June had a history of cancelling medical appointments, so together they designed a plan of care to make sure June was able to attend her medical appointments.

June continues to work with her care coordinator to remain medically stable, ensuring she is taking her medications as prescribed and calling

a counselor or medical health provider when issues arise. They stay in touch on the phone, talking at least every 30 days, and June knows she

can reach out to her care coordinator for assistance at any time.

Humana Member Story

Wed, 25 Oct 2023 20:31:26 GMT

Humana Helps To Alleviate Burdens For Member And Family

Joy, a Humana member in her early 90s, is dealing with multiple chronic conditions that impact her memory and her mobility. She lives with her

family, who are her primary caregivers, in a two-story home. Joy’s bedroom is on the second floor, and she uses a cane, walker and chair

lift on stairs for mobility in her home. Following a recent fall and hospitalization, Joy’s family started experiencing some caregiver

burnout.

That’s when a Humana care coordinator reached out to Joy and was able to find solutions to help improve her quality of life, along with removing

some of the burden of caregiving from Joy’s family.

When Joy and the care coordinator talked, Joy explained that she’d previously declined homemaker services, a benefit of her Humana plan,

because of COVID, but that she wanted to begin using that service. The care coordinator found a homemaker service in Joy’s area to assist her

with daily activities such as bathing and eating, as well as laundry, housework and shopping. Joy’s benefit included 125 hours of homemaker services per month, and the care coordinator asked the agency to begin services immediately.

Joy’s family felt burdened with keeping enough incontinent supplies on hand. Upon hearing this, the care coordinator offered to assist Joy with

setting up a regular delivery of incontinence supplies from a reputable company.

Understanding that Joy’s family spent a great deal of time worrying about Joy and mobility challenges, the care coordinator suggested Joy

and her family consider getting a Personal Emergency Response System (PERS), an available benefit as part of Joy’s Humana plan. The PERS is a

medical alert system that can help inform Joy’s family if she falls and give Joy greater confidence to move around on her own.

Joy’s family was concerned about keeping track of the billing for services, but the care coordinator reassured them that she would be there to help, including validating services every 90 days and contacting companies involved about any issues.

Today, Joy and her family are doing well. Joy feels more freedom thanks to the homemaker services and her PERS. And, Joy’s family is no longer

struggling with caregiver burnout.

Aetna Member Story (Social Determinants of Health)

Wed, 25 Oct 2023 20:26:04 GMT

Aetna Care Coordinator Helps Family Meet Their Goals

Christina is a care coordinator with Aetna Better Health® of Illinois. When she began working with Adam and his family, Adam was not enrolled in school. He was also struggling with his weight. Adam’s mother was dealing with substance use issues and had a pending case with the Department of Children and Family Services (DCFS). Adam’s mother expressed a desire to address the substance use and be a better parent to keep her family together.

Christina coordinated with DCFS to find substance use support for Adam’s mother. She was nervous about getting help to address the substance use, parenting and other issues. Christina was able to help by sharing her positive experience working with the provider in the past.

With support from Christina, Adam’s mother began participating in substance use services as well as parenting classes. His mother registered Adam for school. Christina also helped her find creative ways to get Adam to eat vegetables — focusing on making small changes to his diet to improve his overall health. Christina checks in with the family regularly to provide encouragement and follow-up. The family continues to make progress toward their goals and as a result, the DCFS case has been successfully closed.

*Names changed to protect privacy

CountyCare Member Story

Wed, 25 Oct 2023 15:36:40 GMT

Long-Term Care Member Has Hope For Happiness, Thanks To CountyCare After Challenges With Complex Conditions

CountyCare member L. Penna, a resident of Albany Care (ICF) since 2000, has been diagnosed with schizophrenia, bipolar disorder, asthma, COPD, anemia and anxiety. She was married and in an abusive relationship prior to the nursing home placement. Currently, Penna shares a room with 4 other residents.

Since she joined CountyCare, the Waiver and Long-Term Care team has connected her to a behavioral health provider for medication monitoring and ongoing support.

The Care Management team has also:

Assessed the member and collaborated on a transition and discharge plan
Collaborated with the University of Illinois Chicago (UIC) on transition approval, provided labs, progress notes, assessment and transition plan
Applied for member ID/ Birth certificate/Social Security card and cell phone
Toured senior living facilities until member found one she desired
Applied for furniture bank and went with member to make selections

The member continues to make great progress. She just recently moved to Victory Center Riverwoods senior living facility as the next step in her wellness journey.

The member is very excited and relieved that she has a hope for happiness. Our Care Management team has scheduled all follow-up appointments with the SLF MD and Suburban Behavioral Health Counseling Center.

They also:

Ensure discharge is appropriate and safe
Stay focused and crafted care plan goals in partnership with the member
Communicated with nursing home placement, receiving facility and health plan throughout the process to avoid any delays

* Names and identifying details have been changed to protect anonymity

CountyCare Member Story

Wed, 25 Oct 2023 15:28:01 GMT

Care Coordination Team At CountyCare Pulls Family Out Of The Cracks, Renewing Hope For A Better Life

It’s so easy to fall through the cracks when it comes to navigating the healthcare system. Patients oftentimes find themselves having to be their own advocates, but many don’t even know where to begin, or the resources available to them.

This is what happened to one CountyCare member and his family, before joining the Medicaid Managed Care Organization.

Sixty-one-year-old Norbert joined CountyCare in early 2021. Prior to, he had been a part of the Medicaid Fee-for-Service Program, where he and his family fell through the cracks.

An initial care coordination assessment in February 2021 uncovered that John had not received medical attention since 2014 when he was admitted to the hospital. After being discharged, he never received any follow up medical attention.

John was born with developmental delays and substantial functional limitations, including aphasia and hearing problems. He lives with his two older sisters, an older brother, and their sick elderly mother. One of his sisters and his brother also have intellectual disabilities. Their father passed away from cancer in 1995, leaving his mother to raise them on her own, until she too fell ill. His mother is now in hospice and is cared for by one of his sisters in the Chicago home they all live in together, the only home Norbert has lived in since birth.

John was at a very high risk of being institutionalized without CountyCare’s intervention. Had it not been for the work of the care coordination team, John would most likely have ended up in a nursing home indefinitely.

John’s care coordinator facilitated:

Educating the family on what resources were available to them and John.
Arranging for doctors and a medical team to visit John at home to assess his medical needs and medication regimen, as well as draw necessary labs.
Securing occupational and speech therapy for John to assist with his aphasia and limited functional capabilities.
Coordinating homemaker assistance, which now visits John five days per week.

John and his family faced a myriad of issues that should have been mitigated by a variety of medical professionals they encountered throughout their healthcare journey, but instead, remained unaddressed until CountyCare team members stepped in and took the time to walk into John’s home and assess and address the various needs of the

member and his family.

This removed a huge burden of stress from one of John’s sisters, who is a caretaker for John, their mother in hospice, and John’s two other siblings, who also have intellectual disabilities. “We felt alone, like the entire world forgot about us,” his sister said. “We gave up.”

John’s care coordinator said her mission with the family, and with all of her members, is to “bring hope, hope and one more time, hope.” And in just six short months, John and his family experienced firsthand what this truly means. In this short time, thanks to the coordination of a variety of inventions, John is now able to prepare and eat his own meals

and snacks, take walks around the block with his sister and enjoy time in the backyard with his family, all notable wins that have given this family hope again.

“Only working together as a team - care coordination team, medical team, home health team - all have to work together to make a difference and bring results,’ said Bozena Miltko, John’s care coordinator. “Even small changes are big changes for members.”

In most instances like this, patients like John would be institutionalized for life, due to caretaker burnout, neglect or hospitalization that leads to continued health decline. Many of those patients get lost within the Fee-for-Service program, which compartmentalizes members and their care and places the burden of navigating care and needs on them, rather than seeing them as a whole person and coordinating care to align with this perspective.

With the intervention of MCO, members benefit from the care coordination team providing better access to medical professionals, helping facilitate care and aiding in obtaining necessary resources like they did for John and his family.

“Every care manager that does a good job is going to run into cases like this,” said Debra Brophy, Director of Integrated Care Management and Behavioral Health at Cook County Health. “This is the norm, this is what we do. (But) you really want to get that great outcome, and that takes time, but thankfully in this case, in six months, this was a great, short

turnaround for this member to see a great outcome.”

* Names and identifying details have been changed to protect anonymity

CountyCare Member Story

Wed, 25 Oct 2023 15:22:34 GMT

62-Year-Old CountyCare Member Regains Mobility And His Life Thanks To Care Coordination Program

Sixty-two-year-old CountyCare member Stevenson Williams joined the health plan in July of 2014 due to his affiliation with Cook County Health. A resident of Harvey, Ill., and school bus driver for about 12 years, Williams led an active life, went on walks for about three miles during work breaks and was a regular at the gym.

One day, he woke up and simply could not walk. “I tried to walk, but it didn’t happen,” he recalled. He went to the doctor, where he has diagnosed with a spinal condition that causes back pain. He also had a degenerative disc, causing him extraordinary pain. His doctor referred him to CountyCare. “My back pain significantly altered my life,” Williams

said. “I was confined to the house. My life changed so much. I couldn’t do the things that most people do.”

That’s when Care Coordinator Jackie Webb stepped in. Jackie and the team arranged all of his durable medical equipment (DME) needs (cane, walkers, mobile wheelchair) to regain his mobility and independence. They also managed his medication refills and coordinated his personal assistance through a homemaker who prepared his meals, cleaned his house and helped him move around the house. Homemakers assist Williams for 4-6 hours, 5 days a week, and accompany him to medical appointments if needed.

“Care Coordination was instrumental in securing my equipment, seeing the right doctors and providing the right direction in my care. My Care Coordinator even went out of her way to tell me about services for people with low income that I didn’t know existed.”

In fact, the CountyCare Care Coordinator team secured a ComEd grant that the utility company offers to families with CountyCare insurance. The grant applies up to $500 per calendar year to the member’s ComEd utility bill. Thanks to the Care Coordination team, Williams has benefited from this grant for three years, a true lifesaver for those who are on a fixed income or have a disability.

Williams is currently receiving care under CountyCare’s Long-Term Services & Supports (LTSS) waiver team as part of his rehabilitation journey where an expert team ensures he receives the services needed to be reintegrated into the community.

Now retired, Williams can perform his daily activities, attend his medical appointments, go grocery shopping and live a more independent life. This is in great part thanks to his homemaker assistance—and all because of the Care Coordination Program at CountyCare.

“CountyCare supported all my needs,” Williams said. “I appreciate all CountyCare has done for me. If there is one thing I can add, as much as I like my waiver team, I want my Care Coordinator Jackie back. I miss her.”

* Names and identifying details have been changed to protect anonymity

BlueCross BlueShield Member Story

Wed, 25 Oct 2023 15:19:27 GMT

BlueCross BlueShield Of Illinois Changes Member's Health Trajectory By Getting Her The Help She Needs

Diana is a 75-year-old member who was recently diagnosed with hypertension, diabetes, heart failure, high cholesterol, and gout. In recent months, her health deteriorated, and it became evident that she needed home care assistance.

Diana recognized that she needed assistance for everyday tasks and was in need of a home care aide, but she was apprehensive of receiving such care due to the ongoing COVID-19 public health emergency. She was also hesitant of strangers entering her home.

Patricia, a BCCHP care coordinator, called Diana and spoke in great length regarding Diana’s home health needs. Patricia explained the benefits of home health assistance, how the extra support could increase her quality of life, and the COVID-19 safety precautions home health agencies would take to ensure her safety.

Patricia found a home care agency and aide that aligned with all of Diana’s needs. Diana has since found her new home care aide extremely helpful and conducive to supporting her with exercise. Diana is much happier now with her home health care aid – she goes for daily walks, smiles much more, and is optimistic about her future.

BlueCross BlueShield Member Story

Wed, 25 Oct 2023 15:16:58 GMT

BlueCross BlueShield of Illinois Provides Peace Of Mind At Home For Member On Elderly Waiver

A BCBS of Illinois member was discharged from a nursing facility on July 2021. His daughter and Power of Attorney (POA) drove for over an hour multiple times per week to check on him. She was overwhelmed by the level of care needed when the member first returned home from the nursing facility. The member was resistant to assistance, he frequently sent homemakers away when they arrived for their shifts. He also showed cognitive decline.

The member provided permission for his care coordinator to speak with his POA (daughter) for his care and assessments. Upon completion of the initial assessments, it was identified that member needed increased

homemaker hours and an Emergency Home Response System (EHRS). He was stratified as high risk and monthly care plan reviews were completed. An Automatic Medication Dispenser (AMD) was offered, and the member and his daughter agreed to install. The daughter also spoke with neighbors who agreed to aid while she was away and to call

her as needed.

The member has now had the Automatic Medication Dispenser for over a month. His daughter reported that the Automatic Medication Dispenser is helping and that she only visits every other Saturday instead of multiple times per week. The member’s neighbor stops by on the weekend to visit and calls the daughter if any concerns arise. The

daughter continues to notice her father’s decision-making skills are slower than they used to be but not where he cannot live independently. The daughter reports she is feeling less overwhelmed and is now able to

visit as his daughter rather than as a caretaker.

She expressed that the services are helping the member remain at home and give the family peace of mind that he is cared for and there are enough people involved to check on him regularly. The member has not sent his homemakers away like he had in the past and his physical and occupational therapy sessions have been completed successfully.

He continues to have need for home exercises and still has weakness but is much stronger than when he returned home from the nursing facility in July 2021. The member has been doing so well and showing progress with the services that we were able to change his risk stratification from high risk to moderate risk.

Aetna Member Story

Wed, 25 Oct 2023 15:11:51 GMT

Aetna's Care Coordination Helps Member Regain Her Independence

Kimberly Jones, a 64-year-old Caucasian female, was admitted to a long-term care facility for rehabilitation and physical therapy in May 2021 after suffering a stroke that left her with left side weakness and impaired mobility.

Before this trauma, Kim was living independently in Lake County, IL, with a beautiful view of the lake from her window. This was the first time in her life losing independence, mobility, and the ability to care for herself, and she desperately wanted to regain her independence and strength and return home.

Aetna’s care coordination team:

Educated her on the transition process and her benefits as an Aetna Better Health member.
Secured a free cell phone for her through a community partner that included unlimited data benefits and internet hotspot.
Established homemaker services and an emergency home response system.
Worked with family and friends to modify home accessibility.
Coordinated home healthcare and regular check ins with her PCPs.
Setup home delivery of medications.
Arranged for her to be vaccinated
Ensured she was equipped with medical equipment and home care supplies including a fully electric hospital bed.

Kim had no idea these benefits were available to her through her Medicaid plan. She expressed to the Aetna team that she was so happy to be home and how grateful she was to have a team of people that were very dedicated to helping her and advocating on her behalf.

She explained that her view from her nursing home room was a gray concrete wall, and now at home, she wakes up again to the beautiful view of the lake.

“Community resources and benefits are not advertised on billboards or on TV, so it’s up to us as care coordinators and case managers to educate and advocate for our members,” said Amy Bossman, Case Management Coordinator at Aetna Better Health.

Meridian Member Story

Tue, 26 Sep 2023 00:05:05 GMT

Meridian Helps Member Deliver Healthy Baby Boy

Tia, a 27-year-old enrolled in care management for high-risk pregnancy, had a history of hypertension and mental health disorders. During Care Manager Jennifer Rose Held’s first discussion with Tia, she denied having symptoms of hypertension. Jennifer utilized her nursing skills and conducted motivational interviewing with Tia.

Jennifer discovered Tia had not been taking her hypertension medications, nor was she aware of the symptoms of high blood pressure during pregnancy. Jennifer provided education to Tia and successfully enrolled her in Meridian’s Obstetric (OB) Remote Patient Monitoring program. Tia received a phone, Bluetooth blood pressure cuff, and real-time support along with notifications/education based on her blood pressure readings.

The week after enrolling in Meridian’s OB Care Management program, Tia called Jennifer for assistance as she was experiencing a panic attack and wanted someone to take her to the hospital. Jennifer calmed Tia down and helped her through the situation by providing coping mechanisms for her anxiety.

After the conversation, Tia was relaxed and did not require a trip to the hospital. Jennifer made sure to call her back a few hours later to check in. Tia expressed gratitude for all the support and reassurance Jennifer provided.

During ongoing interactions with Jennifer, Tia shared that her landlord was displacing her, and she immediately needed to find a new place to live. Jennifer assisted Tia, helping her learn about her county’s eviction policies and linking her to Meridian’s Community Connections department for assistance with housing resources. With Jennifer’s help, the landlord adhered to the eviction policy and granted her a 30-day notice. She also supported Tia by providing contact information for housing alternatives during this timeframe.

Tia found stable housing and maintained healthy habits, including medication adherence, coping skills, attending provider appointments, and developing and following her plan of care. Tia became confident and comfortable collaborating with her providers and care team. She expressed her gratitude for Jennifer’s support. Tia went on to deliver a healthy baby boy on April 24, 2022.

Meridian Member Story

Mon, 25 Sep 2023 23:59:39 GMT

Meridian Connects Member To Employment Opportunity And Resources

This Behavioral Health and employment collaboration story was due to a partnership with one of our external vendors, Supportive Employment. The member’s conditions included anxiety, depression, fibromyalgia, and hypertension. Care collaborations included Medical, Behavioral Health, Vendor, and Community Connections.

The member was referred to the Care Management contracted vendor, Supportive Employment. They assist individuals with intellectual disabilities and mental health conditions in obtaining employment in the community. They also provide the support necessary to ensure success in the workplace. Once the member was connected to Supportive Employment, they were open to any work opportunity.

They assisted her with creating her resume and developing her objective. She then submitted the resume to CPS. In the interim, the member was offered a temporary position at the YMCA where she would operate as the host for the zoom classes while the youth in school waited for the main teacher to begin the curriculum.

Just a few short months after starting that job, they offered the member a full-time position working with the disabled youth during summer school. Supportive Employment continued searching to replace the temporary assignment with a permanent one, and the member obtained a position with another company in addition to securing a permanent one with CPS.

The relationship with our Care Coordinator allowed them to identify the member's need to obtain meaningful employment. This allowed them to maintain a quality of life that allowed them to provide for their son. According to the member, the Supportive Employment program kept her frame of mind in a positive state. She appreciated all of our efforts to support her during the process of gaining employment.

Humana Member Story

Mon, 25 Sep 2023 23:55:59 GMT

Humana Steps in to Help Member Manage Chronic Condition

Joe, a Humana member, has a medical history of uncontrolled type 2 diabetes mellitus, high blood pressure, high cholesterol and multiple sclerosis (MS). In the past, Joe has missed appointments with his primary care physician (PCP) and his endocrinologist. He’s also had multiple hospital readmissions due to diabetic ketoacidosis, a serious complication of diabetes that occurs when your body can’t produce enough insulin. To complicate things further, Joe is a smoker without a stable place to live.

Family issues left Joe without his medical supplies and stable housing, which he believes led to his last hospitalization. It was then that a Humana care manager stepped in to help Joe get a handle on his chronic conditions. The care manager began by making sure Joe had a working glucometer, understood how to check his blood sugar four times per day, and knew how to administer his insulin. Upon hearing he was running low on supplies, the care manager also called his pharmacy to get him a refill on diabetes test strips.

Once his diabetic testing supplies were in order, the care manager turned to coordinating his care after the hospitalization, arranging for transportation for follow-up appointments and making sure the transportation service had Joe’s correct phone number and address on file. The care manager then called Joe’s endocrinologist to coordinate an appointment as soon as possible, and the Humana care manager ensured she spoke directly with the PCP care manager assigned to Joe’s case. Together they were able to secure a continuous glucose monitor (CGM) for Joe as a benefit of his Humana plan, helping to prevent future hospital readmissions by enabling Joe to better monitor and control his blood sugars.

BlueCross BlueShield Member Story

Mon, 25 Sep 2023 23:33:17 GMT

A Man Finds Stability With Blue Cross Blue Shield

While attempting to retake control of mental health following a history of substance abuse, one man’s journey on his road to recovery has overcome numerous obstacles. Barriers to achieving health and wellness are different for every individual.

After successfully obtaining a subsidized apartment, with assistance of startup expenses, Jacob was able to settle and stabilize within his community. He remains well engaged with his newfound community supports team, care coordinators, and his providers. This steady environment has even increased Jacob’s compliance with his medications and health plan. He has remained sober and recently obtained an emotional support cat to improve his overall wellbeing.

For privacy and HIPPA reasons, the names of the member and his family in this story have been changed.

Aetna Member Story

Mon, 25 Sep 2023 23:23:15 GMT

A Team Effort To Answer A Crisis Call

When Lindsay* told Aetna Better Health® of Illinois care manager Nema she was having thoughts about dying, there was no time to waste. Nema immediately dialed 988, the Suicide and Crisis Lifeline, where a counselor got on a three-way call with Lindsay. Nema also used internal communication to contact her manager and the behavioral health team.

During the call with the 988 counselors, Lindsey said she hadn’t taken any action to hurt herself and didn’t want to go to the emergency room. She expressed that she had been having thoughts that she would be better off dead. Our behavioral health team was supporting Nema and her manager during this time to provide input and ensure Lindsay’s safety and well-being. Lindsay was asked to identify a support person she could call if she had similar thoughts in the future and was educated on coping skills she could use if the thoughts returned. If her support person wasn’t available, she was encouraged to call 988 as an immediate source of help.

When the team determined that there were no behavioral health providers in Lindsay’s community, she was connected with the “My Own Doctor” referral line.

Lindsay was grateful for the support and the referral for additional services. Nema made sure that Lindsay’s support person was close by for the rest of the day. She also scheduled a phone appointment between Lindsay and the crisis counselor the following day. Finally, Nema scheduled a follow-up call with Lindsey to make sure her behavioral health appointment was scheduled.

The team involved in Lindsay’s care showed professionalism, empathy and support for Lindsay and for one another.

Aetna Member Story

Mon, 25 Sep 2023 23:16:39 GMT

Hopeless To Hopeful

Tucker, a 33-year-old member of Aetna Better Health of Illinois, had been in the hospital since attempting suicide. After he swallowed drain cleaner, he had to have his stomach and esophagus removed leaving him with a trach and J-tube and the inability to eat food or drink by mouth.

Tucker was homeless and had difficulty getting a permanent discharge plan due to his previous aggressive and suicidal behavior, refusals of care, and his medical condition. He was discharged to a shelter for a short time but returned to the hospital when he didn’t follow NPO instructions or perform proper trach care. He didn’t need acute hospital care but wasn’t safe caring for himself in the community.

Lisa, an RN care manager with Aetna Better Health of Illinois was assigned to Tucker’s case. She immediately scheduled a care team meeting to address Tucker’s depression before referring him to a long-term care facility. The hospital discharge planner and care managers from the health plan contacted a list with more than 100 facilities over a period of five months until identifying a long-term care provider who agreed to work with Tucker. He was then successfully discharged from his lengthy hospital stay to a long-term care nursing facility where he is now receiving nursing care and mental health assistance.

The persistence of our care management team ensured Tucker was not inappropriately discharged to a shelter. Their efforts focused on Tucker’s safety and wellbeing, to ensure his behavioral health needs are met and that he is not at risk for frequent hospital stays or death related to improper trach care, suicide attempts or malnutrition.

*Member and care manager names changed to protect privacy

CountyCare Member Story

Mon, 25 Sep 2023 21:54:05 GMT

Mother Of Four Credits CountyCare For Living A ‘Healthy Life And Having Healthy Children’

"I love, love, love CountyCare,” said Deanna Chandler, a 39-year-old working mom of four (three boys and one girl) when she reflects upon her health, as well as her children, for the past few years. The Harvey resident has been a CountyCare member since around the time her oldest son, now 20, was born.

“I ended up reading all the options available to me at the time and CountyCare stood up. They cover vision, dental and everything we needed. In addition, they have increasing incentives for the OTC Rewards Card, which comes in handy. We are rewarded for what we are supposed to—being healthy.”

Chandler developed gestational diabetes during her third pregnancy, which later transitioned into type 2 diabetes. Both her mom and dad had a history of diabetes. Her diabetes was uncontrolled and she even had an episode where her vision went out. Luckily, CountyCare’s Care Coordination nurses Camille Haynes and Jackie Webb were there to manage her diabetes and provide the support she and her family needed. “CountyCare has been there for me no matter what, from medications for me and my children to my diabetes needs. They never closed the door on me,” she recalled.

Chandler had a complicated third pregnancy since the baby was born premature, and she underwent two blood transfusions. She was in labor for three days, from Good Friday until her bundle of joy made his debut on Easter day. “It was so worth it. Just to see his pretty face,” she recalled.

Over the years, CountyCare has cared for Chandler and her 4 children, all CountyCare members, through:

Medication assistance and delivery
OTC Rewards Card and the ability to get eligible items when most needed
Sleep Safe Kit (portable crib, pacifier and crib) through the Brighter Beginnings Program
Diapers
Annual Book Club
Transportation services to doctors’ appointments
Nurses’ home visits for her and the children

Just this past April 29, 2022, Chandler delivered her fourth baby four weeks prior to her due date. “I had the best care,” Chandler remembered. A healthy 6 pounds, 3 ounces and 17 inches of pure love is the newest addition to the family. And diabetes is in the past, now completely managed.

“I am feeling great,” Chandler confessed. “Some mothers have the blues after they deliver a baby, not me. I love being a mom. It’s a blessing for me to be healthy and have the energy for my kids. My children have no diabetes. They are healthy. I am so thankful for CountyCare. I have the best Care Coordination team ever. They are phenomenal. I will never trade it in for anything in the world. They are my extended family.”

Molina Member Story

Mon, 25 Sep 2023 21:43:00 GMT

Molina’s Care Coordination Team Goes Above and Beyond to Meet the Needs of a Member

Molina’s care coordination team outreached a 55-year-old Illinois member in January 2021 after she was identified as high risk. Evelyn White shared with Molina that she was not doing well and had an array of social determinants of health needs and was struggling with her physical and mental health.

Among the challenges she faced, Evelyn expressed not being able to get an appointment with her primary care provider and was struggling to pay her rent and utility bills. The care coordinator immediately called her PCP office and patched Evelyn in on three-way call and was able to secure an appointment for her.

Additionally, in just a few weeks, the Molina care coordination team:

Arranged for transportation to and from her appointment(s).
Scheduled additional preventative screenings for her including a mammogram.
Connected her with agencies that could assist in helping her pay her rent and utilities.
Arranged for a landscaping company to service the exterior of her building, making it easier for her to utilize her front door. (The landlord had neglected landscaping upkeep).
Connected her landlord with an agency to ensure the entire building had a working furnace for the winter.
Ensured all other necessary building/home repairs were addressed.
Connected her with a case manager who helped her secure mental health telehealth counseling to address behavioral health symptoms she had been experiencing.
Ensured she was able to complete all follow up visits and protocols for her medication regimen.
Secured vision and dental care for her.

Molina’s team says they are still in regular communication with Evelyn, and she reports to be doing very well now. The team noted that avoiding hospitalization for her was paramount because she had not been taking her medications due to her not being able to see her PCP for checkups or medication refills.

Molina’s care coordination team encompasses a diverse ecosystem that work interchangeably with members, including case managers and community connectors, among others. Community connectors specifically try to identity the members that could potentially be at high risk for health needs but not presenting to providers in that manner.

Molina’s outreach processes consist of the use of HRS’s and HRA’s. However, Molina does not limit its efforts to assess member risk factors solely based upon completed screenings or assessments, rather uses all available data and tools to assist in that effort to ensure no member is missed.

One such tool Molina uses is predictive modeling software to identify Social Determinants of Health (SDOH) risk in a way HRA and HRS’s cannot, to make the cracks smaller when it comes to providing a holistic approach to healthcare.

They do this by identifying the likelihood of SDOH’s, subsequently outreaching those highest-risk members, and connecting them with the appropriate providers and resources.

The special aspect of Molina’s Community Connector teams, and what brings a unique touch, is that they know the social determinants of health needs and they know the communities they serve which may not occur in a fee for service model.

In that model, a member like Evelyn, may have had to independently discover these resources or her PCP would have had to recommend them. Both scenarios are unlikely to have occurred for a member who was not seeing her physician. In situations like this, a member could easily end up lost in the hospital system.

Molina Member Story

Mon, 25 Sep 2023 21:38:50 GMT

Molina Helps Six-Year-Old Boy with a Grim Diagnosis and a Grueling Four Month Hospital Stay go from Hopeless to Thriving

Imagine taking your six-year-old child to the hospital for a fever and pain. The hospital initially admits him for an appendectomy, only to later discover he actually has cancer.

Imagine being the mother of that child and having the hospital question whether your home is safe enough for your child to live in with his diagnosis. You have no means to move, no job, limited social support, and don’t even know where to start the process to improve your living conditions when you have three other children to take care of as well.

That’s what happened to one Illinois family, who through the help of Molina’s Managed Care Medicaid Program, was able to go from a grim diagnosis and a grueling four month hospital stay, to a stable and healthy new home - and life.

When a Molina case manager first spoke with six-year-old Jermaine Johnson’s mother, she didn’t know if her son would live another week. She told the case manager all she wanted was her son to be comfortable and at home.

A home that the hospital questioned was healthy and stable enough for her six-year-old son, now battling cancer. Jermaine shared a room in the family’s two-bedroom apartment with his three siblings, which greatly increased his risk of infection.

In addition to all of the difficulties the family faced, they had little social or family support, and Ms. Johnson was struggling to pay for transportation to and from the hospital to visit her son. Fortunately, doctors and nurses were able to stabilize Jermaine and his condition began to improve.

During his stay, Jermaine’s case triggered Molina’s discharge team to further investigate and subsequently refer him to a case manager. This care coordination connection would be the beginning of a new life for Jermaine and his family.

His case manager was able to connect the family with cancer resources, as well as apply for grant assistance to help with their financial needs. Additionally, social determinants of health (SDoH) experts at Molina worked to identify any other opportunities to further assist the family including securing SSI benefits for Jermaine, assisting with helping Ms. Johnson find employment and supporting the process of acquiring a four-bedroom home and furniture.

After four months, six-year-old Jermaine was discharged to a stable and healthy home where he now has his own bedroom. The case manager worked with the hospital to train Ms. Johnson to be his caregiver and since his discharge, he has yet to be readmitted. Jermaine continues to successfully keep up with his doctors appointments and treatments.

Humana Member Story

Mon, 25 Sep 2023 21:09:12 GMT

A Part Of The Humana Family:

A Member Story Told by Their Care Coordinator

I have had the extreme pleasure of working with Mr. and Mrs. C for the past 3 years. They are simply a joy and are a true testament to the value of care management services.

Mr. C is 86 years old, and Mrs. C is 83 years old. They have been members with Humana since 2017 in the Illinois MMP program. Mrs. C still operates her own small business that she is very proud of. Though they have financial struggles, they are grateful for everything they have and have a strong support network within their family and community.

Mr. and Mrs. C were introduced to me in 2020 at the onset of the pandemic. I first spoke to Mr. C, who expressed worry about running out of food and concern about how he would get more since he was scared to leave his home due to his health (he has asthma) and worried about contracting COVID-19.

At the time, Humana offered the Basic Needs program to members, where care managers could refer a member to receive a food box. I was able to set this up for him and also provide information for local food pantries. However, because of having asthma, he did not feel comfortable going to pantries and he inquired about food delivery options. He was used to being independent and leaving his home as needed but due to the pandemic, he became homebound. Fortunately, the State of Illinois modified its rule for home delivered meals to include eligibility for the elderly who became homebound due to the pandemic.

This was a program Mr. C wanted to set up but because of his breathing problems, he asked me to speak to his wife.

Through this conversation, I learned that Mrs. C was also a Humana member and could benefit from the same resources. Mrs. C was eager to partner with me and the rest is history.

Over the last several years, I have worked with them to maintain home delivered meals, as well as to address other needs that have come up. They have struggled financially due to having limited incomes and I have been able to provide various community resources to assist. Both have had their own struggles managing their health and they have become more dependent on their family for help. One benefit they are both very grateful for are the OTC benefits that Humana provides. Both are advised to take Vitamin C by their PCP but this would be unaffordable to them if they had to purchase it on their own. Through the OTC benefit, each is able to order the amount they need at no cost to them.

I truly look forward to my contacts with Mr. and Mrs. C. Sometimes I talk to them more frequently depending on what their needs are. Each contact is significant for them, even if it may seem minor to others. One of Mr. C’s favorite times of the day is the morning while he waits in anticipation for the home delivered meal volunteers to come. Mornings are the best time to reach Mrs. C and each time she tells me how much they appreciate receiving home delivered meals, how nice the volunteers are, and even what kinds of meals they are receiving. In her own words, “home delivered meals has saved our lives; you are an angel.” I tear up even writing that because referring clients for this service is part of my job, however the service really does save lives.

They also now have a standing OTC order and request to have us place this order for them at the beginning of each benefit period so that it is always available to them. When I first began talking to Mrs. C, she would often end our calls by saying “I love you, Anne!” I felt uncomfortable at first but as our relationship has developed, I really think she considers me to be part of her extended family and I hold a very special place in my heart for both of them.

CountyCare Member Story

Mon, 25 Sep 2023 20:57:29 GMT

Homeless Man Feels He Has His Life Back Thanks To CountyCare Care Coordination

For Oliver Gray, 63, life has proven to have its challenges. For more than 10 years, he has been homeless. Oliver used to be a healthy person and stable in his job. In fact, he had a spacious house, where most of his family members used to live and for many years, he trained dogs for Chicago celebrities.

After he had a son 18 years ago with his girlfriend at the time, her family denied him the ability to see him, creating a legal battle that took seven years. During that time, Oliver suffered three heart attacks and a stroke. “Those were stressful times for me,” he remembers. He lost everything—his house, the opportunity to see his son and his job. He first saw his son when he was six months old and, after some time, was granted five years of visitation, one hour a week, to spend time with him. “My relationship with my son is still weak because I don’t get to see him as much. I recently went to see him at a football game about four months ago, and we hugged.” His son just started college in August of 2022.

Lonely and feeling hopeless, Oliver received a call last year out of the blue that changed his life. CountyCare’s Social Work Care Coordinator Samantha “Sam” Sota reached out to him as part of the services the health plan offers to its members. “I was in the hospital when Sam called. My heart was weak from my heart history. I lost a lot of strength and was using a wheelchair to help me move.” The two connected right away due to similar challenging environments they both experienced growing up. Since that call in 2021, Sam has been working closely with Oliver to make sure he has access to the care and support he needs. In fact, she even helped Oliver find a free bike to keep him active.

Sam joined CountyCare in 2019, and she is one of the many dedicated team members within Care Coordination who provides personalized, coordinated care to members to ensure they achieve the best outcomes. She is the first member in her family to attend graduate school. “It is a rewarding feeling to coordinate critical health care services for members, especially to those most in need, particularly in the most underserved communities. I can’t see myself doing anything else but this,” says Sam.

Care Coordinators play a critical role since they support members’ health care needs before these escalate into an emergency room visit, where costs can prove higher.

They:

Schedule appointments with primary care providers and specialists
Connect members to valuable resources as needed
Support and educate members about aspects of their health
Check medication status to ensure members follow their regimen

Prior to Sam working with Oliver, he was missing his medical appointments. Now, Sam makes sure she coordinates his medical appointments with doctors and specialists and reaches out to make sure he attends. During this journey, they have empowered each other. “Sam is amazing. She is a gem. I was in a bad psychological state when she first called me,” remembers Oliver. “She was an inspirational person who kept telling me that I needed to go back to the things I like to do.”

Since being a CountyCare member, Oliver has benefited from free medications to treat his high blood pressure, heart and asthma, transportation services to his doctors’ appointments, the expertise of specialists and dental offerings like crowns.

Nowadays, you can find Oliver doing street art, sculpturing and mentoring children on art skills and how best to train their dogs.

“I am grateful for CountyCare. I didn’t know these services existed. I appreciate getting my medications and transportation to my doctors’ appointments when money is tight,” says Oliver.

“The Creator has been good to me. You can’t sit around and cry. I am a fighter. It’s on you to do it,” says Oliver. “I am in pain but walk, my walk is a struggling one, but sexy,” says Oliver as he laughs.

BlueCross BlueShield Member Story

Mon, 25 Sep 2023 20:52:05 GMT

BlueCross BlueShield of Illinois Coordinates Across States To Get Critical Infant The Care She Needs

During July 2022, Niah, a one-year-old member from Naperville, IL, with a history of complex heart conditions such as congenital malformations, hypertrophic cardiomyopathy, and cardiac arrhythmia required a lifesaving surgical procedure. Due to Niah's complex condition, she, and her family needed to travel to Boston, MA so that Niah could receive her surgery.

Realizing that Niah's surgery was so specialized it could only be done at Boston Children's Hospital, the BCCHP care coordination team quickly sprang into action. Niah's care coordinator worked diligently with her interdisciplinary care team to execute a single case agreement (SCA) with Boston Children's Hospital so that she could have the surgery.

Going above and beyond, her care coordinator also sought financial assistance on behalf of Niah's family through BCCHP's Social Determinants of Health Fund (SDOH) – a fund designed to provide members with funding for basic needs, allowing members to focus on their health goals and subsequently improving the overall health of Blue Cross and Blue Shield of Illinois communities. Niah was then successfully airlifted via an air lift ambulance to Boston Children’s Hospital – all arranged by her BCCHP care coordinator.

With the help of the SDOH funds for travel and lodging, Niah’s family was able to be with her in Boston for her surgery. To ensure that Niah and her families' needs were met, Niah's care coordinator called every day, even on weekends. Niah’s surgery was successful! She is back in the Chicagoland area and is currently recovering with heart arrythmias and G-tube placement at Lurie's Children Hospital. She is doing well post-surgery.

*Names changed to protect privacy

Molina Member Story

Tue, 31 Jan 2023 23:13:33 GMT

Molina's Care Coordination Team Seamlessly Synchronizes Behavioral and Material Healthcare for Pregnant Mom

Twenty-eight-year-old Samantha Brown, living in metro east Illinois, had an extensive history of anxiety and depression. Samantha stopped taking her medication after becoming pregnant and was not keeping up with her medical or behavioral health appointments during her pregnancy.

There are a lot of misconceptions around what pregnant women can or can’t take.

Additionally, the stigma that plagues behavioral health can sometimes make it difficult for expectant mothers like Samantha to bring up any BH issues with their OBGYN.

After becoming a Molina member, the care coordination team was able to:

Educate and encourage her about re-engaging with her providers.
After she delivered a healthy baby, aided in the process, with oversight from her providers, of helping her resume her behavioral health medications.
Tag-teamed her OBGYN appointments with her behavioral health ones, particularly in first 2-3 months after delivery due to the high risk of postpartum, to ensure compliance with appointments and treatment plans.
Ensured she had transportation services to and from her appointments.

Samantha attended all her appointments and is reported to be doing well. In cases like this, oftentimes the lines between maternal and behavioral health do not get coordinated which makes it more difficult to achieve optimal health outcomes for members if a care coordination team can’t step in and assist, like Molina’s did.

Humana Member Story

Sun, 01 Jan 2023 23:03:47 GMT

Humana Helps Member Find Hope for the Future

Jan, a Humana member, lives with a chronic mental health condition, with a history of expressing urges to self-injure and feelings of needing additional support. About a year ago, Jan was hospitalized following a suicide attempt.

When on the phone with her care coordinator, Jan expressed suicidal ideations, and the care coordinator stayed on the phone with Jan to provide support while also arranging to have her evaluated at an ER. During her behavioral health hospitalization, the care coordinator kept in touch with Jan to help coordinate her care. The care coordinator reached out to Jan's psychiatrist to ensure she was getting her medications filled on time, a concern Jan had.

Today, Jan is doing better, taking a monthly, long-acting injection to help manage her mental health condition and attending weekly therapy to help manage her mental health condition and attending weekly therapy to help her cope with paranoid thoughts and anxiety. Jan hasn't had a behavioral health hospital readmission in a year, something she attributes to her diligence in attending behavioral health appointments, working hard to manage her symptoms and consistently taking her psychiatric medications.

She still talks to her care coordinator for help with resources and her care plan goals, and Jan is happy to report she now has a part-time job.

IAMHP

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