Molina Member Story

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.
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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.