Beyond routine care and wellness, one of the major reasons for having health insurance is to protect yourself and your family in case of serious illness or injury. At Health Options, our medical management approach ensures that you also have a team of healthcare experts at your side in times of a serious medical crisis. In addition, our Care Managers are here for everyday wellness questions and at every step of recovery after a major medical incident.
Our Care Management Team partners with local agencies to find the help our Members need, from financial assistance to transportation, housing, and other issues affecting wellness and recovery. On-staff medical, pharmacy and healthcare experts help Members access medication and durable medical equipment, receive authorization support and assistance with provider outreach, and drug formulary education. The team also makes outbound calls to our Members to assist with chronic illness support or to provide post-discharge coordination from hospital stays. This collaborative approach to medical management focuses on improving care, creating positive health outcomes, and reducing the total cost of care.
What does a medical management approach look like to our Members? On a day-to-day basis, our in-house pharmacy team keeps Members updated about drug recall changes in medication availability and ways to access prescription medications at lower costs. Our team will also reach out to encourage immunizations, wellness visits, and other low-cost, or $0 cost-share benefits that can help our Members live their healthiest lives. In cases of hospitalizations and transitions to home, our medical management’s Site of Care Program offers Members the option to transition certain medications and infusions to a preferred site of care, including in-home care.
If a Member needs extra care for a particular condition, our team is instrumental in securing assistance. For example, one Member of our asthma outreach program had concerns about her condition combined with possible COVID-19 symptoms when the virus first emerged. Her COVID-19 symptoms kept her from seeing her primary care provider. After using a walk-in clinic for testing to determine she was COVID-19 negative, she continued to have a cough, low-grade fever, and fatigue. Our Care Management team was able to quickly find her an in-network pulmonologist who treated her with antibiotics for suspected pneumonia. She also had her asthma medications adjusted, and her condition improved.
Our hands-on strategies have resulted in more than $12.1+ million saved through Care Management programs since 2017, a 48 percent total reduction in our hospital readmission rate from 2018 to 2020. Our Script Saver program, led by in-house pharmacists, provided personal outreach to Members that led to out-of-pocket savings of $98,000 on medications in 2020. All of these efforts combined help improve health and reduce costs for our Members.
Call us if you have a question about prescription drug costs, need support for an upcoming medical procedure, or have a serious medical crisis. Our medical management team is in your corner, and they can be reached through Member Services at (855)624-6463, or use our secure email messaging.
As part of an effort to expand access to free and accessible world-class fitness in beautiful public spaces, Community Health Options has partnered with National Fitness Campaign (NFC) to build Fitness Courts® across Maine.
The Fitness Court is an outdoor bodyweight circuit training gym that supports all-level workouts and can be completed in as little as seven minutes a day. The Fitness Courts are free to use, designed for all fitness abilities, and suitable for ages 14 and older. With the free Fitness Court app, available for iOS or Android, users can take classes, learn workout routines, and get fit.
The ultimate goal is to fight back against preventable diseases caused by sedentary behavior and transform the next decade so that millions of Americans will choose outdoor wellness activities for healthier lives.
“Mainers are known for enjoying the great outdoors. Our partnership with the NFC will help more adult Mainers enjoy exercising outside and will allow them to be their healthiest selves, mentally and physically,” said Kevin Lewis, president and CEO of Health Options. “Our vision to be a leader in transforming and improving individual and community health naturally aligns with the NFC’s work.”
Through the NFC partnership, grant-funded Health Options Fitness Courts will be constructed in easily accessible public spaces beginning in Summer 2022. The NFC and Health Options will begin accepting grant funding applications on November 4, 2021, to support Fitness Court construction in local communities.
Qualified municipalities, schools, and other organizations who own accessible public space are encouraged to apply here: nationalfitnesscampaign.com/maine. Grant recipients will receive a wellness toolkit and design resources to aid in planning, funding, and launching their outdoor Fitness Court and community wellness campaign. To learn more about National Fitness Campaign and how to qualify for funding, visit: nationalfitnesscampaign.com/maine.
Watch this video to learn more.