When a woman broke her femur in a fall, she was admitted to a rural Maine hospital where doctors discovered she had a pulmonary embolism that may have contributed to the weakness that triggered her collapse. That made the situation much more complicated.
Once alerted to the case, a Community Health Options Care Management team member called the hospital, made some simple introductions and offered to assist. But while the hospital’s care manager appreciated the call, she wasn’t sure how an insurer could help—what they really needed was someone who could find a rehabilitation facility.
But finding a rehab facility is exactly how the Care Management team can help Health Options’ Members. Our team quickly found an in-network rehabilitation facility and helped obtain the durable medical equipment the woman needed to start walking again. Then, once the woman was at the rehab facility, the care manager scheduled weekly updates with the rehab’s social worker to ensure a smooth transition and help coordinate care.
Even amid a setback—the woman wound up back at the hospital with sepsis—Care Management continued to ensure continuity of care and helped get the patient back to the rehabilitation center. By coordinating this kind of collaboration between providers and facilities, Health Options looks to create better health outcomes for Members, often while keeping costs down.
Health Options’ Maine-based care teams help patients work through life’s toughest health challenges, even helping to find meal services to remove such barriers to health as food insecurity or finding transportation to ensure Members can get to important appointments. The teams also show Members how to save on long-term prescriptions by using mail order and patient assistance programs or taking advantage of retailer discounts and coupons.
One Member recently said, “My care manager, without hesitation, has provided resources that I needed and some that I didn’t even know I needed! I know how busy we all are, and my care manager has always made me feel like a priority.”
Community Health Options Members can get help managing chronic conditions, ensuring smooth transitions from the hospital to home, finding behavioral health resources and managing maternity and post-partum care. Additionally, Heath Options’ Medical Management team offers complex care management for Members experiencing diagnoses such as metastatic cancer, organ failure or pediatric trauma.
To access these services, call our Maine-based Member Services team at (855) 624-6463, available from 8 a.m. to 6 p.m., Monday through Friday.
Community Health Options will soon expand its virtual health services and provide Members access to virtual primary care providers, giving them consistent care when they need it anytime, anywhere. The new service can help make it easier for Members struggling to find a nearby provider accepting new patients, whether they need preventive and routine care or help managing more complex issues.
