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We’re on your team

Oct 05, 2021
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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.


Many of us are waiting weeks or months to book medical appointments. Or taking a long drive to get to the only provider taking new patients—often more than an hour away. And once in the office, chances are we’re spending more time in waiting rooms just for a routine appointment.

The national shortage of healthcare workers has been well-documented, and Maine is feeling it, too, with access to providers emerging as one of the greatest barriers to treatment. By the end of 2022, Maine had just 580 doctors practicing family medicine, an 18% decline from 2019, according to The Portland Press Herald, leaving fewer doctors for a growing population.

During the pandemic, patients discovered the convenience of telehealth and began meeting with their providers through a phone call or video chat from the comfort of their own homes. The concept certainly wasn’t new—Community Health Options Members had access to Amwell® behavioral telehealth well before Covid-19 struck.

That concept has expanded to virtual primary care, giving people the option through an online care team, expanding access to care. Alongside its traditional provider network, Community Health Options now offers Members 18 and older the option to choose a virtual-first primary care team through Firefly Health.

When it comes to health outcomes, many studies have shown patients miss fewer virtual appointments, helping them to stay on track with their health needs. And in a recent pilot program, Walmart employees with diabetes who used virtual care saw a 24% average reduction in glucose levels and patients with hypertension had a 14% reduction in blood pressure, the company said in 2023 when it expanded its program to Maine, among other states.