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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.

SEE ALSO

You are cordially invited to join Health Options' 2021 Annual Member Meeting on Thursday, November 18, from 4:30 – 6:00 p.m. via Zoom's online meeting platform.

Use this Health Options' 2021 Annual Member Meeting link to register and get the login details at Eventbrite.

    • If using the Zoom login page, enter webinar ID number 928 6857 5459 and passcode 743788
    • Attendees may also join by phone at (646) 876-9923. Enter webinar ID 928 6857 5459 and passcode 743788.

Our 2021 meeting will cover Health Options' year in review, including fiscal updates, grant activity, improvements to plans and procedures, and the 2022 Board of Directors’ election results. We will be joined by two speakers: Tym Rourke, senior director at Third Horizon Strategies and former director at the New Hampshire Charitable Foundation, and Leslie Clark, executive director of Portland Recovery Community Center (PRCC).

Tym and Leslie will discuss “The Other Epidemic: Escalating Substance Use Disorders in Maine and Beyond.” As the pandemic continues, it’s more important than ever to devote state, federal, and community-based resources to removing barriers to care and improving substance use treatment. Tym and Leslie will discuss their experiences working to provide greater access to prevention, treatment, and recovery services.

For questions about the meeting, contact Health Options Member Services, Monday through Friday, 8:00 a.m. – 6:00 p.m., at (855) 624-6463.

And remember to let your voice be heard! All Health Options Members 18 years and older are eligible to vote in our board of directors’ election. Candidate biographies and voting instructions have already reached you by email or traditional mail. Voting ends November 5, 2021.