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Waiver benefits provide in-home assistance and improve our member’s quality of life

One member, who had been in her Healthy Connections Prime plan for two years, greatly needed in-home assistance but always declined help. A new care coordinator explained the benefits of being on the waiver program, and ended up convincing the member to accept assistance. The member has been receiving waiver benefits, including a personal care attendant, for about six months, and she is extremely pleased. The assigned personal care attendant is a perfect match - she respects the member’s need for independence and works with her to get things done. The member's apartment is always clean now, but more importantly her care coordinator has noticed a positive change in the way she talks about the future.

“I feel like a new woman. My quality of life has changed so much for the better in the last year.”

One of our members has been dealing with chronic medical conditions for the last five years. She has difficulty breathing and had two hospitalizations in the previous year related to this condition. She enrolled in her Healthy Connections Prime MMP’s care management program. At that time, her health was declining and was having difficulty cooking, cleaning and getting out of bed.
Upon first contact with a care coordinator, the member expressed, “My condition is getting worse and I don’t think I’m getting the best care with my doctors.” In the time she has been actively working with her care coordinator, the member has received a hospital bed to use at home, assistance with obtaining needed medical equipment to help her breathe easier at night, and CLTC waiver supports for assistance with daily tasks such as meal preparation, shopping, transportation, and basic communication (phone, email, internet). She has not had an inpatient admission since she started using this equipment and receiving the additional support. She told her care coordinator, “I feel like a new woman. My quality of life has changed so much for the better in the last year.”

“I want to be a Healthy Connections Prime member for an extremely long time. You are all so helpful, patient and understanding…”

Our Healthy Connections Prime plan received a thank-you card from a member that reads, (edited to remove identifying details):

“Just a note to let you all know how much I appreciate your help whenever I ring up your plan. It was always confusing to me...For the life of me I’ll never be able to explain why I ever decided (absent-mindedly) to leave Healthy Connections Prime. I received all of my usual medications as prescribed by my doctor at no charge to me. I was told to call this health plan the next day in order to re-enroll for as soon as possible...I want to be a Healthy Connections Prime member for an extremely long time. You are all so helpful, patient and understanding when I was in tears and completely confused. Thank you for coming to my much needed assistance. Thank you again”

Quick assistance with an emergency medication refill

Our member’s care coordinator received a message from the member’s granddaughter that the member’s blood pressure medication had been mistakenly thrown in the trash and the medicine was contaminated. It was too early for a refill to be covered so the pharmacy told the granddaughter to contact her grandmother’s Healthy Connections Prime plan. The care coordinator worked with the health plan’s pharmacy department to get a refill override for this medication, and the medication was filled within the hour for the family to pick up. The member could now continue with her blood pressure treatment. She and her family expressed  gratitude for the assistance and quick resolution.

"Grateful for the Care and Attention Provided by the MMP"

The MMP Community Health Navigator (CHN) visited a member who had been hard to reach for quite some time. The member did not speak much English and asked the CHN to come back the next day when her daughter was available. The CHN returned the next day and was able to fully explain all of the benefits of the MMP plan, schedule an appointment with a doctor as the member who had not seen one in years, and completed some health assessments. The member shared that she had negative experiences with a prior Medicare provider and had been wary of health plans. From her experience with the MMP, the member was grateful for the in home visit and the care and attention provided by the CHN in answering all of her and her daughter’s questions.

Thankful for the MMP care coordinator who went the extra mile for him

After a member was discharged from the hospital, he had trouble reaching someone at the pharmacy to secure a prior authorization for the medication he needed post-discharge. He reached out to his MMP care coordinator to express his concerns about his situation. The care coordinator helped to contact the pharmacy on the member’s behalf and successfully sorted out the prior authorization. The care coordinator then physically went to pharmacy to ensure the medication was filled and ready for pickup. The member was able pick up his medication and was very thankful for the “extra mile” that his MMP care coordinator went to ensure he had his medication.


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