True Stories
Ryan's Path to Recovery:
Coordination to Heal the Whole Person
A car accident when he was just twelve years old cost Ryan both his legs—and almost cost him his future, as well. Ten years later, after multiple surgeries, he was unemployed, uncommunicative, and addicted to drugs and alcohol. Finally, facing release from a hospital with wounds that he was told would take three years to heal, Ryan was enrolled in Medicaid Coordinated Care . His two case workers teamed up to make a difference.
Susan and Greg realized that Ryan needed more than medical care: he needed people who cared. Since his family's resources were so limited, they found a suitable nursing home where he could start to heal, and then worked with his family to provide a safe environment for his return home. They took the time to assemble an effective support system: an amputee support group, mental health counseling, a connection with Ohio's Vocational Rehabilitation services. They even padded his wheelchair to promote better healing.
Today, Ryan gets the behavioral as well as physical health support he needs. His wounds are healing faster than expected, and he's starting to look for work. Now that he has Care Coordination to help him navigate the health care system, Ryan can look forward to an independent, productive future.
Patty's Champion:
A Mother Empowered to Care for Her Kids
When she began to work with Patty and her family, Nancy, a Medicaid Care Coordination case manager, knew that time and care would be needed. Six of Patty's eight children have asthma, so to keep them well and avoid the severe attacks and hospitalization that so often occur when prevention is absent, they needed checkups, medication, and, of special importance with asthma, flu shots.
What Nancy found, however, was a caring parent faced with insurmountable barriers to getting medical care. Nancy knew that asthma case management alone would not be enough. She marshaled the resources of the whole community. A voucher to shop at the St. Vincent DePaul Society allowed Patty to dress her children warmly enough for the outdoors, and to prepare them hot meals again with a microwave and other household items. Church pastors helped her get a refrigerator. Nancy even found the family a clothes dryer.
Even with all that, the seizure condition that makes driving impossible for Patty might have kept them from getting care. But transportation is a regular benefit of Medicaid Care Coordination, so the family has a simple, reliable way to get to doctor appointments on time
Fee for service Medicaid would have paid for doctor visits. But it took Medicaid Care Coordination to overcome the barriers and help this family stay healthy.
Visionary Care:
Zachary's Long Road to Eye Health
Without the knowledge and persistence of a concerned Medicaid care manager named Ray, Zachary's eventual blindness from a congenital eye condition was a certainty. With no effective treatment available nearby, Ray would not give up, finally locating a surgeon in Boston, Massachusetts, who could perform a unique medical procedure that has helped patients like Zachary. The surgeon agreed that Zachary was a good candidate, so Ray worked with the health plan to review the research and get approval for Zachary to have the procedure. Thanks to Ray's caring and resourcefulness, Zachary has a chance to avoid lifetime disability with all its costs and difficulties.
Agnes' Cane:
A Senior's Independence Rests on Small Services
Staying on her own was becoming increasingly difficult for 77-year old Agnes. No wonder: although her doctor had prescribed a cane, she didn't know how to order one; and she had been without eyeglasses for a year, as well. A visit from Joyce, a licensed social worker from her Medicaid Care Management plan, laid the foundation for continued independence. Joyce's foresight didn't stop with the glasses and cane. She arranged transportation for a needed mammogram, and completed the screening process for services available through the local Area Agency on Aging. Now, not only can Agnes walk and see better, she'll stay healthier with home delivered meals five days a week, and the help of home health aide with laundry, shopping and house cleaning. As she put it, "I'm doing very well."
Tabitha's Clean Sweep:
A New Vacuum Keeps a Little Girl Out of the Hospital
Nine-year-old Tabitha was suffering through multiple trips to the emergency room because of ongoing asthma attacks. Her Coordinated Care case manager wanted to know why, so she coordinated appointments for the little girl with an allergist and a pulmonologist. Based on their recommendations, the case manager made sure Tabitha had the equipment and medication she needed to control her asthma; and even arranged for a skilled nurse to provide care for Tabitha and education for her mother about providing a safe, clean home environment that would reduce the start of attacks. But when the case manager reached out to community services for the plastic covers for bedding, sweeper with HEPA filter and microfiber dusting cloths Tabitha's mother needed to keep her daughter healthier, the help was just not available. Undaunted, the case manager turned to her own colleagues at the Care Coordination Plan, who took up their cause and donated the items through the company's Christmas Family program!
Tabitha hasn't had an ER visit in many months—and continues to get better through effective care coordination by her health plan.
Jim's Life-Changing Conversation:
How a Care Coordinator Made a Difference Just By Listening
Jim struggled through life with paranoid schizophrenia and severe obsessive compulsive disorder, intensified by a speech impediment that made it difficult for him to communicate with his health care providers. Upon learning about Jim's situation, his case manager set up an appointment, and included the health plan's pharmacy coordinator. They talked for an hour, and Jim had a chance to discuss his concerns and ask questions in an unpressured, welcoming environment; and Jim left with the case manager's direct contact information, so he always had someone to turn to for supportive discussion of his questions and concerns. Now, because he took the time to listen, the care coordination case manager has been able to help identify Jim's health care and human services needs, and make sure he can access the right care when he needs it.
