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Finding Solutions - Aetna Better Health of Illinois

 

*Customer's name changed to protect privacy 

Our Medicaid partners like Aetna are continuing to connect customers with specialized services. Sarah* is an Aetna Better Health of Illinois customer who sees a specialist to treat her autoimmune disorder. She required bloodwork that involved the blood sample to be frozenv prior to being sent for analysis. Her home was more than an hour away from a lab equipped to routinely handle this request and, because of this, she was concerned she would have to cancel her appointment. 

An Aetna Nurse and Care Coordinator found a solution and was able to find a lab closer to Sarah's home for the lab work. The nurse educated Sarah about transportation benefits, such as mileage reimbursement, and even provided directions to the lab. 

When the Care Manager followed up to ensure that Sarah was able to attend her lab appointment and get her bloodwork drawn, she expressed gratitude for going above and beyond to make arrangements with the lab. Sarah had mentioned that it had been a stressful and frustrating ordeal to navigate this medical episode prior to Case Management involvement. The Care Manager continues to follow Sarah to support her holistic care needs to achieve optimal health outcomes and quality of life.

 

Sober Living - Blue Cross Blue Shield

Our Medicaid partners like Blue Cross Blue Shield are continually making a difference in the lives of customers to make sure they have great outcomes. When one of their customers came out of recovery treatment for alcohol abuse and didn't have a supportive environment that would help him maintain his sobriety, the BCBS care coordinator and Integrated Care Team found a sober living community for him. However, he could not afford the program. A fund to address social determinants of health paid for 30 days of sober living. During that time, the care coordinator worked with the facility to find him a full-time job. 

His new job allowed him to continue to pay for the sober living community where he has lived for three months. He remains sober, attends AA meetings, addresses his physical and behavioral health needs, and remains engaged in care coordination.

 

Senior Care – Blue Cross Blue Shield 

Our Medicaid partners like Blue Cross Blue Shield are continually working to make sure that Medicaid customers receive the care they need, when they need it the most. When a BCBS customer was discharged from a nursing facility, his daughter was overwhelmed by the level of care he needed when he first returned home. The customer was resistant to assistance; he frequently sent homemakers away when they arrived for their shifts. He also showed cognitive decline. 

The customer provided permission for a care coordinator to speak with his daughter for his care and assessments. Upon completion of the initial assessments, it was identified that he needed increased homemaker hours and an Emergency Home Response System (EHRS). He was stratified as high risk and monthly care plan reviews were completed. An Automatic Medication Dispenser (AMD) was offered, and he and his daughter agreed to install it. 

He has now had the AMD for over a month and his daughter reported that it is helping. She reports that she is feeling less overwhelmed and is now able to visit as his daughter rather than as a caretaker. She added that the services are helping her father remain at home and give family peace of mind that he is cared for and that there are enough people involved to check on him regularly. He continues to have need for home exercises and still has weakness but is much stronger than when he returned home from the nursing facility. He has been doing so well and showing so much progress with the services that BCBS was able to change his risk stratification from high risk to moderate risk.


Creating a Caring Environment - Meet Jordan 

Diagnosed with cancer, six-year-old Jordan (name changed for privacy) was at risk for infection in his two-bedroom apartment with three siblings, but the family couldn't afford to move. Jordan's managed care case manager and a social determinants of health specialist helped the family get financial aid, as well as a job and caregiver training for his mom. They now live in a four-bedroom home. Jordan was happy to move into his own bedroom, and his mom serves as his caregiver. Jordan remains stable and has not been readmitted since.

 

Child Support Services - Meet the Nickerbocks (name changed for privacy) 

A non-custodial parent wanted to travel internationally to be married over New Year's but owed nearly $40,000 in child support payments. The HFS Passport Unit walked the parent through the process, and a check was sent for $32,000. The parent is sending HFS the final payment to be able to go to a February wedding. Most importantly, the mother of a 15-year-old boy is now getting the support she is owed.

 

Living a More Independent Life - Meet John 

Born with developmental delays and functional limits, John (name changed for privacy) received incomplete care in the fee-for-service program. He was at risk for lifelong institutionalization. After an assessment, his MCO care coordinator arranged for medical teams and therapists, educated John's family about resources, and coordinated homecare assistance. In just six months John now prepares and eats his own meals, takes walks with his sister, and enjoys time in the backyard with his family. His family has hope again.

 

YouthCare Success Story - Caring for a Child with Autism 

Natasha, the mother of a teenage girl with autism, says, "YouthCare is caring for us and has been a real blessing. Our care coordinator checks up on us, telling me about services I didn't know about and asking how they can help. My daughter is my life and I'm hers, and I'm appreciative of YouthCare for their help." 

Natasha adds that she is particularly appreciative of the assistance with transportation, saving the family money and making care more accessible. In addition, when her daughter's vital medication was delayed her care coordinator stepped in to help.

 

YouthCare Success Story – Personal Care 

Tina is a nurse and mother of three pre-teenage children. She admitted, "At first, I was frankly leery about YouthCare because it meant change. But I can't say enough now about the services. Our care coordinator truly does care and it shows, as she goes above and beyond. The personal care we get makes me so much more comfortable, helping cut through the red tape to get us the services we need." 

The family lives in a rural area, so the care coordinator has worked closely with Tina to find the ideal, local doctor to help them face their healthcare challenges.

 

YouthCare Success Story – Care After Cancer Treatment 

Amber owns a business and is the mother of a young child that is facing major health challenges after brain cancer treatment. She says, "With help from our care coordinator, YouthCare has been absolutely amazing. She made the whole transition easy. To have someone in our corner to help has given us peace of mind." 

Amber's son has more than two dozen doctors helping treat a large range of issues. This challenge has made assistance from their care coordinator especially valuable. During the early weeks of the Covid-19 pandemic, her son needed crucial medicine from Italy, which had been suffering especially hard. Their care coordinator tracked down possible sources and secured the medication. The care coordinator also calls before and after surgeries to check on his progress and continually provides help.


 

 

 



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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director




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