Recently, our clinical team identified a member facing multiple barriers to healthcare access. One exceptional Member Advocate took action to solve for more than adherence, demonstrating how dedication and creative problem-solving can transform a patient's life.
The Challenge
A member living in a remote mountain community faced several critical obstacles:
- No local delivery services available in his area
- Lack of personal transportation
- Reliance on neighbors who could only help outside business hours
- Lost mailbox key preventing receipt of mail-order medications
- Unable to receive prescribed home oxygen therapy after hospitalization
Taking Action
Our Member Advocate took comprehensive steps to address each barrier:
- Initiated replacement of his mailbox key to enable one-time and ongoing receipt of critical mail-order prescription meds
- Arranged plan-provided transportation services that had previously been difficult to access
- Identified additional coverage through an alternate plan to help alleviate out-of-network costs for an oxygen supplier willing to deliver to his remote location and assisted with cumbersome approval paperwork
- Communicated with Care Coordinators familiar with his case to ensure that the care team was aligned on the member’s needs and new service providers.
- Set up home meal deliveries and additional support services to help the member to stay well on a longer-term basis
The Impact
Through this coordinated effort, we restored the member's access to critical medications to meet adherence measures while also establishing reliable transportation and securing the necessary oxygen therapy delivery to keep this member on track. These efforts, along with coordinating additional support services Improved his overall quality of life.
This case demonstrates how going beyond standard protocols and taking a holistic approach to member care can create life-changing outcomes. By addressing both medication adherence needs and social determinants of health, we helped transform a potentially dangerous situation into a safer, more sustainable care solution.
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