By Dodie Grovet, Corporate Clinical Programs Training Manager, Molina Healthcare, Inc. and Dyette Hernandez, Corporate Manager, Care Management, Molina Healthcare, Inc.
As one of the largest family participating Hispanic-owned business in the United States, Molina Healthcare — which serves Medicaid, Medicare, CHIP, Marketplace and dual eligible plans — has always viewed its mission as reaching and providing quality well and preventive care to traditionally underserved Americans.
One ongoing challenge in health care is getting members to understand and follow doctors’ orders. For some low-income members with multiple medical problems, lack of adherence to a treatment plan can lead to a rapid decline in their health, excessive use of the Emergency Department and extra costs. Many times the root of the issue of non-adherence is not addressed.
For these members, Molina Healthcare has found an effective solution: Community Connectors. Community Connectors may serve as liaisons between patients and clinicians and take a personal approach to assessing needs and assisting the treatment team with coordinating members care. Working one-on-one, they coach members to self-manage their chronic conditions, connect them to community resources and advocate on their behalf. Community Connectors are thoroughly familiar with the community and the available resources that can help members improve or maintain their health.
Specifically, at Molina’s health plan in New Mexico, where we launched the program a decade ago, we began by using our health care utilization database to identify members who frequently visited the Emergency Department, abused controlled substances, or received fragmented care, which may have resulted in poorly controlled chronic diseases such as diabetes, cardiovascular disease and asthma.
We tasked the Community Connectors with reaching this underserved group, and quickly found that the initial challenge was simply locating these members. One of the primary reasons for being unable to locate a member is when the member does not report a change in residence. This causes their billing/location data to become inaccurate.
Our original focus was providing education on managing health, connecting members to traditional health-related social services and advocating for them within the appropriate health systems. However, we quickly learned that we had to find basic community resources to help members meet their essential needs of life (food, shelter and safety) first and then focus on the other “traditional” health issues.
For example, when depression and pain sent Molina member Rose to the Emergency Department for the fifth time in three months, she was referred to Thomas, a Community Connector. He visited Rose at her home, where she told him about drug deals, bomb threats, arson and a murder that had all taken place in her apartment complex. Thomas researched Rose’s statements about her apartment complex and found that every one of them was true.
Thomas was able to find Rose new Section 8 housing in a different city closer to her provider, and also obtained a donated laptop in which she could connect to the internet at her local senior center. Now in a safe, comfortable home, Rose pays her bills online, keeps regular doctor appointments, leads an active social life, loves crocheting hats that are donated to the homeless and hasn’t been back to the Emergency Department.
Another member named Michael had COPD, heart disease, cirrhosis of the liver, hypertension, depression and malnutrition. Aggravating all these conditions were his painful, ill-fitting dentures that caused sores to form on his gums and kept him up at night. Michael had called Molina’s member services team to complain that he was unable to get new dentures, but then didn’t return his case manager’s follow-up letters or calls in response to his complaint. Michael was assigned to a Community Connector who coordinated calls between Michael’s dental clinic and Molina’s prior authorization department. By coordinating communication between Michael, the dental clinic and Molina’s authorization department, the Community Connector was able to resolve an administrative issue. Michael now has a new smile, is able to eat nutritious meals and feels healthier in every way. There are many more stories just like these.
Community Connectors are an extension of case management and the interdisciplinary care team in all 11 states where Molina operates health plans. In each one, Community Connectors have served to improve access to preventive and primary care for our members, enhance their health and reduce their use of the Emergency Department, along with decreasing associated hospital costs.
In New Mexico, the program has demonstrated savings of $4,564 per enrollee and reduced emergency department use, days of inpatient care and drug abuse. There was also a significant reduction in numbers of claims and payments after the Community Connector intervention.
One study of our model, which looked at costs from six-months before to six-months after the intervention, found lowered costs in emergency department usage, inpatient care, non-narcotics prescriptions and narcotics prescriptions.
We believe the model is so successful because it’s a win-win. It’s a win for the members because they have improved health outcomes and a better quality of life. And, it’s a win for Molina because we are decreasing health care costs. We’ve seen in meeting with our members that traditional health care can only go so far. We value the importance of meeting members where they live to truly see the barriers they face in achieving healthy lifestyles. With this knowledge, we can provide the type of care that will improve and maintain health. We’re proud to bring this kind of personalized program to more members all the time — while we support the company mission of helping those who need it most.