After gentle, persistent prodding, a member finally revealed to care manager Debbie Hayes why she repeatedly fell in her home.
“Well, she says, ‘I have a hole in the floor in front of my washing machine,’” said Hayes, who coordinates care for Blue Cross and Blue Shield (BCBSIL) Medicaid members, describing the conversation. “I knew there was something going on. I think she was embarrassed.”
Hayes considered the revelation great progress. She had worked years to gain the trust of this member, a 65-year-old rural Illinoisan who required care coordination after a fall at home led to a nursing home stay. At last, they reached a point where the member became comfortable enough to disclose something so personal — and important.
That critical turn in their relationship fueled Hayes’ determination to help the member stay in her home and avoid long-term nursing home care.
"We’ve been able to provide real therapeutic support and strengthen trust between our members and care coordinators."
The BCBSIL Medicaid Behavioral Health Care Coordination team arranged for the floor repair to make the member’s home safer, paying for the work through a program supported by the Illinois Department of Health and Family Services. In 2020, the team established the Behavioral Health Care Coordination Social Determinants of Health Program by reinvesting payments it receives from the Illinois Department of Healthcare and Family Services for providing quality care to Medicaid members.
BCBSIL’s program increases eligible members’ access to basic needs that improve their health and wellness, preventing unnecessary hospital admissions and promoting improved outcomes.
“As Illinois first confronted the COVID-19 pandemic in 2020, we knew that Medicaid customers would have a variety of needs, including some that went beyond health care coverage itself but that could still have a major impact on health outcomes across the state,” said Department of Healthcare and Family Services Director Theresa Eagleson.
“We asked the health plans to submit proposals showing how they would invest funds in Illinois communities to provide support, and they came up with creative and impactful ways to help Medicaid customers, providers and community partners," Eagleson said. "We appreciate the creativity and customer focus demonstrated in this and other projects.”
BCBSIL has supported nearly 2,500 members who must participate in Medicaid care coordination to be considered.
“The program was born out of the pandemic to see how the Medicaid managed care organization could support its most vulnerable members,” said Amy Danahey, BCBSIL Medicaid behavioral health’s associate clinical programs manager. “We had been dreaming about doing something like this for ages.”
For example, something as simple as a pair of new pants can help a member reach a level of achievement and build confidence needed to get a new job, said Kate Thierry, BCBSIL Medicaid’s behavioral health clinical programs manager. A journal and art supplies may help promote healing for a member who has experienced trauma.
“Through the program we’ve been able to provide real therapeutic support and strengthen trust between our members and care coordinators,” Danahey said.
Nationwide, research shows a person’s race, education level, occupation, economic status and ZIP code can dramatically affect their life expectancy. In Chicago alone, life expectancy can vary as much as 30 years, depending on neighborhood or ZIP code.
Statewide, such disparities have been linked to inequities in maternal and child health, behavioral health and chronic diseases and conditions, including cancer, stroke and diabetes.
Insurers, health care providers and policymakers understand how factors such as housing, healthy food and income influence health, especially for people with Medicaid coverage. These social determinants of health and health-related behaviors may account for as much as 90% of a person’s health outcomes.
BCBSIL’s program helps bridge these gaps by meeting needs that can help members thrive.
“We’re trying to break down barriers for members,” Thierry said. “Through the care coordination process, we collaborate with members to help identify what is preventing them from reaching their health goals and create a plan.”
After receiving approval from the program, Hayes found a contractor to assess and estimate the member’s repair needs, which were more extensive than the member divulged. The contractor discovered the member could not use her walker to get into her kitchen, increasing her risk of falling.
He repaired the floor as Hayes requested. Now, he is taking on the cost of remodeling the member’s kitchen and replacing her washing machine, Hayes said.
The member, overwhelmed by the generosity, was in tears when she called Hayes to express her gratitude. She didn’t expect Hayes to keep her word to help.
“She felt she would never trust anyone because she said people don’t do what they say they’re going to do,” Hayes said. “This is somebody who really needed some assistance. It feels good to help someone. It’s priceless.”