Living alone in her late 50s/early 60s, Beth* was battling depression. An ongoing battle with obesity and diabetes had limited her mobility, and her breathing was labored. She felt overwhelmed, isolated, and she rarely left her home.
Then in 2014, things started to change for Beth. When UnitedHealthcare received its regular reports from the Medicaid agency in the state where Beth lived, one of the company’s clinical coordinators noticed a concerning pattern in Beth’s health and well-being. That’s when the UnitedHealthcare representative contacted Beth and enrolled her in Health Homes, a program that supports some of the most vulnerable individuals within this state’s Medicaid population.
As part of the program, Beth began to work with a care coordinator from a local social services organization. The coordinator collaborated with specialists and social services agencies to develop a tailored care plan.
The care team helped Beth manage her conditions, address barriers to care and ensure that her behavioral health and medical needs were met. They collaborated with her to set personal health goals, connected her to community support groups and visited her at home each month.
Beth’s feelings of isolation began to slowly fade away.
In the three years that she was enrolled in the Health Homes program, she had regular primary care and behavioral health appointments, became more active in her community and overall dramatically improved her health.
One of Beth’s goals was to leave her home without the use of a wheelchair or oxygen. With her care coordinator as one of her biggest champions, she is on a path to do just this.
Beth is now involved in personal growth workshops and attends support groups and behavioral health classes. In a recent home visit, she excitedly reported that she attends two fitness classes a week and is “exhausted from using the fitness center's pool."
Beth’s story shows the impact of coordinated care on bringing together different behavioral, social and medical care providers – and putting the patient at the center of everything,” said Sharon Williams, a regional Health Homes director at UnitedHealthcare.
*Note: Beth is not the patient’s real name; her name and demographics have been changed to preserve her privacy.