One member at a time

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DANIELLA HAROLD, CARE COORDINATOR, OPTIMA HEALTH COMMUNITY CARE: My name is Daniella Harold. I’m a Care Coordinator for Optima Health Community Care. Most of the members that we see are vulnerable or emerging risk.

RANDY RICKER, VICE PRESIDENT, OPTIMA HEALTH COMMUNITY CARE: Optima Health Community Care is a new program to serve the special population of Medicaid recipients here in the state of Virginia. Optima has grown with the state of Virginia over a 22 year period in managed Medicaid and our population has grown to now over 180,000 Virginians covered under our core Medicaid plan. 

DANIELLA: As the Care Coordinator I will be there to support them. A lot of times in their previous interactions they haven’t had anyone care or they feel that no one cares. So they kind of feel defeated. I make sure to take everything in that they tell me and that I’m making sure that it’s being addressed and heard.

AMANDA BECKER, LCSW, DIRECTOR OF BEHAVIORAL HEALTH AND ADDICTION SERVICES, OPTIMA HEALTH COMMUNITY CARE: Sometimes the systems that we’ve developed to help people are so complicated that no one can manage them on their own. So as we added more and more Care Managers into people’s lives, it allows for you to get that communication going and be able to establish a model of care that actually is going to attend to the needs of that member.

DANIELLA: The program itself is patient centered. It’s individualized to the member. We do an individualized care plan with them at the end of their assessment and that care plan outlines goals that they want to work on - short term and long term goals.

RANDY: That idea of having a member have goals for their life, you don’t do that in insurance! This is a different program. The member's experience is being heard and understood by somebody whose whole job is to get to know them and help them navigate the system. It’s transformative.

DANIELLA: We start to build a rapport, we check in if they’ve got a doctor’s appointment coming up, make sure they have transportation to it because some don’t. We have members who sometimes don’t have housing. We have members who need food and pantry resources. 

AMANDA: That Care Coordinator is looking from the top down and she, or he, is able to see all the different players that are providing care to this member on all the different levels. Where are we overlapping resources? Where are the gaps in care? What are - who’s not at the table that needs to be at the table? But also develop relationships with our member.

DANIELLA: I want to make sure that they know if they call Optima Health Community Care, they’re going to speak to me and I’m going to get it done.

RANDY: Our mission, being part of Sentara Healthcare, is to improve health daily. And that’s a critical part of this program.

DANIELLA: I think the most important thing to understand about the Optima Health Community Care program is that we are doing this for the members and we all have one goal, which is to make sure these members are healthy and that we give them the support that they need.