Member story: How Complex Care Management helped a family in Texas

One way in which UnitedHealthcare works to improve health outcomes is to identify all factors affecting a member’s health and well-being. Many members who have complex medical conditions also face social and economic disparities. Care requires an approach that addresses the social drivers of health, coordinates care across settings, and emphasizes collaboration to improve health outcomes.

Considering the social and economic drivers of health

The Texas STAR Program is a managed care program that covers pregnant individuals, families and children whose incomes are below the federal poverty threshold. When one of our 4-year-old STAR members was diagnosed with autism, intellectual and developmental disabilities, and speech delay, she was quickly identified for complex care management.

Her mother expressed a need for multiple services, including health education, care coordination and access to community resources that would help her support her family. She was also experiencing financial stressors, such as paying out of pocket for diapers and needing to care for her children while living on a fixed income.

Her mother was put in contact with a complex care management service coordinator for UnitedHealthcare Community Plan of Texas. The service coordinator assessed each of the family’s needs and identified the services that would best address them. First, she consulted with internal teams to ensure that the member’s health care requirements were met. Next, she recognized a need for the member to begin speech, occupational and physical therapy services. In addition, the service coordinator connected the family to community programs, educational resources and services, such as:

  • Community resources to assist in getting diapers at a discounted rate.
  • Programs that offer discounted internet and electricity services.
  • Education on state resources to help the mother navigate her daughter’s new diagnoses. This included information on how to be put onto the state’s waiver interest lists.
  • Behavioral health services to start the process of getting the member into applied behavioral analysis therapy.
  • Education on the mileage reimbursement program through UnitedHealthcare’s transportation provider, ModivCare.

Focusing on the right services at the right time

The member and her family benefited from complex care management that aligned services and resources with their needs. Since connecting with the service coordinator, the mother shared that she enrolled her daughter in a prekindergarten program and met with school district personnel to determine her daughter’s Individualized Education Program.

The member was also approved for Supplemental Security Income (SSI), and her mother is in the process of enrolling her in STAR Kids, a Medicaid managed care program that provides Medicaid benefits to children and adults ages 20 and younger who have disabilities.

Taking a comprehensive, collaborative approach, allowed the member’s whole-person health to be considered so she can achieve optimal health and well-being. 

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