Member story: Ongoing care coordination for whole-person health

UnitedHealthcare Community Plan of Texas is committed to helping people live healthier lives. This includes careful consideration of the member’s own goals for their health and well-being and whether their basic needs are being adequately met. For members with special health care needs, individualized and ongoing care coordination is instrumental for member success. Service coordinators are at the heart of care coordination. They manage referrals, wraparound supports and connect members to the physical, behavioral and non-clinical services they need to live healthier lives.

Care coordination to address social drivers of health

In 2019, a Texas member and his mother were experiencing housing insecurity. The mother had been injured while performing her job. She was receiving workers’ compensation but the decrease in income meant they had to move in with family. The member was enrolled in STAR, a managed care program that covers pregnant individuals, families and children whose incomes are below the federal poverty threshold. The member was also eligible for the Children with Special Health Care Needs Program and the Adoption Assistance or Permanency Care Assistance programs.

The family worked with a STAR service coordinator from UnitedHealthcare to develop a care plan that considered the member’s health care needs as well as the family’s physical needs. This included addressing food and housing insecurity, two major social determinants of health. The service coordinator referred the family to the Supplemental Nutrition Assistance Program and connected them to a UnitedHealthcare housing specialist to help address their housing needs.

The service coordinator continued to meet with the member and his family to learn about their evolving needs and to offer referrals and resources to close gaps in care. This support continued for several years as the family faced a series of hardships.

Using a whole-person approach for better health outcomes

Now 18, the member continues to receive support from UnitedHealthcare Community Plan of Texas. After becoming eligible for Supplemental Security Income, he transitioned from the STAR program to STAR Kids. Currently, he’s working with a STAR Kids service coordinator and an adult transition specialist to develop a plan that will allow him to become more independent.

Continued service coordination, referrals and wraparound support were all used to support his whole-person health. The member and his family were placed at the center of the team, and the care plan was shaped by their ideas and perspectives about what they needed to live healthier lives. 

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