The Promise of Coordinated Care: Zena’s Story
Coordinated care makes a difference. It prevents avoidable hospital re-admissions, transitions people out of institutional settings, and helps people thrive in their communities. Read Zena’s case study.Date Updated: 01/18/2016
The Promise of Coordinated Care
Access Makes a Difference
Zena was interviewed 10 years ago for a media profile on the working poor. During that time, Zena’s primary focus was her children – putting food on the table and paying the electricity bill.
Her own needs were secondary. Having struggled with bipolar disorder throughout her life, Zena is now focusing on her health. After years of inconsistent access to doctors and supportive
services, she says she now has a team of individuals who are “looking out for my physical and emotional well-being.”
“I am sharing my story with the hope that I can help someone else. I don’t know where I would be without this program.“ – Zena
When Zena previously had severe depression and chronic pain, she would experience significant crises. Limited by a lack of finances and information about services, she couldn’t access programs that might have helped her and instead resorted to using the emergency department for psychiatric care. Scheduling appointments with doctors was so challenging that she stopped going altogether. It was a representative from her health plan that informed her about the benefits available through Cal MediConnect. Zena gained tools to avert crisis and improve her health, including connecting with a care manager. “It is a lot easier to get referrals now, make timely appointments with doctors and to receive personal, hands-on assistance. Mary, my care manager calls me 1-2 times each week to check on my moods and medication.”
Zena recently started attending wellness classes about nutrition, mindfulness, and managing chronic pain. This year, Zena will enroll in a Community-Based Adult Services program which offers meals, exercise, and community outings. She has goals to schedule an appointment with a therapist at a behavioral health center and attend a pain clinic for the first time because it is a benefit of her new health plan. She is engaged in her own care and meeting a community of people who are working toward the same goal of better health.
“Now that I am progressing, it would be more harmful to me if I did not take these extra steps.”
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This is the third report coming from the California Medicaid Research Institute (CAMRI) project entitled: Comprehensive Analysis of Home- and Community-Based Services in California. The report describes Medicare and Medi-Cal spending for those beneficiaries using long-term services and supports funded by Medi-Cal.
The California Medicaid Research Institute (CAMRI) developed an integrated and longitudinal database containing Medi-Cal and Medicare claims and assessment data of LTSS recipients in California in 2008. CAMRI’s integrated database provides a unique opportunity to look at characteristics and program spending across the entire care continuum for beneficiaries with LTSS needs within Medi-Cal and for dual eligibles across Medicare and Medi-Cal. This report focuses on LTSS use and spending in the eight duals demonstration counties.
On March 27, 2013, the State of California and the Centers for Medicare and Medicaid Services (CMS) formalized a Memorandum of Understanding (MOU) to establish a Federal-State partnership to implement the Dual Eligibles Integration Demonstration, also referred to as Cal MediConnect. This Fact Sheet provides background information about Cal MediConnect and summarizes the key points of the MOU.