Shortly after the July 1, 2024 launch of the Tailored Plan, Partners Health Management exemplified the power of integrated care by swiftly and effectively resolving two urgent and complex situations to meet the unique needs of its members.
In one instance, a tailored care manager sought assistance from the nurse consultant team to ensure a member received necessary supplies and medication without interruption. The situation required precise coordination among several parties, including a specialty provider, a supply vendor, a pharmacy, a residential facility, the Partners Utilization Management team, the provider, the tailored care manager and the member’s guardian.
Through this collaborative effort, Partners ensured the member’s needs were met efficiently and effectively. The guardian later confirmed that the member continued to receive all required supplies and medication without any disruptions. This outcome exemplifies how coordinated care can significantly enhance the quality of life for members and their families.
Separately, a member contacted Partners at the end of the week, urgently seeking life-saving enteral formula for their infant. Their current vendor had informed them they could no longer supply the formula due to Medicaid rate constraints, leaving the family in a precarious position as the weekend approached.
Partners acted swiftly, identifying and engaging a new vendor capable of providing the formula. Although the new vendor also faced challenges with Medicaid rates, Partners negotiated a single-case agreement to ensure the family received the formula in time. This rapid response averted a potentially life-threatening scenario and underscored Partners’ dedication to member care.
These two cases illustrate the strength of the Tailored Plan integrated care approach. By fostering collaboration across teams and stakeholders, LME/MCOs can consistently deliver timely, innovative solutions to complex challenges. The public system continues to set the standard for integrated care—putting members at the center of every decision.
For more information, visit Partners’ website here.
About the North Carolina Association of Public Community Health Plans
The North Carolina Association of Public Community Health Plans (NCAPCHP) is dedicated to improving the health and well-being of North Carolina’s communities through advocacy, collaboration, and support for North Carolina’s four LME/MCOs – Alliance Health, Partners Health Management, Trillium Health Resources, and Vaya Health – and the members, families, and providers we serve. The NCAPCHP works with state/county/local agencies and policymakers, healthcare providers, and community stakeholders to ensure access to high-quality, equitable care for individuals with complex needs.
For more information, please contact [email protected] or visit www.NCPublicHealthPlans.com.